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173 Cards in this Set
- Front
- Back
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Septum
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Cartilage that separates the right and left nasal cavaties.
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Sinus
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Air cavity that conducts fluid from the eustation tubes and tear ducts to and from the nasopharynx
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Eustachian Tubes
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A tube that connects the ear with the nasal cavity
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Nasolacrimal Ducts
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Tubula vessels that drain teaars and debris from the eyes into the nasal cavity.
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Mucous Membrane
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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.
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Pharynx
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Amuscular tube that extends from the back of the soft palate to the superior aspect of the esophagus.
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Gag Reflex
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Mechanism that stimulates retching, or striving to vomit, when the soft palate is touched.
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Vallecula
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depression between the eppiglottis and the base of the tongue.
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Intubation
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Passing a tube into a body opening.
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Larynx
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The complex structure that joins the pharynx with the trachea.
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Glottis
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Liplike opening between the vocal chords.
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Sellick Maneuver
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Pressure applied in a posterior direction to the anterior cricoid cartilage; occludes the esophagus. Very Light pressure is needed.
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Aspiration
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Inhaling foreign material such as vomitus into the lungs.
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Cricothyroid Membrane
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Membrane between the cricoid and thyroid cartilages of the larynx.
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true Vocal Chords
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White bands of cartilage that regulate the passage of air through the larynx and produce voice by contraction of the laryngeal muscles.
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Thyroid Cartilage
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Shield shape. Forms the anterior prominence called the adams apple.
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Arytenoid Cartliage
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Forms the pyramid shaped attachment for the vocal chords posteriorly, is a landmark for intubation.
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The narrowest Part of adult trachea
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Glottic Opening
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Pyriform Fossae
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Recess that form the lateral borders of the larynx.
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Cricoid Cartilage
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Forms the inferior border of the larynx. first tracheal ring. Forms a complete ring. Esophagus lies behind the cricoid cartilage.
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Vagus Nerve
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Inervates the mucous lining of the larynx. Stimulation can cause: Bradycardia, hypotension and bradypnea
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Tracheaa
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10-12 cm long tube that connects the larynx to the mainstem bronchi.
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Bronchi
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Tubes from the trachea into the lungs
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Alveoli
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Microscopic air sacs where most oxygen and carbon dioxide gaas exchanges.
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Tidal Volume
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Depth of Respiration. 500 - 800 mL
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Lung Capacity
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6 Liters
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Non rebreather
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Preferred method of Delivering o2. Resevoir needs to be 3/4 full.
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Partial rebreather
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for Peds. Take out valve in the non rebreather mask.
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General Breathing Rates
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Adult: 12-20
Children: 15-30 Infant: 25 - 50 (40 - 60) |
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Maximum Suctioning Time
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No more than 10 seconds
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BVM ventilation rates
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Bag once every 6 seconds.
For Peds. Bypass the pop- off valve to increase pressure. |
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3 major areas in upper airway
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Nasopharynx
Oropharynx Laryngopharynx (Hypopharynx) |
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Nasal Cavity Structures
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Turbinates
Hard & Soft Palate Sinus Cavity Lacrimal Ducts |
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Nasopharynx structures
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Tonsils/Adenoids
Uvula |
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Oropharynx Structures
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Tongue
Valecula (void at base of tongue @ the epiglottis) Landmark for intubation. |
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Larynx Structures
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Vocal Chords
Esophagus trachea Glottic Opening Hyoid Base Extrinsic Ligament (cricoid Cartilage) Thyroid Cartilage Arytnoid Cartilage Pyriform Fossae: an area, not a structure |
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Lower Airway Anatomy
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Trachea
Bronchi Alveoli Lung Parenchyma: areas that are functional Pleura Cartilage becomes smooth muscle |
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Anatomy of Peds airway
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Large Tongue
Palate much more anterior Epiglottis much more round |
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Anatomy of Alveoli
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Respirations occurs at the area
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Physiology of Respiratory System
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Diffusion across alveolar membrane.
About 500cc inpired air 150cc dead air space inspired O2 is about equal to expired CO2 |
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Partial Pressure of Gas
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Pressure exerted by each component of a gas mixture
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O2 concentration in atmospheric air
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21%
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Normal Arterial Partial Pressure
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PaO2= 80 - 100 torr
PaCO2= 35 - 45 torr |
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Oxygen concentration in the blood
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O2 saturation = O2 Concentration/O2 Capacity x 100%
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Chemoreceptor Locations
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Medulla, Aortic Arch, Carotid
Stimulated by levels of O2 |
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Cerebral Spinal Fluid (CSF)
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Carries CO2. Is located in the brain, brain stem and spinal cord
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Pneumotaxic Center
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Located in the Medulla. Stimulated by CO2 levels
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Total Lung Capacity (TLC)
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Maximum adult capacity is 6 liters
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Alveolar Volume (Vmin)
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Amount of gas moved in and out of the respiratory tract in one minute. Vmin= VT x respiraatory rate
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Tidal Volume (VT)
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Average volume of gas inhaled or exhaled in one repiraatory cycle. VT=500mL (5-7cc/kg)
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Alveolar Minute Volume (Va-min)
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Amount of gas that reaches the alveolar for gaas exchange in one minute.
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inspiratory Reserve Volume (IRV)
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The amount of air that can be maximally inhaled after normal inspiration.
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Functional residual Capacity
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Volume of gas that remains in your lungs at the end of normal exhalation
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Expiratory Reserve Volume (ERV)
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The amount of air that can be maximally exhaled after a normal expiration.
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Forced Expiratory Volume (FEV)
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Amount of air that can be maximally epired after maximum expiration
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Endotracheal Complications
DOPE |
Dislodgement
Obstruction Pneumothorax Equipment Failure |
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Miller Blade
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Straight Blade
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Macintosh Blade
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Curved Blade
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Auscultation (in order)
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1-Epigastrum
2-Right Lung 3-Left Lung 4-trachea |
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ETCO2
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End Tidal CO2 detector
Bright yellow= O2 Purple = CO2 |
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Capmeter + Capnograph
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Shows CO2 levels
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Rapid Sequence intubation
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Paralizing a PT to facilitate intubation
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atelectasis
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alveolar Collapse due to insufficient surfaactant or deflated alveoli
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Parenchyma
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principle or essential (functional) parts of an organ. Alveoli is the core of the lung parenchyma.
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pleura
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membranes connective tissue covering the lungs. 2 layers; visceral and parietal
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inspired air concentration
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O2=20.94%
Nitrogen= 79.01% CO2= 0.04% |
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expired Air concentrations
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O2= 16.4%
Nitrogen = 79.6% CO2= 4.0% |
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Ventilation
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The mechanical process that moves air into and out of the lungs
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PA
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alveolar partial pressure
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Pa
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arterial partial pressure
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Total atmospheric pressure
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760.0 torr
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Total Alveolar Pressure
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760.0 torr
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Diffusion
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Movement of a gas from an area of higher concentration to an area of lower concentration
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Oxygen Concentration in the Blood
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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) |
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Hypoventilation
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reduction in breaathing rate and depth
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Pneumothorax
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Accumulation of air or gas in the pleuraal cavity
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Hemothorax
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Accumulation in the pleural cavity of blood or fluid containing blood
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Pulmonary embolism
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Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood.
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FiO2
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concentration of oxygen in inspired air.
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IPPV
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Intermittent Positive-Pressure Ventilation.
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Hypercarbia
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Excessive pressure of Carbon dioxide in the blood. Treated by increasing the rate and/or volume of ventilation and correcting underlying cause.
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Respiratory Rate
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Number of times a person breathes in 1 minute
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Main Respiratory Center
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Located in the Medulla, if this fails the apneustic center in the pons takes over.
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Hypoxemia
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decreased partial pressure of O2 in the blood
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Hypoxic Drive
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Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs. Condition found in Pt.s with COPD.
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Causes of Respiratory Increase
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Fever, Emotion, Pain, Hypoxia, Acidosis, Stimulant Drugs
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Causes of Respiraatory Decrease
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Depressant Drugs, Sleep
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Upper Airway Obstruction
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An interference with air movement through the upper airway.
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Causes of Upper Airway Obstruction
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Tongue, Foreign Bodies, Trauma, Laryngeal spasm and edema, aspiration
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Most Common Airway obstruction
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Tongue
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Extubation
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Removing a tube from a body opening
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Paradoxical Breathing
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Assymetrical chest wall movement that lessens respiratory efficiency
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Flail Chest
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Defect in the chest wall that allows a segment to move freely, causing paradoxical chest wall movement.
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Dyspnea
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An abnormality of breathing rate, pattern or effort.
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Anoxia
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The absence or near absence of oxygen
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Pulsus Paradoxus
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drop in blood pressure of greater than 10 torr during inspiration
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Kussmauls Respirations
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Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis
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Cheyne-Stokes
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Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury
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Biot's
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irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure.
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central neurogenic hyperventilation
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deep rapid respirations indicating ICP
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Agonal Respirations
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Shallow, slow or infrequent breathing, indicating brain anoxia
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Compliance
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The stiffness or flexibility of the lung tissue
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Pulse Oxymetry
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A measurement of hemoglobin oxygen saturation in the peripheral tissues
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French
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Unit of measurement approximately equal to one third millimeter
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Endotrachial Intubation Equipment
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Larygoscope
ETT 10mL Syringe Stylet BVM Suction device Bite Block Magill Forceps Tape |
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ET protective equipment
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Gloves, mask, eyeware
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Common Paraalytic Agents
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Succinylcholine
Vecuronium Atracurium Pancuronium |
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Larynx
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•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 |
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Carina
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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 |
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Bronchi
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•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. |
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Alveoli
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•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. |
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Lungs
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•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 |
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Process of Gas exchange
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•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. |
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Regulation of Ventilation
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•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 |
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Hering Breur Reflex
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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.
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Pneumothorax
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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. |
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Esphageal Detector Device
(EDD) |
A bulb syringe used to detect proper placement of the endotracheal tube
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Cor Pumonale
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Hypertrophy of the right ventricle resulting from disorders of the lung.
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Positive End-Expiratory Pressure (PEEP):
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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 |
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Croup
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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. |
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laryngoscope
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Instrument for lifting the tongue and epiglottis in order to see the vocal chords
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ETT Size for Pediactrics
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Age in years + 16/4
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ETT Size for Females
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7.0-8.0mm with 21mm insertion
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ETT size for Males
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7.5-8.5mm with 23mm insertion
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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.
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Goblet cells
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Cells that produce mucus
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Forms of respirations
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Coughing
Sneezing Sighing Grunting |
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Common Causes of airway obstruction
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Tongue (most common)
Foreign Body aspiration Laryngospasm Laryngeal Edema Trauma |
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Causes of Respiratory Distress
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Upper & Lower airway obstruction
inadequate ventilation Impairment of respiratory muscles Impairment of nervous system |
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FiO2
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The concentration of oxygen in inspired air.
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Types of O2 cylinders
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D - 400 L
E - 660 L M - 3,450 L |
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Venturi mask
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High-Flow oxygen mask that delivers very precise concentrations of O2. Used to treat COPD with respiraatory drive problems.
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Formula for calculating drips (gtts.) per minute (min.):
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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 |
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Formula for calculating drip rate of IV fluids:
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ml./hr. = total fluids ordered
total hours to run Example: ml./hr. = 1000 ml. = 125 ml./hr. 8 hr. |
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How many cc does ETT Pilot Balloon need?
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10cc. Be sure not to overinflate the balloon, as this could cause tracheal necrosis.
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Major Purpose for using a Stylet during endotracheal intubation.
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To maintain a preset curve in the tube.
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How to Manage Severe Epiglottitis
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DO NOT intubate unless airway failure in imminent. This may cause a sever laryngospasm. Oxygenate without agitation and rapid transport to OR.
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Maximum time limit for each intubation attempt
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30 seconds and wait 30 seconds between each attempt while hyperventilating the pt. Do not try more than 3 times to intubate the pt.
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How to correct Esophageal intubation.
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Take out immediateley, hyperventillate for 30 seconds and re-intubate the pt. Esophageal intubation is lethal and can cause regurgitation.
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Indications for Rapid Sequence intubation
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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 |
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Depolarizing RSI Drugs
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Succinycholine: Substitute acetylcholine, has a stimulating effect and causes fasiculations (muscle twitching). Most commonly used due to fast action and short duration.
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Non-depolarizing RSI Drugs
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Vecuronium
Atracurium Pancuronium Block Acetylcholine uptake, do not allow stimulation and do not cause fasiculations. |
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Pediatric Airway
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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. |
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Intubation for Peds. <8 yo
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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. |
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Pharyngo-Tracheal Lumen Airway
PtL |
A two-tube system.
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What will Beta2 Stimulation Cause?
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It will cause the bronchiole to dilate.
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Effects of Vagal stimulation during intubation
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Coughing, retching, bradycardia, hypotension, bradypnea
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Sufactant
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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.
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Alveolar Macrophages
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Type of cell found in the alveoli, part of immune system that digest particles, bacteria and other foreign material.
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Physiologic Shunt
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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.
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hilum
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Point at which the bronchi and blood vessels enter the lung
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Bronchial Arteries
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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.
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Lung capacity/Volume in mL
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TLC 6,000
Vital Capacity 4,800 inspiratory reserve 3,000 tidal volume 500 expiratory volume 1,200 residual volume 1,200 |
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Crepitus
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Crackling sounds
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Tactile Fremitus
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Vibratory tremors felt through the chest by palpation.
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Trachial deviation
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Any position of the trachea other than midline
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Subcutaneous emphysema
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Presence of air in the subcutaneous tissue
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Capnogram
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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 |
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Why do you not give lasix to someone with pneumonia?
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Because it dries the secretions and causes them to become thick and sticky blocking the airways.
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OPQRST for Respiratory
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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? |
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Spirometry and Peak Flow values for Adults
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Normal 550-650 L per min, Peak Flow
Severe 100 L per min Peak Flow |
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Peak Flow
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Handheld device that determines peak expiratory flow rate (PEFR). Can measuer tidal volume.
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"10 and 10" for Cardiac Arrest
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10 minutes of CPR and no CO2 past 10 minutes. Reflects No Hope for Pt.
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Esophageal impaction
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1-2mg of glucagon would cause smooth muscle relaxation to cause the bolus to go down.
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Leading cause of sepsis
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pneumonia
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ARDS
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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.
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Pink Puffer
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Emphysema
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Blue Bloater
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Chronic Bronchitis
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Why do you not give aspirin to an asthma patient?
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It can exacerbate the asthma by releasing histamines. Always ask pt if they have asthma before giving aspirin.
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Diaphoresis
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(sweat) results from release of epinephrine
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FVC
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Forced Vital Capacity
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FEV
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Forced expiratory Volume
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s3
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Sign of heart failure
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