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154 Cards in this Set
- Front
- Back
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Click for a key point
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Airway management and ventilation are the first and most critical steps in the initial assesment of every patient you will encounter
Page 533 |
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Your deliberate and precise use of simple, basic airway skills is the key to successful airway management.
Page 533 |
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Gas necessary for energy production
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Oxygen
Page 534 |
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Waste product of the body's metabolism
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Carbon dioxide
Page 534 |
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The exchange of gases between a living organism and its environment
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Respiration
Page 534 |
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This portion of the airway extends from the mouth and nose to the larynx and includes the nasal cavity, oral cavity, and pharynx
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Upper airway
Page 534 |
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Content review
Upper airway components |
1.Nasal cavity
2.Oral cavity 3.Pharynx Page 535 |
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Cartilage that separates the right and left nasal cavities
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Septum
Page 535 |
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Air cavity that conducts fluids from the eustachian tubes and tear ducts to and from the nasopharynx
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Sinus
Page 535 |
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A tube that connects the ear with the nasal cavity
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Eustachian tube
Page 535 |
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Tubular vessels that drain tears and debris from the eyes into the nasal cavity
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Nasolacrimal ducts
Page 535 |
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Nostril
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Nare
Page 535 |
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Lining in body cavities that handle air transport; usually contains small, mucus secreting cells
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Mucous membrane
Page 535 |
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Slippery secretion that lubricates and protects airway surfaces
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Mucus
Page 535 |
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Click here for a key point
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Always remember that improper or overly aggressive placement of tubes or mechanical airways can cause significant bleeding that direct pressure might not control
Page 535 |
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A muscular tube that extends vertically fro the back of the soft palate to the superior aspect of the esophagus
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Pharynx
Page 536 |
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Content Review
Regions of the pharynx |
1.Nasopharynx
2.Oropharynx 3.Laryngopharynx Page 536 |
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Mechanism that stimulates retching, or striving to vomit, when the soft palate is touched
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Gag reflex
Page 536 |
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Depresion between the epiglottis and the base of the tounge
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Vallecula
Page 536 |
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Passing a tube into a body opening
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Intubation
Page 536 |
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The complete structure that joins the pharynx with the trachea
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Larynx
Page 536 |
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liplike opening between the vocal cords
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Glottis
Page 537 |
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Pressure applied in a posterior direction to the anterior cricoid cartilage; occludes the esophagus
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Cricoid pressure
Page 537 |
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Inhaling foreign material such as vomitus into the lungs
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Aspiration
Page 537 |
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Membrane between the cricoid and thyroid cartilages of the larynx
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Cricothyroid membrane
Page 537 |
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Content review:
Lower airway components |
1.Trachea
2.Bronchi 3.Alveoli 4.Lung parenchyma 5.Pleura Page 537 |
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10 - 12 cm long tube that connects the larynx to the mainstem bronchi
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Trachea
Page 538 |
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Tubes from the trachea into the lungs
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Bronchi
Page 538 |
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Microscopic air sacs where most oxygen and carbon dioxide gas exchanges take place
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Alveoli
Page 539 |
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Alveolar collapse
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Atelectasis
Page 539 |
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Principal or essential parts of an organ
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Parenchyma
Page 539 |
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Membranous connective tissue covering the lungs
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Pleura
Page 539 |
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The space between the visceral pleura and the parietal pleura
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Pleural space
Page 540 |
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Respiration that occurs in the lungs between the alveoli and the red blood cells
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External (Pulmonary) respiration
Page 541 |
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Respiration that occurs in the peripheral capillaries between the red blood cells and the various body tissues
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Internal (Cellular) respiration
Page 541 |
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The mechanical process that moves air into and out of the lungs
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Ventilation
Page 541 |
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The pressure exerted by each component of a gas mixture
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Partial pressure
Page 543 |
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Symbol for alveolar partial pressure
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PA
Note the A is capitilized signifyig it is alveolar reading Page 544 |
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Symbol for arterial pressure
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Pa
Note the a is in lower case signifying it is an arterial reading Page 544 |
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Movement of a gas from an area of higher concentration to an area of lower concentration
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Diffusion
Page 544 |
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Reduction in breathing rate and depth
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Hypoventilation
Page 545 |
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Accumulation of air or gas in the pleural cavity
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Pneumothorax
Page 545 |
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Accumulation in the pleural cavity of blood or fluid containing blood
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Hemothorax
Page 545 |
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Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood
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Pulmonary embolism
Page 545 |
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Concentration of oxygen in the inspired air
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FiO2
Stands for fraction of inspired oxygen Page 545 |
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Click here for a key point
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Never withold oxygen from any patient whose clinical condition indicates its need
Page 545 |
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Excessive pressure of carbon dioxide in the blood
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Hypercarbia
Page 546 |
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Number of times a person breathes in 1 minute
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Respiratory rate
Page 546 |
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Decreased partial pressure of oxygen in the blood
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Hypoxemia
Page 547 |
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Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs
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Hypoxic drive
Page 547 |
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Maximum lung capacity
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Total lung capacity
Page 548 |
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Average volume of gas inhaled or exhaled in one respiratory cycle
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Tidal volume
Page 548 |
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Amount of gas inhaled and exhaled in 1 minute
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Minute volume
Page 548 |
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The maximum lung capacity; The total amount of air contained in the lung at the end of mximal inspiratiion
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Total lung capacity
(TLC) Approximately 6 liters Page 548 |
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The average volume of gas inhaled or exhaled in one respiratory cycle
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Tidal volume
(VT) Approximately 500 mL Page 548 |
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The amount of gas in the tidal volume that remains in air passageways unavailable for gas exchange
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Dead space volume
(VD) Approximately 150 mL in an adult male |
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The amount of gas in the tidal volume that reaches the alveoli for gas exchange
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Alveolar volume
(VA) Approximately 350 mL in an adult male VA=VT - VD Page 548 |
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The amount of gas moved in and out of the respiratory tract in 1 minute
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Minute volume
(Vmin) Vmin=VT x respiratory rate Page 548 |
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The amount of gas that reaches the alveoli for gas exchange in 1 minute
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Alveolar minute volume
(VAmin) VAmin=(VT - VD) x respiratory rate or VAmin = VA x respiratory rate Page 548 |
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The amount of air that can be maximally inhaled after a normal inspiration
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Inspiratory reserve volume
(IRV) Page 548 |
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The amount of air that can be maximally exhaled after a normal expiration
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Expiratory reserve volume
(ERV) Page 548 |
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The amount of air remaining in the lungs at the end of maximal expiration
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Residual volume
Page 548 |
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The volume of gas that remains in the lungs at the end of normal expiration
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Functional residual capacity
(FRC) FRC = ERV + RV Page 549 |
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The amount of air that can be maximally expired after maximum inspiration
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Forced expiratory volume
(FEV) Page 549 |
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Click here for a key point
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Blockage of the airway is an immediate threat to the patient's life and a true emergency
Page 549 |
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An interference with air movement through the upper airway system
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Upper airway obstruction
Page 549 |
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Content review
Causes of airway obstruction |
1.Tongue
2.Foreign bodies 3.Trauma 4.Laryngeal spasm and edema 5.Aspiration Page 549 |
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Click here for a key point
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Since the glottis is the narrowest part of an adult's airway, edema or spasm of the vocal cords is potentialy lethal
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Removing a tube from a body opening
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Extubation
Page 550 |
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What are the a,b,c's
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Airway, Breathing and circulation
Page 551 |
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Asymmetrical chest wall movement that lessens respiratory efficiency
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Paradoxical breathing
Page 552 |
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Defect in the chest wall that allows a sefment to move freely, causing paradoxical chest wall motion
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Flail chest
Page 552 |
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bluish discoloration
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Cyanosis
Page 553 |
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An abnormality of breathing rate, pattern, or effort
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Dyspnea
Page 554 |
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Oxygen deficiency
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Hypoxia
Page 554 |
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The absence or near absence of oxygen
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Anoxia
Page 554 |
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Drop in blood pressure of greater than 10 torr durring inspiration
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Pulsus paradoxus
Page 554 |
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Deep, slow or rapid, gasping breathing commonly found in diabetic ketoacidosis
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Kussmaul's respirations
Page 554 |
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Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury
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Cheyne-Stokes respirations
Page 554 |
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Irregular pattern of rate and depth with sudden periodic episodes of apnea, indicating increased intracranial pressure
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Biot's respirations
Page 554 |
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Deep, rapid respirations, indicatiing increassed intracranial pressure
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Central neurogenic hyperventilation
Page 554 |
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Shallow, slow, or infrequent breathing , indicating brain anoxia
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Agonal respirations
Page 554 |
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This sound points to what kind of airflow compromise:
Snoring |
Results from partial obstruction of the upper airway by the tongue
Page 555 |
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This sound points to what kind of airflow compromise:
Gurgling |
Results from the accumulation of blood, vomitus, or other secretions in the upper airway
Page 555 |
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This sound points to what kind of airflow compromise:
Stridor (A harsh high pitched sound heard on inhalation) |
Associated with laryngeal edema or constriction
Page 555 |
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This sound points to what kind of airflow compromise:
Whezzing (A musical, squeaking, or whistling sound heard in inspiration and/or expiration, |
Associated with bronchiolar constriction
Page 555 |
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This sound points to what kind of airflow compromise:
Quiet (diminished or absent breath sounds) |
A serious problem with the airway, breathing, or both
Page 555 |
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This sound points to what kind of GAS EXCHANGE compromise:
Crackles (rales): A fine bubbling sound heard on inspiration, |
Associated wtih fluid in the smaller bronchioles
Page 556 |
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This sound points to what kind of GAS EXCHANGE compromise:
Rhonchi: a coarse, rattling noise heard on inspiration |
Associated with inflamation, mucus, or fluid in the bronchioles
Page 556 |
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The stiffness or flexibility of the lung tissue
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Compliance
Page 556 |
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Click here for a key point
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A fall in the pulse rate in a patient with airway compromise is an ominous finding
Page 556 |
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an abnormally low amount of oxygen in the body tissues
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anoxia
Page 556 |
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inadequate oxygenation of the blood.
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hypoxemia
Page 556 |
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A measurement of hemoglobin oxygen saturation in the peripheral tissues
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Pulse oximetry
Page 557 |
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The saturation of arterial blood with oxygen as measured by pulse oximetry expressed as a percentage
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Oxygen saturation percentage
(SpO2) Page 557 |
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A recording or display of the measurement of exhaled carbon dioxide concentrations
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Capnography
Page 557 |
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A simple and inexpensive tool to help determine whether an endotracheal tube is in the trachea or the esophagus
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Esophageal detector device
(EDD) Page 563 |
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Testing done utilizing a disposable plastic chamber into which the patient exhales forcefully after maximal inhalation
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Peak expiratory flow testing
Page 563 |
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Click here for a patho pearl
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Always try basic airway maneuvers before resorting to advanced ones
Page 563 |
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Click here for a key point
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During airway management always wear protective eyewear and gloves to avoid contact with the patients body
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Uncuffed tube that follows the natural curvature of the nasopharynx, passing through the nose and extending from the nostril to the posterior pharynx
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Nasopharyngeal airway
Page 568 |
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Unit of measurement approximately equal to one-third millimeter
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French
Page 568 |
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Click here for a key point
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Never use a nasopharyngeal tube when you suspect a basilar skull fracture because it can inadvertantly pass into the cranial vault
Page 569 |
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Semicircular device that follows the palate's curvature
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Oropharyngeal airway
Page 570 |
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Click here for a key point
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Do not use an oropharyngeal airway in conscious or in semiconscious patients who have a gag reflex, because it may cause vomiting or laryngospasm
Page 570 |
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Click here for a key point
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Endotracheal intubation is clearly the prefered method of advanced airway manage
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Content review:
Endotracheal intubation equipment |
1.Laryngoscope (handle and blade
2.Endotracheal tube 3.10 mL syringe 4.Stylet 5.Bag valve mask 6.Bite block 7.Magill forcepts 8.Tape or tube holding device Page 57. |
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Instument for lifting the tongue and epiglottis in order to see the vocal cords
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Laryngoscope
Page 574 |
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What are the sizes for laryngoscope blades
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Range in size from 0 for infants to 4 for adults
Page 575 |
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Tube that is passed into the trachea to protect and maintain the airway and to permit medication administration and deep sucitoning
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Endotracheal tube (ETT)
Page 575 |
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What is the lengths available for the Endotracheal tube (ETT)
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Ranges from 12 -32 cm
Also has an inside diameter of 15 mm and outside diametr of 22 mm that ataches to a Bag valve mask Page 575 |
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What are the internal tube diameters of the Endotracheal tube
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2.5 - 4.5 mm uncuffed
5.0 - 9.0 mm cuffed Page 575 |
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Plastic covered metal wire used to bend the ETT into a J or hockey stick shape
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Stylet
Page 577 |
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Scissor style clamps with circular tips
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Magill forceps
Page 579 |
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Content review
Endotracheal intubation indicators |
1.Respiratory or cardiac arrest
2.Unconscioussness or obtusion without gag reflex 3.Risk of aspiration 4.Obstruction due to foreign bodies, trauma, burns, or anaphylaxis 5.Respiratory extremis due to disease 6.Pneumothorax, hemothorax, or hemopneumothorax with respiratory difficulty Page 580 |
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Content review
Complications of endotracheal intubation |
1.Equipment malfunction
2.Teeth breakage and soft tissue lacerations 3.Hypoxia 4.Esophageal intubation 5.Endobronchial intubation 6.Tension pneumothorax Page 581 |
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Click here for a key point
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To avoid hypoxia during intubation, limit each intubation attempt to no more than 30 seconds before reoxygenating the patinet
Page 582 |
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Click here for a key point
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Esophageal intubation is potentially lethal if you do not recognize it immediately
Page 582 |
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to blow into
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Insufflate
Page 583 |
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What is the appropriate ETT tube depth placement at the teeth, gums, or lips
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21 cm at the teeth for women
23 cm at the teeth for men Page 583 |
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In regards to endotracheal intubation what does the acronym BURP stand for
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Backward
Upward Rightward Presure The laryngoscope operatior uses his right thumb and index finger to apply pressure to the thyroid cartlige (Adams apple) and mainipulate in this fasion to achieve a better view of the epiglottis. At this point an assistant takes over while the laryngoscope operator places the ETT tube Page 586 |
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Giving medications to sedate (induce) and temporarily paralyze a patient and then performing orotracheal intubation
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Rapid sequence intubation
Page 596 |
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Click here for a key point
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Succinylcholine is the preferred neuromuscular blocking agent for emergency RSI
Page 596 |
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Content review
Common paralytic agents |
1.succinylcholine
2.Vecuronium 3.Atracurium 4.Pancuronium Page 596 |
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Temporary stop in breathing
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Apnea
Page 598 |
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Through the nose and into the trachea
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Nasotracheal route
Page 604 |
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Through the nose and into the trachea
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nasotracheal route
Page 604 |
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The tunnel through a tube
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Lumen
Page 607 |
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Content review
Intubation devices |
1.(ETT) Endotracheal tube
2.(ETC) Esophageal tracheal combitube 3.(LMA) Laryngeal mask airway 4.(PtL) Pharyngotracheal lumen airway 5.(EGTA) Esophageal gastric tube 6.(EOA) Esophageal obturator airway Page 607 |
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Surgical airway technique that inserts a 14 guage needle into the trachea at the cricothyroid membrane
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Needle cricothyrotomy
Page 615 |
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Surgical airway technique that places an endotracheal or tracheostomy tube directly inot the trachea through a surgical incision at the cricothyroid memberane
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Open cricothyrotomy
Page 615 |
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Narrowing or constriction
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Stenosis
Page 616 |
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Injury caused by pressure within an enclosed space
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Barotrauma
Page 616 |
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A clinical situation in which a conventionally trained paramedic experiences difficulty with mask ventilation and or endotracheal intubation
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Difficult airway
Page 620 |
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Four "class" level airway assesment for use in consious patients, defined by the ability to visualize all, part, or none of the tonsillar pillars and/or the uvula
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Mallampati classification system
Page 624 |
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Mallampati classification system
Name the classes 1 - 4 |
Class 1 Entire tonsil clearly visible
Class 2 Upper half of tonsil fossa visible Class 3 Soft and hard palate clearly visible Class 4 Only hard palate visible Page 624 |
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Four grade level airway assesment for use in unconcious patients defined by the ability to visualize all, part, or none of the glottic opening and/or the vocal cords
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Cormack and leHone classification system
Page 625 |
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Cormack and leHone classification system
Name the 4 grades |
Grade 1 Entire glotic opening and vocal cords may be seen
Grade 2 Epiglottis and posterior portion of glottic opening may be seen, with a partial view of vocal cords Grade 3 Only epiglittis and (sometimes) posterior cartilages seen Grade 4 Neither epiglottis nor glottis seen Page 625 |
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Airway assessment used by some EMS personel to rate the percentage of glottic opening (POGO) one can visualize from "0" percent (None) to "100" percent (All)
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POGO classification system
Page 625 |
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Opening in the anterior neck that connects the trachea with ambient air
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Stoma
Page 627 |
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Click here for a key point
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Timely replacement of a stoma devices outer cannula is important because the stoma can constrict within just a few hours to prohibit it s replacement without dilation
Page 628 |
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To remove with a vacum type device
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Suciton
Page 629 |
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Click here for a key point
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An adequate and properly functioning suction unit is essential for airway management
Page 629 |
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Regulator used to transfer oxygen at high pressures from tank to tank
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High pressure regulator
Page 633 |
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Pressure regulator used for delivering oxygen to patients
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Therapy regulator
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Click here for a key point
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You must continually reasses the patient who requires oxygen therapy to be certain that the method of delivery and flow rate are adequate
Page 633 |
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Catheter placed at the nares
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Nasal cannula
Page 634 |
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High flow face mask that uses a Venturi system to deliver relatively precise oxygen concentrations
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Venturi mask
Page 634 |
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Content review
Oxygen delivery devices |
1.Nasal cannula
2.Venturi mask 3.Simple face mask 4.Partial rebreather mask 5.Nonrebreather mask 6.Small volume nebulizer 7.Oxygen humidifier Page 634 |
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Click here for a key point
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If you do not correct any significant decrease in the patients rate or depth of breathing respiratory or cardiac arrest may occur
Page 635 |
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Click here for a key point
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Exercise care when you attempt to generate enough pressure to ventilate the lungs
Page 365 |
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Content review
Ventilation methods |
1.Mouth to mouth / Mouth to nose
2.Mouth to mask 3.Bag valve device 4.Demand valve device 5.Automatic transport ventilator Page 635 |
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Ventilation device consisting of a self inflating bag with two one way valves and a transparent plastic face mask
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Bag valve mask
Page 636 |
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A ventilation device that is manually operated by a push button or lever
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Demand valve device
Page 637 |
