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173 Cards in this Set

  • Front
  • Back
Septum
Cartilage that separates the right and left nasal cavaties.
Sinus
Air cavity that conducts fluid from the eustation tubes and tear ducts to and from the nasopharynx
Eustachian Tubes
A tube that connects the ear with the nasal cavity
Nasolacrimal Ducts
Tubula vessels that drain teaars and debris from the eyes into the nasal cavity.
Mucous Membrane
Lining in body cavities that handle air transport; usually contains small, mucous- secreting cells called Goblet Cells. Mucus is a slippery secretion that lubricates and protects airway surfaces.
Pharynx
Amuscular tube that extends from the back of the soft palate to the superior aspect of the esophagus.
Gag Reflex
Mechanism that stimulates retching, or striving to vomit, when the soft palate is touched.
Vallecula
depression between the eppiglottis and the base of the tongue.
Intubation
Passing a tube into a body opening.
Larynx
The complex structure that joins the pharynx with the trachea.
Glottis
Liplike opening between the vocal chords.
Sellick Maneuver
Pressure applied in a posterior direction to the anterior cricoid cartilage; occludes the esophagus. Very Light pressure is needed.
Aspiration
Inhaling foreign material such as vomitus into the lungs.
Cricothyroid Membrane
Membrane between the cricoid and thyroid cartilages of the larynx.
true Vocal Chords
White bands of cartilage that regulate the passage of air through the larynx and produce voice by contraction of the laryngeal muscles.
Thyroid Cartilage
Shield shape. Forms the anterior prominence called the adams apple.
Arytenoid Cartliage
Forms the pyramid shaped attachment for the vocal chords posteriorly, is a landmark for intubation.
The narrowest Part of adult trachea
Glottic Opening
Pyriform Fossae
Recess that form the lateral borders of the larynx.
Cricoid Cartilage
Forms the inferior border of the larynx. first tracheal ring. Forms a complete ring. Esophagus lies behind the cricoid cartilage.
Vagus Nerve
Inervates the mucous lining of the larynx. Stimulation can cause: Bradycardia, hypotension and bradypnea
Tracheaa
10-12 cm long tube that connects the larynx to the mainstem bronchi.
Bronchi
Tubes from the trachea into the lungs
Alveoli
Microscopic air sacs where most oxygen and carbon dioxide gaas exchanges.
Tidal Volume
Depth of Respiration. 500 - 800 mL
Lung Capacity
6 Liters
Non rebreather
Preferred method of Delivering o2. Resevoir needs to be 3/4 full.
Partial rebreather
for Peds. Take out valve in the non rebreather mask.
General Breathing Rates
Adult: 12-20
Children: 15-30
Infant: 25 - 50 (40 - 60)
Maximum Suctioning Time
No more than 10 seconds
BVM ventilation rates
Bag once every 6 seconds.
For Peds. Bypass the pop- off valve to increase pressure.
3 major areas in upper airway
Nasopharynx
Oropharynx
Laryngopharynx (Hypopharynx)
Nasal Cavity Structures
Turbinates
Hard & Soft Palate
Sinus Cavity
Lacrimal Ducts
Nasopharynx structures
Tonsils/Adenoids
Uvula
Oropharynx Structures
Tongue
Valecula (void at base of tongue @ the epiglottis) Landmark for intubation.
Larynx Structures
Vocal Chords
Esophagus
trachea
Glottic Opening
Hyoid Base
Extrinsic Ligament (cricoid Cartilage)
Thyroid Cartilage
Arytnoid Cartilage
Pyriform Fossae: an area, not a structure
Lower Airway Anatomy
Trachea
Bronchi
Alveoli
Lung Parenchyma: areas that are functional
Pleura
Cartilage becomes smooth muscle
Anatomy of Peds airway
Large Tongue
Palate much more anterior
Epiglottis much more round
Anatomy of Alveoli
Respirations occurs at the area
Physiology of Respiratory System
Diffusion across alveolar membrane.
About 500cc inpired air
150cc dead air space
inspired O2 is about equal to expired CO2
Partial Pressure of Gas
Pressure exerted by each component of a gas mixture
O2 concentration in atmospheric air
21%
Normal Arterial Partial Pressure
PaO2= 80 - 100 torr
PaCO2= 35 - 45 torr
Oxygen concentration in the blood
O2 saturation = O2 Concentration/O2 Capacity x 100%
Chemoreceptor Locations
Medulla, Aortic Arch, Carotid

Stimulated by levels of O2
Cerebral Spinal Fluid (CSF)
Carries CO2. Is located in the brain, brain stem and spinal cord
Pneumotaxic Center
Located in the Medulla. Stimulated by CO2 levels
Total Lung Capacity (TLC)
Maximum adult capacity is 6 liters
Alveolar Volume (Vmin)
Amount of gas moved in and out of the respiratory tract in one minute. Vmin= VT x respiraatory rate
Tidal Volume (VT)
Average volume of gas inhaled or exhaled in one repiraatory cycle. VT=500mL (5-7cc/kg)
Alveolar Minute Volume (Va-min)
Amount of gas that reaches the alveolar for gaas exchange in one minute.
inspiratory Reserve Volume (IRV)
The amount of air that can be maximally inhaled after normal inspiration.
Functional residual Capacity
Volume of gas that remains in your lungs at the end of normal exhalation
Expiratory Reserve Volume (ERV)
The amount of air that can be maximally exhaled after a normal expiration.
Forced Expiratory Volume (FEV)
Amount of air that can be maximally epired after maximum expiration
Endotracheal Complications

DOPE
Dislodgement
Obstruction
Pneumothorax
Equipment Failure
Miller Blade
Straight Blade
Macintosh Blade
Curved Blade
Auscultation (in order)
1-Epigastrum
2-Right Lung
3-Left Lung
4-trachea
ETCO2
End Tidal CO2 detector
Bright yellow= O2
Purple = CO2
Capmeter + Capnograph
Shows CO2 levels
Rapid Sequence intubation
Paralizing a PT to facilitate intubation
atelectasis
alveolar Collapse due to insufficient surfaactant or deflated alveoli
Parenchyma
principle or essential (functional) parts of an organ. Alveoli is the core of the lung parenchyma.
pleura
membranes connective tissue covering the lungs. 2 layers; visceral and parietal
inspired air concentration
O2=20.94%
Nitrogen= 79.01%
CO2= 0.04%
expired Air concentrations
O2= 16.4%
Nitrogen = 79.6%
CO2= 4.0%
Ventilation
The mechanical process that moves air into and out of the lungs
PA
alveolar partial pressure
Pa
arterial partial pressure
Total atmospheric pressure
760.0 torr
Total Alveolar Pressure
760.0 torr
Diffusion
Movement of a gas from an area of higher concentration to an area of lower concentration
Oxygen Concentration in the Blood
Oxygen Saturation: SpO2- O2 combined with hemoglobin.
Oxygen Saturation = O2 content/O2 capacity x 100%
(ratio of the bloods actual O2 content to its total O2-carrying capacity)
Hypoventilation
reduction in breaathing rate and depth
Pneumothorax
Accumulation of air or gas in the pleuraal cavity
Hemothorax
Accumulation in the pleural cavity of blood or fluid containing blood
Pulmonary embolism
Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood.
FiO2
concentration of oxygen in inspired air.
IPPV
Intermittent Positive-Pressure Ventilation.
Hypercarbia
Excessive pressure of Carbon dioxide in the blood. Treated by increasing the rate and/or volume of ventilation and correcting underlying cause.
Respiratory Rate
Number of times a person breathes in 1 minute
Main Respiratory Center
Located in the Medulla, if this fails the apneustic center in the pons takes over.
Hypoxemia
decreased partial pressure of O2 in the blood
Hypoxic Drive
Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs. Condition found in Pt.s with COPD.
Causes of Respiratory Increase
Fever, Emotion, Pain, Hypoxia, Acidosis, Stimulant Drugs
Causes of Respiraatory Decrease
Depressant Drugs, Sleep
Upper Airway Obstruction
An interference with air movement through the upper airway.
Causes of Upper Airway Obstruction
Tongue, Foreign Bodies, Trauma, Laryngeal spasm and edema, aspiration
Most Common Airway obstruction
Tongue
Extubation
Removing a tube from a body opening
Paradoxical Breathing
Assymetrical chest wall movement that lessens respiratory efficiency
Flail Chest
Defect in the chest wall that allows a segment to move freely, causing paradoxical chest wall movement.
Dyspnea
An abnormality of breathing rate, pattern or effort.
Anoxia
The absence or near absence of oxygen
Pulsus Paradoxus
drop in blood pressure of greater than 10 torr during inspiration
Kussmauls Respirations
Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis
Cheyne-Stokes
Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury
Biot's
irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure.
central neurogenic hyperventilation
deep rapid respirations indicating ICP
Agonal Respirations
Shallow, slow or infrequent breathing, indicating brain anoxia
Compliance
The stiffness or flexibility of the lung tissue
Pulse Oxymetry
A measurement of hemoglobin oxygen saturation in the peripheral tissues
French
Unit of measurement approximately equal to one third millimeter
Endotrachial Intubation Equipment
Larygoscope
ETT
10mL Syringe
Stylet
BVM
Suction device
Bite Block
Magill Forceps
Tape
ET protective equipment
Gloves, mask, eyeware
Common Paraalytic Agents
Succinylcholine
Vecuronium
Atracurium
Pancuronium
Larynx
•Plays major role in speech
•Filtering device for the digestive and respiratory tracts
•Located by the thyroid cartilage, or Adam’s apple
•Composed of
o 3 pairs of cartilage:
 Arytenoid
 Corniculate
 Cuneiform
o Thyroid cartilage
o Epiglottis
•Possesses 2 pairs of folds
•Upper fold forms the vestibule, or false vocal cords
•Lower fold forms the true vocal cords
•Space between the folds is called the glottic opening
Carina
The point at which the trachea bifurcates into the right and left mainstem bronchi.


The conduit system, from the trachea to the terminal bronchioles, must be intact for the air to enter the lungs.

Maintaining an open airway is critical
Bronchi
•Carina has many nerve endings, stimulation of this area produces violent coughing.
•Right mainstem is essentially a straight path, explaining why foreign material gets into it more often---pneumonia more common in right lobes.
•Mainstem bronchi divide into the secondary (lobar) bronchi.
•Final division is the bronchioles, approx. 1mm thick, which are lined with smooth muscles that can contract.
•After approx. 22 divisions, the bronchioles become terminal bronchioles.
Alveoli
•Respiratory bronchioles divide into the alveolar ducts.
•These terminate into the alveolar sacs, or alveoli.
•Approx. 300 M alveoli in the lungs.
•Alveolar walls consist of thin layers of Type I cells
•The alveolar lining, supportive tissue, and capillaries make up the respiratory membrane.
•Gas exchange surface measures approx. 70 meters2.
•Type II cells secrete a surfactant material to reduce the surface tension.
•Alveolar macrophages are another type of cell found within the alveoli.
Lungs
•Main organs of respiration
•Right lung contains 3 divisions or lobes
•Left lung has only 2 lobes
•Lungs are covered by connective tissue called pleura
•The pleura is unattached to the lungs, except at the hillum
•Pleura has 2 layers:
o Visceral-covers the lungs and does not contain nerve fibers
o Parietal-lines the thoracic cavity and contains nerve fibers
•A small amount of fluid is normally found in the pleural space
•Surface tension maintains the contact between the lungs and the chest wall
Process of Gas exchange
•Ventilation – mechanical process of moving air in and out of the lungs.
•Diffusion – the movement of molecules through a membrane from an area of greater concentration to an area of lower concentration.
•Perfusion – the circulation of blood through the capillaries.

Provide oxygen to a patient with a lung diffusion problem to increase the concentration gradient that drives oxygen into the capillaries. When fluid accumulation or inflammation is present, consider administering diuretics or anti-inflammatory drugs.
Regulation of Ventilation
•Lower portion of the brain stem, specifically the medulla, control ventilation.
•Sends a constant, repetitive, signal to the lungs to initiate inspiration
•The medulla contains both an inspiratory and expiratory center
•Medullary signal is transmitted via the phrenic and intercostals nerves
•The medullary signal can be modified by voluntary centers in the cerebral cortex, hypothalamus, and the pons
•Stretch receptors are located on the visceral pleura and the walls of bronchi and bronchioles
Hering Breur Reflex
Signals from the stretch receptors in the lungs become stronger when the patient inhales. As the lungs begin to recoil, the signals become less intense, allowing the medulla to begin another inspiratory phase. This mechanism prevents the lungs from becoming over inflated.
Pneumothorax
A collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall.

•Open Pneumothorax – air enters the pleural space through an injury to the chest wall.

•Closed Pneumothorax – air enters the pleural space through an opening in the pleura that covers the lung.

•Tension Pneumothorax – develops when air in the pleural space cannot escape, causing a build-up of pressure and collapse of the lung.
Esphageal Detector Device

(EDD)
A bulb syringe used to detect proper placement of the endotracheal tube
Cor Pumonale
Hypertrophy of the right ventricle resulting from disorders of the lung.
Positive End-Expiratory Pressure (PEEP):
A method of holding the alveoli open by increasing expiratory pressure.

Some bag-valve units used in EMS have PEEP attachments.

Also EMS personnel sometimes transport patients who are on ventilators with PEEP attachments
Croup
laryngotracheobronchitis
The respiratory symptoms are caused by inflammation of the larynx and upper airway, with resultant narrowing of the airway.
Croup is characterized by a harsh 'barking' cough, stridor (a high-pitched sound heard on inhalation) and fever. Hoarseness is usually present. More severe cases will have respiratory distress.
laryngoscope
Instrument for lifting the tongue and epiglottis in order to see the vocal chords
ETT Size for Pediactrics
Age in years + 16/4
ETT Size for Females
7.0-8.0mm with 21mm insertion
ETT size for Males
7.5-8.5mm with 23mm insertion
Laryngeal Mask Airway
(LMA)
tube with an inflatable cuff that is inserted into the pharynx. It causes less pain and coughing than an endotracheal tube, and is much easier to insert. However, it does not protect the lungs from aspiration, making it unsuitable for anybody at risk of this complication.
Goblet cells
Cells that produce mucus
Forms of respirations
Coughing
Sneezing
Sighing
Grunting
Common Causes of airway obstruction
Tongue (most common)
Foreign Body aspiration
Laryngospasm
Laryngeal Edema
Trauma
Causes of Respiratory Distress
Upper & Lower airway obstruction
inadequate ventilation
Impairment of respiratory muscles
Impairment of nervous system
FiO2
The concentration of oxygen in inspired air.
Types of O2 cylinders
D - 400 L
E - 660 L
M - 3,450 L
Venturi mask
High-Flow oxygen mask that delivers very precise concentrations of O2. Used to treat COPD with respiraatory drive problems.
Formula for calculating drips (gtts.) per minute (min.):
gtts./min = ml./hr. x drip rate administration set
60 min.
Example:
gtts./min = 125ml./hr. x drip rate administration set=
60 min.
gtts./min = 125 x 10 (macro drip)= 1250 = gtts./min = 20.8
60 60
gtts./min.= 125 x 60 (mini or micro drip)= 7500 = 125 gtts./min
60 60
Formula for calculating drip rate of IV fluids:
ml./hr. = total fluids ordered
total hours to run
Example: ml./hr. = 1000 ml. = 125 ml./hr.
8 hr.
How many cc does ETT Pilot Balloon need?
10cc. Be sure not to overinflate the balloon, as this could cause tracheal necrosis.
Major Purpose for using a Stylet during endotracheal intubation.
To maintain a preset curve in the tube.
How to Manage Severe Epiglottitis
DO NOT intubate unless airway failure in imminent. This may cause a sever laryngospasm. Oxygenate without agitation and rapid transport to OR.
Maximum time limit for each intubation attempt
30 seconds and wait 30 seconds between each attempt while hyperventilating the pt. Do not try more than 3 times to intubate the pt.
How to correct Esophageal intubation.
Take out immediateley, hyperventillate for 30 seconds and re-intubate the pt. Esophageal intubation is lethal and can cause regurgitation.
Indications for Rapid Sequence intubation
Impending Respiratory Failure
Acure Airway Disorder (facial burns, upper airway trauma, epiglottitis)
AMS with risk of vomiting and aspiration (Glascow score of 8 or less)
Status Elipticus
Depolarizing RSI Drugs
Succinycholine: Substitute acetylcholine, has a stimulating effect and causes fasiculations (muscle twitching). Most commonly used due to fast action and short duration.
Non-depolarizing RSI Drugs
Vecuronium
Atracurium
Pancuronium

Block Acetylcholine uptake, do not allow stimulation and do not cause fasiculations.
Pediatric Airway
Structures are preportionally smaller and more flexible.
The tongue is larger.
The epiglottis is floppy and round.
The glottic opening is higher and more anterior in the neck.
The vocal chords slant upward, toward the back of the head and are closer to the base of the tongue.
The narrowest part of the airway is the cricoid cartilage, not the glottic opening as in adults.
Intubation for Peds. <8 yo
Straight Laryngoscope is preferred.
ETT size = age in yeaars + 16 / 4
ETT iserted no more that 2 - 3 cm past vocal chords.
Uncuffed ETT is preferred.
Pharyngo-Tracheal Lumen Airway
PtL
A two-tube system.
What will Beta2 Stimulation Cause?
It will cause the bronchiole to dilate.
Effects of Vagal stimulation during intubation
Coughing, retching, bradycardia, hypotension, bradypnea
Sufactant
Secreted by the Type II cells found in the alveolar surface. It decreases the surface tension to keep the the alveoli open for gas exchange.
Alveolar Macrophages
Type of cell found in the alveoli, part of immune system that digest particles, bacteria and other foreign material.
Physiologic Shunt
Not all alvioli remain patent during gas exchange, a small percentage of blood will pass through the alveoli without exchanging O2 and Carbon Dioxide. Affects approximately 2 percent of total blood flow to the lungs.
hilum
Point at which the bronchi and blood vessels enter the lung
Bronchial Arteries
Branch from the aorta provide most of the blood supply to the lungs. Bronchial veins returns blood from the lungs to the superior vena cava.
Lung capacity/Volume in mL
TLC 6,000
Vital Capacity 4,800
inspiratory reserve 3,000
tidal volume 500
expiratory volume 1,200
residual volume 1,200
Crepitus
Crackling sounds
Tactile Fremitus
Vibratory tremors felt through the chest by palpation.
Trachial deviation
Any position of the trachea other than midline
Subcutaneous emphysema
Presence of air in the subcutaneous tissue
Capnogram
Reflects CO2 concentrations overtime. Divided into 4 phases: Phase I-Baseline (no CO2)
Phase II- Respiratory Upstroke (CO2 in alveoli)
Phase III- Repiratory Plateau (nearly contant CO2 level)
Phase IV - Inspiratory phase sudden downstroke returns to baseline
Why do you not give lasix to someone with pneumonia?
Because it dries the secretions and causes them to become thick and sticky blocking the airways.
OPQRST for Respiratory
O- what were u doing when this started?
P- does anything mak eit better?
Q- how does it make u feel?
R
S- 1-10
T- how long has this been going on?

Similar past episodes?- Ever been intubated?
Spirometry and Peak Flow values for Adults
Normal 550-650 L per min, Peak Flow
Severe 100 L per min Peak Flow
Peak Flow
Handheld device that determines peak expiratory flow rate (PEFR). Can measuer tidal volume.
"10 and 10" for Cardiac Arrest
10 minutes of CPR and no CO2 past 10 minutes. Reflects No Hope for Pt.
Esophageal impaction
1-2mg of glucagon would cause smooth muscle relaxation to cause the bolus to go down.
Leading cause of sepsis
pneumonia
ARDS
Adult repiratory distress syndrom. Form of pulmonary edema that is caused by fluid retention in the interstital space within the lungs. Is a part of MODS.
Pink Puffer
Emphysema
Blue Bloater
Chronic Bronchitis
Why do you not give aspirin to an asthma patient?
It can exacerbate the asthma by releasing histamines. Always ask pt if they have asthma before giving aspirin.
Diaphoresis
(sweat) results from release of epinephrine
FVC
Forced Vital Capacity
FEV
Forced expiratory Volume
s3
Sign of heart failure