Chapter 26 Respiratory Emergencies

Front 1

air enters primairily through?

Back 1

nares (nostils)

Front 2

nares lined with

Back 2

nasal hairs serve as filiters

Front 3

external nares sperated by

Back 3

nasal septum

Front 4

after passing thru nares air is pulled over

Back 4

turbinates ridges of tissue that are covered with mucous membrane and contain many blood vessesles which mucous membrane traps more particulate matte and the large surface of the turbinates warms and humidifies the air

Front 5

intubation or tracheostomy aloow inhaled air to skip this trip

Back 5

bypasing the humidifiaction an filering

Front 6

because turbinites contain many blood vessesles

Back 6

they easily swell causing stuffy nose or bleed epistasis

Front 7

bean ectomies

Back 7

removal of foriegn objects from nose

Front 8

mouth (oropharynx) also contain many blood vessels and covered by mucous membrane

Back 8

swelling can be extreme and potentially dangerous

Front 9

angioedema

Back 9

allergic reaction that may cause sever swelling of the tongue and lips

Front 10

oropharynx and nasopharynx meet

Back 10

in the back of the throat at the hypopharynx (gag reflex most promient here

Front 11

gag reflex can cause

Back 11

vagal bradycardia slow hb caused by vagal nerve stimulation and increased intracranial pressure

Front 12

larynx
glottis

Back 12

voicbox
opening at top of trachea

are typically considered the dividgin line between the upper and lower airway

Front 13

thryoid carilage is the most

Back 13

obvious sign external landmark of the larynx

Front 14

several cartaliges may be visiable when intubatio

Back 14

support the vocal cords

Front 15

arytenoid cartilages

Back 15

appear as two pearly white lumps at the end of each vocal cord

Front 16

either side of the glottis

Back 16

tissue forms a pocket called the piriform fossa sometimes ng tubes or et tubes will get stuck here casuing tenting that visiable externally on the neck must be with drwqan a few inches and reinserted

Front 17

glotting opeing covered by

Back 17

epiglottis (many people aspirate around it )

Front 18

cricoid cartialage

Back 18

just below the th thytoid cart can be palpated . forms complete ring and maintains the trachea in an ope position

Front 19

pressin on the anterior portion of the ring compresse the esophagous while keeping the trachea open

Back 19

sellick maneuver (appyling pressure to cricoid cartilage

Front 20

small space between the thyroid cart and cricoid cart

Back 20

cricothyroid membrane doesnt contain many blood vessels and is covered only by skin and minimal subcutaneous tissue

Front 21

trauma or swelling of any of the laryngeal structures ccan create

Back 21

life threatening airway obstruction

Front 22

tracheostoma

Back 22

a surgical lopeing into the trachea

Front 23

wasted ventilation is called

Back 23

anatomic dead space about 1ml per pound avg 150ml based on 150pd person

Front 24

average breath (tidal volume)

Back 24

700ml subtact 150ml from that equals 550ml that would participate in ventilation at the alveolar level the other would fill tube and never be exposed to blood flow

Front 25

truck of these tubes called

Back 25

thracheobronchial tree is the trachea about 10-13 cm long extends from the sixth cervical verebra to its point of bifurcation (carina) at roughly the fifth thoracic vertabrea nipple level

Front 26

carina

Back 26

point of bifurcation of the right and left mainstem bronchi , located at 5th intercostal space nipple level! (where trachea seperates!)

Front 27

mainstem bronchi branch into

Back 27

lobar bronchi segmetal bronchi, and bronchioles (account for 15 branchings of the airway and are lined with ciliated epithelium (cilia) )

Front 28

cilia

Back 28

little hair like structures that rythmically wave in a pattern that helps move particulate mautter up and out of the airway

Front 29

if anything gets deeper into the lungs than level 15 there is no

Back 29

mechanism to get it back out

Front 30

goblet cells

Back 30

cells produce a blanket of mucus that covers the entire lining of the conducting airways the mucus covers the cilia and forms a two layered blanket that is thick at the surface (gel layer) and thin and watery next to the cilia sol layer gel floats over sol layer

Front 31

cilia constantly push the

Back 31

gel layer up and out of the airway where it is either swallowed or expectorated

Front 32

dehydrated pesons or medicated persons such as antihistamines that dry normal secrtions

Back 32

the sol layer will begin to dry up and the cilia will not be able to move secretions

Front 33

overhydrated pt

Back 33

the cilia will wave meaNINGLESSLY IN A DEEP WATER LAYER WITH OUT EVER AFFECTING THE THICK GEL LAYER

Front 34

smooth muscle

Back 34

surronds the conducting airways down to the subsegemnatl level

Front 35

bronchoconstriction occurs

Back 35

wehn the smooth muscle contricts around the these larger airways

Front 36

below th smooth muscle level

Back 36

bronchodialator meds have lilttle effect upon the airways wheezing

Front 37

wheezing resloved by bronchodialator meds

Back 37

probably cause by constriction of the smooth muscles

Front 38

wheezing not resloved by brochondialor meds

Back 38

may be caused by a variety of pathologic conditions deeper in the tracheobronchial tree

Front 39

terminal airways and alveoli

Back 39

include branches 16 - 24 (terminial brchioles )

Front 40

the tracheobronchical tree ends with

Back 40

alveoli

Front 41

alveoli cluster around

Back 41

terminal bronieoles

Front 42

capillaries cover the laveoli and brnchil tubes from level

Back 42

16 -24

Front 43

the alveoli and terminal bronchioles

Back 43

actually make up the majority of the lung mass

Front 44

gass exchange is probaly most efficeint where

Back 44

in the alveoli but a significant amount of gas is also exhanged across respiratory bronchioles

Front 45

teminal bronchiloes are

Back 45

very thin and have little structure whch is helpfulf for gas exhange but means the lac k cilia mucous blanket smooth muscle or rigid structures

Front 46

part of the lung collectively know n as the lung parenchyma

Back 46

terminal bronchiols and alveoli forigen material gets in to the it typically never comes out

Front 47

empysema may affect the parenchyma ( terminal bronchioles and alveoli

Back 47

destroying what structures components that are present when that happens th terminal branches of the trach tree become so weak that they collapse during exhalaiton and trap air in the alveoli

Front 48

alveloi lined with

Back 48

substance known as surfactant which reduces surface tension and helps keep them expanded

Front 49

atelectasis

Back 49

surfactant is decreased or the alveoli are not infalted the allveoli collapse which result in a a condition known as telectasis

Front 50

smoking or diessaes destroys certain types of cells

Back 50

in the alveolus it cannaot repair itself

Front 51

alveoli can repair itself if

Back 51

certain types of cells survive an illness

Front 52

pulmonary circulation begins at the

Back 52

right ventricle where the pulmonary artery branches into increasingly smaller vessels wutil the pulmonary capillary bed surrounds the alveoli and terminal bronchioles there is more circuliaton to lung bases than lung apices

Front 53

most infectins and pathologic conditions affect what part of lungs?

Back 53

bases because of gravity

Front 54

pulmonary cappilaries

Back 54

very narrow and typically only allow red blood cells single file thru

Front 55

polycythemia

Back 55

surplus of redblood cells over time often caused by chronic lung disease and chronc hypoxia

Front 56

cor pulmonale

Back 56

right heart failure secondary to chronic lung diesease pushing thicker than normal blood thru the tiny pulmonary capillaries can put a significant strain on right side of heart when alveol are distened by COPD they push agains the cap bed further narriong the caps and straiing right side of heart

Front 57

hypoventelating

Back 57

not mving adequate volumes of gas

Front 58

hypercapnic

Back 58

too much carbon dioxide in blood

Front 59

guillan barre syndrome

Back 59

spinal cord injury) problems iwth muscles and nerves that make breathing work

Front 60

negative pressure breathers

Back 60

air suckers

Front 61

thorax is

Back 61

airtight box with flexiable diaphargm ( the major muschles of breathing ) at the bottom and open tube at top (trachea)

Front 62

holes in thorax

Back 62

sucking chest wound

Front 63

multiple ribs brokene in more than on place

Back 63

flail chest free floating sections of the thorax gets sucked in when you breathe limiting the amount of air that can be sucked in the trachea

Front 64

exhalation

Back 64

passive process usually unless in asth m a retractive airway disease or copd may need to use abdomnial muschles to push air out no longer passive process

Front 65

apneustic breathing

Back 65

resulsts from damage to apneustic center shor brisk inhalation with long pause before exhalaiton (severe pressure in cranium or direct trauma to brain)

Front 66

biot respiration

Back 66

center that contols breathing rythm is damaged pattern grossly irregular sometime lengthy apenic periods

Front 67

chyne stokes resp

Back 67

high brain function depth of breathing (volume of snoring ) crecendo decresendo increase deccrease followed by apenic period exaggerated cheyne stokes may be seen in pts who have a severe brain injury

Front 68

hering breuer reflex

Back 68

stretch receptors in lungs are respnsible this reflex. which causes you to cough if you take too deep a breahth

Front 69

respiration

Back 69

is the process by which 02 is taken into the body dirtibuted to the cells and used byth cells to make energy
respiration takes place in each cell involves using 02 and glucose to make envergy taht allows the cell to do its work

Front 70

failure to deliver 02 efficeintly results in

Back 70

cellular hypoxia

Front 71

hpoxia kills

Back 71

cells making it impossiable to make energy to do their work and cause acidosis

Front 72

ph

Back 72

an expression of how many free ions are in a solution

Front 73

carbon dioxide not efficiently disposed of

Back 73

accumlates with water to form bicarbonate result is acidoises

Front 74

hyperventnilation

Back 74

person breaths too effectively and blows oof more co2 than usual resulting in alkalossis

Front 75

anxiety can be a early sign of

Back 75

hypoxia

Front 76

confusion lethargy an coma

Back 76

late signs of hypoxia

Front 77

medulla controls most resp fucntions

Back 77

in brain damgage to it causes a variety ogrepiratory abnorms

Front 78

right side of heart pumps blood to

Back 78

lungs

Front 79

left side of heart

Back 79

recieves blood from the lungs and pumps around the body

Front 80

severe hypoxia causes

Back 80

bradycardia

Front 81

uncorreceted hypoxic insult

Back 81

may result in letha lcardia arrhythmias suacha vdib or vtach

Front 82

changes in fluid balance

Back 82

right heart puping pressures or left heart pumping pressure can cause various forms of chf

Front 83

seeking a sitting postion when short of breath

Back 83

orthopnea

Front 84

fluid balance acid bas balance and bp are

Back 84

controlled in part by kidneys

Front 85

pts with sever renal disease

Back 85

often present with respirtaoty sings and symptos

Front 86

emphysema

Back 86

barrel chest prused lip breathing tachypneic do not typically present with profound hypoxia and vyanosis x(pink puffer)

Front 87

chroinc bronchitits

Back 87

obese , often encountered in chair or recliner where they sleep in upright positon surrounded by tissue they spit into overflowing ashtray urinial so they dont have to get up for frequent trips to restroom

Front 88

tall thin young adults

Back 88

predisposed to spontanoues pnemothorax

Front 89

women who smoke and take birth control pills

Back 89

predisposed to pulimonary embolism

Front 90

beware the pt who in respiratory distress

Back 90

who is willing to lie flat ie sign of sudden deterioration

Front 91

bony retractions

Back 91

most common in infants and small children rigid structue of the thoraxi is still flexiabale on inhalation may pull strnum ito the chest visble deformity

Front 92

soft tissue retractions

Back 92

soft tissue is pulled in around the bones inhalation the spraclavicular intercosatan subziphonied areas

Front 93

nasal flaring

Back 93

the nostils are pulled wid e open on inhaltion

Front 94

tracheal tugging

Back 94

thyroid carliage is pulled upward and the are just aboue the sternal nothc is sucked inward with inhalaiton

Front 95

paradoxiacal respiratory movement

Back 95

epigastrium is pulle din with inhalation while the abdoemn pusehs out creating a se saw qappearace as two move in opposing directins

Front 96

pulsus paradoxus

Back 96

profound intrathosci pressure changes cause the peripheral pulses to weaken or disaperar on inspiration

Front 97

minute volume (mv)

Back 97

rate times tidal volume (rXvt)

Front 98

quiet tachypenea

Back 98

prompt you to consider shcok

Front 99

decline in PaO2 hypoxemia

Back 99

will maifest initially as restlessnes confusion and worst case as combactive behavior

Front 100

increase in PaO2

Back 100

USUALLY HAS SEDATIVE effects makin pt sleepy and hard to rouse

Front 101

pulsus paradoxus

Back 101

profound intrathosci pressure changes cause the peripheral pulses to weaken or disaperar on inspiration

Front 102

minute volume (mv)

Back 102

rate times tidal volume (rXvt)

Front 103

quiet tachypenea

Back 103

prompt you to consider shcok

Front 104

decline in PaO2 hypoxemia

Back 104

will maifest initially as restlessnes confusion and worst case as combactive behavior

Front 105

increase in PaCO2

Back 105

USUALLY HAS SEDATIVE effects makin pt sleepy and hard to rouse

Front 106

mucous membarane

Back 106

tissue inside pts mouth under eyelids under nail beds is usually same pink color in all healthy pts

Front 107

normal hemoglobin level

Back 107

hempglobin level of 12-14g/dl

Front 108

cyanosis

Back 108

blue discoloration

Front 109

chocholate brown skin

Back 109

high levels of methemoglobin derived from nitrates and some toxic exposure s typically more evidednt in pts vnous blood than the skin and mucous membnranes

Front 110

pale skin

Back 110

caused by a reduction of blood flow to the small vessels near the surcace of the skin caused by hypoxia shock catecholalomine release such as epi or norepi or cold enviroment

Front 111

signs of dehydration

Back 111

dry cracked lips a dry furrowed ongue and dry sunken eyes skin assesment mab be of less value in some older people

Front 112

paroxysmal nocturnal dyspnea

Back 112

dyspnea that comes on suddely in the middle of the night is an omnious sign may signal left heart failure worsening copd or both occours because of accumulation of fluid in the alveoli or pooling of secretions in the bronchi during sleep

Front 113

heptojugular reflux

Back 113

occurs when mild pressure on the patients liver causes the jugular veins to engorge further thjis a specifi sign of right heart failure

Front 114

jvd

Back 114

common all the time in patients who have obstuctive lung disease suach as asthma or copd cardiac tamponade pnemothorz hear failure and copd can all cause jvd

Front 115

tactile fremitus

Back 115

chest vibrations secretions in the larfe airways usually easy to feel and to hear

Front 116

listen for et tube placment

Back 116

midaxiallary line