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163 Cards in this Set
- Front
- Back
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Airway primary function |
Provide oxygen into the body and remove co2. |
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Upper airway: strutures and purpose |
Located outside the chest cavity; includes nose, nasal cavity, pharynx and larynx; works to filter, warm, humidify air and protect lower resp tract. |
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Pharynx |
Throat; consists of Naso, Oro, and laryngopharynx. Pharynx is a passage way to both resp and digestive tracts. |
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Nasopharynx |
Respirations filters air Sinus fracture may lead to CSF out of nose. Aggressive tube placement may lead to bleeding |
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Eustachian tubes |
AKA auditory tubes allows drainage of fluid and air from the ear. |
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Oropharynx function and parts |
Functions in respiration and digestive. Includes; lips, cheeks, teeth, tongue, palates Visible part from the mouth |
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Most common airway obstruction for unconscious people |
Tongue |
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importance of teeth for airway |
Assist in ventilation seals, if broken can cause airway obstruction. |
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Tongue |
Attaches to mandible and hyoid bone Most common airway obstruction in unresponsive patient |
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Tonsils function |
Used to keep bacteria from entering |
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Nasopharynx ends and oropharynx begins where |
Uvula |
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2 types of tonsils |
Palatine tonsils: Larger more prominent Adenoids: Near opening of eustachian tubes; inflammation causes ear infections in children. |
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Laryngopharynx function |
Functions in resp and digestive tract Located from epiglottis to glottis |
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2 structures important in laryngopharynx |
Epiglottis and vallecula used for landmarks in intubation |
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Larynx anatomy and function |
Voice box protects vocal cords 9 cartilages |
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Glottis |
Space between vocal cords Entry for intubation |
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Sellick Maneuver: |
Applying cricoid pressure to prevent air in the stomach. |
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Cricothyroid Membrane |
Between thyroid and cricoid cartliage Place for cricothyroidotomy |
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Larynx is embedded with a rich nerve supply from what nerve |
Vagus Nerve |
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Vagus nerve when stimulated during suctioning causes: |
Bradycardia, hypotension, Dec. resp. rate |
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Lower Airway consists of: |
trachea, bronchial tree, alveoli, lungs |
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Purpose of lower airway: |
Gas exchange |
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Where does the lower airway start? |
Trachea/ 4th cervical vertebrae, |
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Lower airway stops at: |
tip of the xiphoid process |
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Trachea: |
10-12 cm long Bifurcates into 2 stems (bronchi) |
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Carina |
Part where trachea divides to left and right stem |
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Right and left lung has how many lobes |
Right 3 Left 2 |
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Hilum |
Point of entry for bronchial vessels, bronchi, and nerves in the lung. |
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Steps from trachea to alveoli |
Trachea segmental bronchi (both stems) Bronchioles alveolar ducts |
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Stimulation of beta 2 receptor results in relaxation or constriction in bronchioles? |
Relaxation |
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Alveoli function |
Point of gas exchange |
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Gas exchange happens through diffusion or osmosis? |
Diffusion |
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Surfactant |
Lubes the alveoli causing ease of expansion and prevents collapse |
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Atelectasis |
Alveolar collpase |
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Pleural space: |
Membrane with space between its layers to prevent friction |
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Visceral pleura |
direct contact with the lung |
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Parietal pleura |
Lines throacic cavity |
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Air or blood can collect in the |
pleural space |
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Main Anatomical difference in Pediatric Airway |
Smaller features |
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Most common obstruction in children |
Tongue |
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What style of blade used for tubing infants and children |
Straight blade; to move epiglottis out of the way |
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Where does larynx start in infants |
C1-C4 |
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Cuffed tubes are typically unnecessary in children younger than... |
8 years old |
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Complication in tubing patients under 8 |
Short trachea results in right main-stemming them |
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What is the primary muscle of inspiration in children |
Diaphragm |
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Big sign for child in resp distress |
Use of accessory muscles |
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Peds intercostal muscles |
Weak, fragile, fatigue easy, paradoxical motion is common due to fragile ribs |
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Peds alveoli |
Smaller and fewer Less gas exchange |
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Ventilation: |
Process of moving air into and out of the lungs |
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Primary stimulus to breath |
Medulla Oblangata |
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Atmospheric pressure and thoracic pressure at end of expiration |
Equal |
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Nerve that causes inspiration to occur |
Phrenic nerve |
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Phrenic nerve upon inspiration causes diaphragm to contract downward causing what pressure |
Negative |
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Exhalation; diaphragm relaxes causing what pressure |
Positive pressure |
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Hering-Breuer reflex |
Prevent overinflation of the lungs |
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Vagus nerve stimulation by hering-breuer reflex causes: |
Inhibiting of inspiration |
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A combo of inspiration and expiration is referred to as: |
Respiratory cycle |
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Normal Tidal Volume for Adult male |
500 ml |
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Normal Tidal volume for a Ped is |
8 ml/kg |
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Respiration is: |
Exchange of gases between a living organism and its environment |
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2 types of respiration called |
External and Internal |
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External respiration is: |
Exchange in gases between lungs and Blood |
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Internal respiration is: |
Gas exchange between Blood and tissues |
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Partial pressure is: |
Pressure exerted by each individual gas in a mix |
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4 main gases in atmosphere |
Nitrogen, Co2, O2, H20 |
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% of 02 at room air |
21% |
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Oxygen diffuses from alveoli into bloodstream, What % of the O2 is bound to hemoglobin? |
97% |
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Pulse oximetry: |
% of oxygen-bound hemoglobin |
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33% of venous hemoglobin is bound to what gas? |
CO2 |
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Causes of decreased oxygen in the blood |
Decreased hemoglobin (anemia, hemorrhage) Smoke filled environment pneumothorax or hemothorax COPD Pulmonary edema, pneumonia, impairing diffusion Impaired blood flow ( P.E.) |
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Hypoxemia |
Decreased oxygen saturated hemoglobin in the blood |
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Hypoxia: |
Decreased oxygen in the tissues |
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Too few red blood cells to meet metabolic demands but at 100% sat; Or too many red blood cells they wont all be saturated, end result is what? |
Hypoxic |
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Indication of hypoxia |
Restlessness, anxiety, and cyanosis |
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Normal O2 bound hemoglobin is at 15 mg/dl, Cyanosis occurs at what? |
5mg/dl |
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Initial management of hypoxia and hypoxemia? |
Increasing ventilation Oxygen PPV or meds |
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Hypercarbia and hypocarbia |
Hypercarbia: excess CO2 Hypocarbai: diminished CO2 |
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Total Lung Volume? |
6 Liters |
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Primary Control of Respiration |
Brainstem |
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2 components of the brainstem controlling breathing |
Medulla oblangata Pons |
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Medulla oblangata controls? |
Involuntary respiration transmitted to phrenic nerve |
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Secondary control if the medulla fails and acts for inspiratory: |
Apneustic center in the Pons |
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Located in Pons and acts as a shut off switch for inhalation? |
Pneumotaxic center |
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Maintaining a balance of what is essential for the respiratory system? |
O2 and Co2 |
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Receptors designed to monitor the levels of Co2 and O2 |
Chemoreceptors |
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Chemoreceptors are found where? |
Medulla, carotid arteries, and arch of the aorta |
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PH of what fluid is responsible for respiratory center stimulation? |
CSF |
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COPD patients retain high what? |
Co2 |
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People with a lower airway obstruction place themselves in what position? |
Tripod position |
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People with an upper airway obstruction place themselves in what position? |
Sniffing position |
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Infant normal Resp Rate per min |
30-60 |
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Toddler normal Resp Rate per min |
24-40 |
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Preschooler normal Resp Rate per min |
22-34 |
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6-12 y/o normal Resp Rate per min |
18-30 |
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13-18 y/o normal Resp Rate per min |
12-16 |
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Anoxia: |
Total lack of oxygen to tissues |
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Angle of louis |
second rib meets the sternum |
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Suprasternal notch |
Base, anterior aspect of the neck, above louis |
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Costal angle |
Angle formed by the lower ribs after the sternum |
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Assessing a Respiratory patient |
General appearance Distress Skin color Posture Talking rate |
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Dyspnea relieved by change in position (sitting up or standing) is called Orthopnea... This indicated what? |
Possible left ventricle failure |
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Paradoxical Motion |
Unequal chest rise Multiple ribs fractures |
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Presence of a barrel chest may result in what medical condition? |
Emphysema |
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Emphysema patients breathe in what way to keep positive pressure on alveoli to keep them inflated? |
Pursed lip breathing |
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Complience |
Resistance from the lungs during ventilation |
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Tidal Volume: |
Total amount of air inhaled or exhaled 500 ml |
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Dead air space: |
Amount of air not involved in gas exchange 150 ml |
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Alveoli air volume: |
Amount of air that does get gas exchange 350 ml |
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Minute Volume: |
Amount of air moved in and out of respiratory tract in a minute Tidal volume X Resp rate |
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FiO2: |
% of oxygen in inspired air |
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Stridor: |
High pitched shrill; upper airway |
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Productive cough: |
Cough producing sputum |
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Hyperventilating |
Rapid, deep breathing |
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Air trapping: |
Obstruction in the pulmonary tree Resp rate increases and shallow Lungs inflate with air |
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Cheyne-Stokes respiration: |
Inc. in rate and depth of breathing Tapers to slower shallower breaths Period of apnea Repeats |
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Kussmaul Resp: |
Deep, gasping, long expiratory Metabolic acidosis |
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Biot's resp: |
Irregular respiration, varying rates Indication; Inc. ICP, brain damage, drugs |
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Agonal Respirations: |
slow, shallow, irregular, from hypoxia in brain |
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D tanks amount: |
400 L airway bag supply |
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Jumbo D tanks amount: |
640 L |
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E tanks amount: |
680 L |
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M tanks amount: |
3450 L ambulance supply |
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Equation for minutes remaining on your O2 |
Total PSI left X (0.28) ------------------------------ Flow (L/Min) |
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Nasal Cannula: percentage of O2 and at what flow? |
25%-45% at 1-6 LPM |
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Simple Face Mask: percentage of O2 and at what flow? |
40%-60% at 6-10 LPM No reservoir on this mask Can only be used on awake patients |
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Partial Rebreather Mask: percentage of O2 and at what flow? |
34%-60% at 6-10 LPM Does have a reservoir bag |
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Nonrebreather Mask facts: |
Does not permit mixing of patients exhaled air with the O2 Prevents inhalation of room air |
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Nonrebreather Mask: percentage of O2 and at what flow? |
100% at 10-15 LPM |
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Venturi Mask: Draws room air into the mask to mix with O2, percentage of O2 and at what flow? |
can give 24%, 28%, 35%, 40%, or 50% Used for COPD patients |
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Common airway obstructions: |
Tongue Foreign bodies Laryngeal edema Aspiration trauma |
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Preferred technique for opening airway in an unresponsive patient with no spinal injury |
Head tilt chin lift |
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Airway opening maneuver for unresponsive patient with spine injuries |
Jaw thrust maneuver |
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Modified Jaw thrust maneuver, difficult with one person |
Same as jaw thrust but with no head tilt |
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Suctionings 3 purposes |
Remove secretions Improve gas exchange prevent atelectasis |
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Suction times adult: |
10-15 seconds |
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Suction times Infant and children: |
No longer than 10 seconds |
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Newborns suction times: |
3-5 seconds |
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Measure OPA and NPA |
corner of mouth to earlobe nose to ear lobe |
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If OPA is too long it could do what? |
Press epiglottis to the larynx blocking larynx |
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If the patients gag reflex comes back with an OPA in, do what? |
Remove it |
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Indications for NPA: |
Altered mental status Unresponsive Intact gag reflex |
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Contraindication for NPA |
Facial trauma or epistaxis |
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Which way is NPA inserted: |
Bevel (opening) toward the septum typically in right nostril. |
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Mouth to Mouth ventilation oxygen % |
16% |
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How much air do you put in lungs? |
Till chest begins to rise |
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Mouth to Mask ventilation % of O2 |
16-17% and up to 50% with O2 |
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Does mouth to mask prevent possible infection? |
No, just helps |
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For the Lone paramedic what is the most effective method of Ventilation? |
Mouth to mask |
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Bag-Mask with O2 at 15 L/min and no reservoir delivers how much O2 in percents? |
40-60% |
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If reservoir is full during BVM how much O2 is being delivered? |
90%-100% |
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First thing you check on your BVM if no good ventilations occur? |
Seal of the mask |
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Corrections for unsuccessful BVM ops |
Mask seal Head position feel for compliance: airway obstruction |
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Indications for automatic transport vent (ATV) |
all patients tubed or not tubed |
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Settings for ATV include... |
Tidal volume Rate Inspiratory time |
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Contraindications for ATV |
Airway resistance Asthma Resp distress syndrome Pneumothorax |
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Tidal volume setting for ATV |
6-7 ml/kg |
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Tracheostomy |
Surgical opening into trachea |
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Gastric tubes may be inserted how? |
Nose or Mouth |
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Pediatric BVM holds how much air? |
450-500 ML |
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Neonate BVM holds how much air? |
250 ML |
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Adult BVM holds how much air? |
1200 L |
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Advanced airways include: |
Esophageal-tracheal Combitube Laryngeal mask Airway ET tube |
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Combitube or esophageal- tracheal tube: |
Does not require vision of vocal cords Sizes are 37 fr and 41 fr; inflate at 80 or 100 ml 2 separate airflow passages Distal cuff is inflated at 15 ml |
