Airway Managment And Ventilation

Front 1

What is the primary objective of airway maintenance?

Back 1

To establish and then maintain a patent airway to ensure proper ventilation (adequate exchange of O2 and CO2) for all patients. Early detection and intervention of airway and breathing problems are, including bystander action, are vital.

Front 2

Modified Respiration Form
(Coughing)

Back 2

Forceful exhalation of a large volume of air from the lungs. This is a protective function that expels foreign material from the lungs.

Front 3

Modified Respiration Form
(Sneezing)

Back 3

Sudden, forceful exhalation from the nose. It is usually caused by nasal irritation.

Front 4

Modified Respiration Form
(Hiccoughing)

Back 4

Sudden inspiration caused by spasmodic contractions of the diaphragm with spastic closure of the glottis. It serves no known physiologic purpose. It has occasionally been associated with acute MI on the inferior surface of the heart.

Front 5

Modified Respiration Form
(Sighing)

Back 5

Slow, deep, involuntary inspirations followed by a prolonged expiration. It hyperinflates the lungs and re-expands atelectatic alveoli. This normally occurs once a minute.

Front 6

What is the primary objective of airway maintenance?

Back 6

To establish and maintain a patent airway. This facilitates effective respiration (the proper exchange of O2 and CO2). Early detection and intervention of breathing problems, including bystanders action is vital to patient survival.

Front 7

Modified Respiration Form
(Coughing)

Back 7

Forceful exhalation of a large volume of air from the lungs. This performs a a protective function in expelling foreign material from the lungs.

Front 8

Modified Respiration Form
(Sneezing)

Back 8

Sudden, forceful exhalation from the nose. It is usually caused by nasal irritation.

Front 9

Modified Respiration Form
(Hiccoughing)

Back 9

Sudden inspiration caused by spasmodic contractions of the diaphragm with spastic closure of the glottis. It serve no known physiologic purpose. It has occasionally been associated with acute MI on the inferior surface of the heart.

Front 10

Modified Respiration Form
(Grunting)

Back 10

A forceful expiration that occurs against a partially closed epiglottis. It is usually an indication of respiratory distress.

Front 11

Functions of the respiratory system:
(Mechanics of Ventilation)

Back 11

Ventilation consists of inspiration (active) and expiration (passive): Inspiration takes place when the diaphragm and intercostal muscles contract and expand the lungs; thus creating a pressure vacuum that draws atmospheric air into the lungs. At the end of inspiration, the respiratory muscles relax, shrinking the thoracic cavity and expelling air from the lungs. This is expiration.

Front 12

Functions of the respiratory system:
(Pulmonary Circulation)

Back 12

Deoxygenated blood leaves the right ventricle through the pulmonary artery which divides to the right and left lung where the arteries fan into smaller arteries and end in the capillaries. Gases are exchanged and then the oxygenated blood travels back to the heart through the pulmonary veins, emptying into the left atrium. Perfusion of the lungs themselves is provided through the bronchial arteries and veins.

Front 13

Methods for measuring O2 and CO2 in the blood and their prehospital use:
(Pulse Oximetry)

Back 13

It is noninvasive, rapidly applied, easy to operate and provides a continual and dynamic reading of peripheral oxygen delivery. Using infrared (deoxygenated) and near red (oxygenated) emitting diodes the pulse oximetry provides a very accurate reading of the oxygen saturation percentage (SpO2) of hemoglobin. This is a fast and mostly accurate way to measure the level of perfusion in the patient. Above 95% is normal, 85% and lower is sever hypoxia. This is a rapid way of seeing if airway interventions are effective or not.

Front 14

Methods for measuring O2 and CO2 in the blood and their prehospital use:
(Capnography)

Back 14

Noninvasive method of monitoring exhaled CO2. End Tidal CO2 (ETCO2) is a noninvasive method of measuring ventilation, metabolism, and circulation. Although initially used in prehospital settings to verify proper ETT placement in the trachea, it is now being used as continual proof of proper placement for documentation, for observing response to medications and showing the effectiveness of CPR. Continuous Waveform Capnography has made this possible.

Front 15

Basic Capnography Rules:
(Sudden Drop of ETCO2 to zero)

Back 15

•Esophageal Intubation
•Ventilator Disconnection or defect
•Defect in CO2 analyzer

Front 16

Basic Capnography Rules:
(Sudden decrease of ETCO2 (not to zero))

Back 16

•Leak in ventilator system; obstruction
•Partial disconnect in ventilator circuit.
•Partial airway obstruction (secretions)

Front 17

Basic Capnography Rules:
(Exponential decrease of ETCO2)

Back 17

•Pulmonary embolism
•cardiac arrest
•hypotension (sudden)
•Severe Hyperventilation

Front 18

Basic Capnography Rules:
(Change in CO2 Baseline)

Back 18

•Calibration error
•Water droplet in analyzer
•mechanical failure (ventilator)

Front 19

Basic Capnography Rules:
(Sudden increase in ETCO2)

Back 19

•Accessing an area of lung previously obstructed
•Release if tourniquet
•Sudden increase in blood pressure

Front 20

Basic Capnography Rules:
(Gradual Lowering of ETCO2)

Back 20

•Hypovolemia
•Decreasing cardiac output
•Decreasing body temperature; hypothermia; drop in metabolism

Front 21

Basic Capnography Rules:
(Gradual Increase in ETCO2)

Back 21

•Rising Body Temperature
•CO2 absorption
•Partial airway obstruction (foreign body); reactive airway disease.

Front 22

SpO2 Reading: 95-100

Back 22

•Normal
•Change FiO2 to maintain saturation

Front 23

SpO2 Reading: 91-94

Back 23

•Mild Hypoxemia
•Increase FiO2 to increase saturation

Front 24

SpO2 Reading: 86-90

Back 24

•Moderate Hypoxemia
•Increase FiO2 to increase saturation
•Assess and increase ventilation

Front 25

SpO2 Reading: <85

Back 25

•Sever Hypoxemia
•Increase FiO2 to increase saturation
•Increase Ventilation

Front 26

Causes for Upper Air Obstruction:
(Foreign Body Aspiration)

Back 26

Often involving alcohol, dentures or young children. An object like a large, poorly chewed piece of food becomes lodged in the hypopharynx. Often mistaken for heart attacks.

Front 27

Causes for Upper Air Obstruction:
(Laryngeal Spasm)

Back 27

A spasmodic closure of the vocal cords that can be potentially lethal. Potential causes are trauma, anaphylaxis, epiglottitis, and inhalation of superheated air, smoke, or toxins. The most common cause of Laryngeal Spasm however is overly aggressive intubation. This especially takes place immediately after extubation, and when the patient is semiconscious.

Front 28

Causes for Upper Air Obstruction:
(Laryngeal Edema)

Back 28

A swelling of the vocal cords that can be potentially lethal. Just below the mucous membrane of the vocal cords is a layer of loose tissue where blood or other fluids can accumulate. The swelling that may take place in this area tends to be slow to subside. Potential causes are trauma, anaphylaxis, epiglottitis, and inhalation of superheated air, smoke, or toxins.

Front 29

Complete airway obstruction maneuvers:
(Heimlich Maneuver)

Back 29

This is the basic life support maneuver that should be conducted for airway obstruction. If the patient is conscious and choking use your fist in a forceful upward thrust in the patients abdomen between the umbilicus and the xiphoid process. If the patient is unconscious use CPR with visualized finger sweeps. Use suction is indicated.

Front 30

Complete airway obstruction maneuvers:
(Removal with Magill Forceps)

Back 30

If the obstruction cannot be removed with the Heimlich maneuvers or CPR, finger sweeps and suction, then using a laryngoscope to visualize the airway in an identical manner as used for orotracheal intubation. Then using the Magill Forceps, carefully remove the obstruction.

Front 31

Causes of Respiratory Distress:
(Inadequate Ventilation)

Back 31

This is inadequate minute volume which negatively effects oxygen intake and carbon dioxide removal. This can come from either a decreased ventilation rate, a depressed respiratory function such as impairment of respiratory muscles; and a decreased oxygen content in the atmosphere itself such as being in a high altitude setting. Other causes of respiratory impairment are, bronchiospasm, intrinsic disease, pneumothorax, hemothorax, and drug overdose. Sepsis can increase the metabolic rate beyond the bodies ability keep up.

Front 32

Causes of Respiratory Distress:
(Impairment of Respiratory Muscles)

Back 32

The muscles primarily impacted in this situation would be the intercostal and the diaphragm. A cause for this impairment would be trauma, thus physically inhibiting the muscles themselves. A flail chest would create paradoxical motion. A possible pneumothorax impairing compliance and so on. A second cause would come from nervous system injury, thus inhibiting or blocking electrical stimulus to the respiratory muscles.

Front 33

Causes of Respiratory Distress:
(Impairment of the nervous system)

Back 33

If the nervous system is impaired the brain’s ability to respond to shifting metabolic needs will be limited. Example would be unable to receive input from stretch receptors, or impaired ability to receive input from chemoreceptors that trigger the ventilation process according to PaCO2 levels, or PaO2 levels in the COPD patient. If the nervous system in impaired, there is a good chance the respiratory muscles will be impaired as well.

Front 34

Diffusion

Back 34

The movement of a gas from and area of high concentration to an area of lower concentration; seeking equilibrium.

Front 35

Osmosis

Back 35

The movement of solvent in a solution from and area of lower solute concentration to an area of higher solute concentration.

Front 36

Stages of hypoxia

Back 36

Normal SAO2: 95-100
Mild Hypoxia: 91-95
Moderate Hypoxia: 86-90
Severe Hypoxia: <85

Front 37

Causes of increased CO2 production

Back 37

•Fever
•Muscle Exertion
•Shivering

Front 38

Origins of Breath Sounds:
(Snoring)

Back 38

Partial obstruction of the upper airway by the tongue.

Front 39

Origins of Breath Sounds:
(Gurgling)

Back 39

Accumulation of blood, vomitus, aspiration, or other secretions in the upper airway.

Front 40

Origins of Breath Sounds:
(Stridor)

Back 40

Laryngeal edema or Constriction
(usually on inspiration)

Front 41

Origins of Breath Sounds:
(Wheezing)

Back 41

Inspiration and/or expiration; bronchial constriction.

Front 42

Reasons for using Cricoid Pressure

Back 42

•Prevent regurgitation/ vomitus/ aspiration
•Gastric Distention
•Facilitate intubation by bringing larynx into view.

Front 43

Signs and Symptoms of Tension Pneumothorax

Back 43

•Progressively worsening compliance
•Diminished unilateral breath sounds
•Hypoxia with hypotension
•Distended neck veins
•Trachea will deviate away from side with tension pneumothorax

Front 44

What is atelectasis

Back 44

Alveolar Collapse

Front 45

Lungs receive their blood supply from which arteries?

Back 45

Bronchial arteries branching off from the aorta.

Front 46

What does CO2 combine with in the blood stream?

Back 46

Hemoglobin

Front 47

What does CO2 becoming in the blood stream?

Back 47

Biocarbonate ion (HCO3)

Front 48

The 4 gases in the atmosphere and their concentrations:

Back 48

•Nitrogen: 78.62%
•Oxygen: 20.84%
•Carbon Dioxide: 0.4%
•Water: 0.50%

Front 49

Endotracheal Intubation Advantages:

Back 49

•Isolates trachea and permits complete control of the airway
•Impedes gastric distension
•Eliminates need to maintain a mask seal
•Offers direct route for suctioning the respiratory passages
•Although not recommended, permits medication administration

Front 50

Complications of Endotracheal Intubation and precautions (1)

Back 50

•Equipment malfunction: Pre-assembled airway kit that is checked regularly
•Tooth breakage and soft tissue lacerations: The Laryngoscope is an instrument to be used carefully, not a tool.

Front 51

Complications of Endotracheal Intubation and precautions (2)

Back 51

•Hypoxia: Use the 30 sec rule. or hold your breath, when you need to breath, the patient needs to breath.
•Esphogeal Intubation: Be careful on initial attempt, make sure to visualize the glottis, auscultate lungs and epigastrium.

Front 52

Complications of Endotracheal Intubation and precautions (3)

Back 52

•Tension Pneumothroax: Be careful to not be rushed or forced. Be ready with decompression needle if a tear or injury does in fact take place.

Front 53

Which patients need RSI?

Back 53

Patients that are awake and have significant AMS, they may combative. If they are hypoxic, with agitation, gag-reflex, clenched teeth, and/or too much muscle tone.

Front 54

Sedative Agents used for RSI: (1)

Back 54

•Midazolan (Versed): Dose: 0.1-0.3mg/kg
•Diazepan (Valium): Dose: 0.2-0.5mg/kg
•Etomdiate (Amidate): Dose: 0.3mg/kg
•Ketamine (ketalar): Dose: 1-2mg/kg

Front 55

Sedative Agents used for RSI: (2)

Back 55

•Sodium Thiopental: Dose: 3-5mg/kg
•Propofol (diprivan): Dose: 1-1.5mg/kg
•Fentanyl: Dose: 3-5mg/kg

Front 56

Adjunct Drugs to RSI and Dosages

Back 56

•Atropine: Dose: 0.01-0.02mg/kg
(min-max. 0.1-0.4)
•Lidocaine: Dose: 1mg/kg

Front 57

Indications for nasotracheal intubation:

Back 57

•Possible spinal injury
•Clenched teeth
•Fractured jaw, oral injuries, or recent oral surgery
•Significant angioedema (facial/airway swelling)
•Obesity
•Arthritis, preventing placement in the sniffing position

Front 58

Contraindications of nasotracheal intubation:

Back 58

•Suspected nasal fracture
•Suspected basilar skull fracture
•significantly deviated nasal septum or other nasal obstruction
•Cardiac or respiratory arrest
•Unresponsive patient: they usually need to help by swallowing.