Chapter 08 Respiratory

Front 1

T or F: Airway and ventilation are the first most critical steps in every pt?

Back 1

True

Front 2

Presence of gas or air in pleural cavity

Back 2

Pneumothorax

Front 3

5 Types of airway obstruction:

Back 3

1. Tongue
2. Foreign bodies
3. Trauma
4. Laryngeal spasm and edema
5. Aspiration

Front 4

What is the most common type of airway obstruction?

Back 4

Tongue

Front 5

Foreign bodies obstructing the hypopharynx are often caused by ___, involve ___ consumption or ___ dislodgement.

Back 5

Food

Alcohol

Dentures

Front 6

Choking in restaurants that looks like a heart attack is often called:

Back 6

Cafe Coronaries

Front 7

T or F: Children do not aspirate things they swallow because their airway is relatively small.

Back 7

False (they aspirate a lot because they put so many things in their mouths)

Front 8

T or F: The glottis is the narrowest part of an adult's airway, therefore edema or spasm of the vocal cords is potentially lethal.

Back 8

True

Front 9

Removing a tube from a body opening:

Back 9

Extubation

Front 10

Trauma, anaphylaxis, epiglottitis, and inhalation of hot gases can cause:

Back 10

Laryngeal spasm and edema

Front 11

The most common cause of laryngeal spasm is:

Back 11

Over aggressive intubation

Front 12

__ is the most commonly aspirated material.

Back 12

Vomitus

Front 13

Obtunded is another word for:

Back 13

Drowsy

Front 14

Damage to the lungs or infection occur in __ to __ % of PTs that aspirate foreign matter.

Back 14

50 - 80

Front 15

Inadequate ventilation can lead to ___ and ___.

Back 15

Hypercarbia and hypoxia

Front 16

___ is the key to airway management in every PT.

Back 16

Viligance

Front 17

___ is to identify any immediate threats to the PT's life.

Back 17

Primary assessment

Front 18

3 primary problems you are looking at during primary assessment:

Back 18

Airway
Breathing
Circulation

Front 19

Normal adult respiration rate:

Back 19

12 - 20

Front 20

_ should be spontaneous, effortless and regular.

Back 20

Breathing

Front 21

Assymetrical chest wall movement that lessens respiratory efficiency.

Back 21

Paradoxical breathing

Front 22

Defect in chest wall that allows a segment to move freely, causing paradoxical chest wall motion.

Back 22

Flail Chest

Front 23

___ includes focused history and physical exam.

Back 23

Secondary assessment

Front 24

Focused history may include:

Back 24

Time of onset
What was PT doing
Allergies
Medications
Past Med Hx

Front 25

Physical exam will include:

Back 25

Inspection
Auscultation
Palpation

Front 26

Bluish discoloration

Back 26

cyanosis

Front 27

An abnormality of breathing rate, pattern or effort

Back 27

Dyspnea

Front 28

Oxygen deficiency

Back 28

Hypoxia

Front 29

The absence or oxygen

Back 29

Anoxia

Front 30

Modified respirations include:

Back 30

Coughing
Sneezing
Hiccoughing
Sighing
Grunting

Front 31

Drop in blood pressure of greater than 10 torr during inspiration.

Back 31

Pulsus paradoxus

Front 32

5 common abnormal respiratory patterens:

Back 32

1. Kussmaul's
2. Cheyne-Stokes
3. Biot's
4 Central neurogenic hyperventilation
5. Agonal

Front 33

Deep, slow or rapid, gasping breathing, commonly found in DIABETIC KETOACIDOSIS

Back 33

Kussmaul's respirations

Front 34

Progressively deeper, faster breathing alternating gradually with shallow, slower breathing indicating BRAINSTEM INJURY.

Back 34

Cheyne-Stokes

Front 35

Irregular rate and depth with sudden, periodic episodes of apnea, indicating increased INTRACRANIAL PRESSURE.

Back 35

Biot's

Front 36

Deep, rapid respirations, indicating INTRACRANIAL PRESSURE.

Back 36

Central neurogenic hyperventilation

Front 37

Shallow, slow or infrequent breathing indicationg BRAIN ANOXIA.

Back 37

Agonal

Front 38

Results from partial obstruction of the upper airway by tongue.

Back 38

Snoring

Front 39

Results from accumulation of bloo, vomit or other secretions in upper airway.

Back 39

Gurgling

Front 40

Harsh, high pitched heard on inhalation. Associated with laryngeal edema or constriction.

Back 40

Stridor

Front 41

Musical, squeaking or whistling on inspiration or expiration. Associated with broncho constriction.

Back 41

Wheezing

Front 42

Lack of sound indicating problem with airway and or breathing.

Back 42

Quiet

Front 43

Sounds that may indicate compromise of gas echange:

Back 43

Crackles
Rhonchi

Front 44

Bubbling sound heard on inspiration. Associated with fluid in the smaller bronchi.

Back 44

Crackles

Front 45

Rattling noise heard on inspiration. Associated with inflammation, mucus or fluid bronchi.

Back 45

Rhonchi

Front 46

Stiffness or flexibility of the lung tissue.

Back 46

Compliance

Front 47

T or F: A fall in teh pulse rate in a PT with airway compromise is not an immediate concern.

Back 47

False

Front 48

Measurement of hemogloblin oxygen sat in the peripheral tissues.

Back 48

Pulse oximetry

Front 49

Saturation of arterial blood with oxygen as measured by pulse oximetry, expressed as a %.

Back 49

Oxygen sat % (SpO2)

Front 50

PaO2

Back 50

Partial pressure of oxygen in blood.

Front 51

What's known as the 5th vital sign?

Back 51

Pulse Ox

Front 52

Normal SpO2

Mild hypoxia

Moderate hypoxia

Back 52

95 - 100%

91 -94%

86 - 90%

Front 53

Measurement of exhaled CO2 concentration.

Back 53

Capnography

Front 54

Disposable ETCO2 detector that contains pH-sensitive, chemically impregnated paper encased within a plastic chamber.

Back 54

Colorimetric Device

Front 55

Detectors that use infrared thechique to detect CO2 in exhaled breath are __?

Back 55

Electronic devices

Front 56

___ reflects CO2 concentrations over time, usually in 4 phases.

Back 56

Capnogram
1. Flatline
2. Upstroke
3. Respiratory Plateau
4. Downstroke

Front 57

4 manual airway maneuvers:

Back 57

1. Head Tilt/Chin Lift
2. Jaw Thrust
3. Jaw Thrus w/o head extension
4. Celleck Maneuver

Front 58

2 basic mechanical airways:

Back 58

1. Nasopharyngeal airway (NPA)

2. Oropharyngeal airway (OPA)

Front 59

4 advanced airway devices that could be used to establish an airway:

Back 59

1. Endotracheal Tube (ET Tube)

2. Esophageal Tracheal CombiTube (ETC)

3. Laryngeal Mask Airway (LMA)

4. Pharyngo-tracheal lumen (PtL)

King Tube not mentioned in book.

Front 60

Instrument for lifting the tongue and epiglottis in order to see the vocal cords.

Back 60

Laryngoscope

Front 61

2 Types of laryngoscope blades:

Back 61

1. MacIntosh blade (Mac-curved)

2. Miller blade (straight)

Front 62

Mac blade is designed to go into the __.

Back 62

Vallecula

Front 63

Miller blade is desgned to go under the ___.

Back 63

Epiglottis

Front 64

An endotracheal tube (ETT) is a flexible, translucent tube ranging from __ to __.

Back 64

12 -32 cm

Front 65

Plastic covered metal wire used to bend teh ETT into a J or hockey-stick shape.

Back 65

Stylet

Front 66

Scissor-style clamps with circular tips.

Back 66

Magill forceps

Front 67

What is a dual-lumen airway with ventilation port for each lumen?

Back 67

ETC or Combitube

Front 68

I hope this works

Back 68

I don't want to do this again

Front 69

What is a tunnel through a tube?

Back 69

Lumen

Front 70

Name some indicators for Endotracheal Intudation
(6)

Back 70

*Respiratory/Cardiac arrest
*Unconsciousness
*Risk of Aspiration
*Obstruction due to foreign bodies, burns, trauma, of anaphylaxis
*Resp. extremis due to diseases
*Pneumothorax, Hemothorax, or Hemopneumothorax w/ resp. difficulty

Front 71

List of Intubation devices

Back 71

Endotracheal Tube(ETT)
Esophageal CombiTube(ETC)
Pharyngo-tracheal lumen airway (PtL)
Laryngeal Mask Airway(LMA)
Esophageal Gastric Tube (EGTA)
Esophageal Obturator Airway (EOA)

Front 72

Do not intubate in the prehospital setting if _____ is present, instead rapid transport to the operating room.

Back 72

Epiglottitis

Front 73

A PtL or pharyngo-trachael lumen airway has how many lumen?

Back 73

Two

Front 74

True or False
Bypassing the upper airway's function of warming, filtering, and humidifying the inhaled air is an advantage of Endotrachael Intubation

Back 74

False
The statement is a disadvanatage

Front 75

A Cobra perilaryngeal airway (PLA) holds soft tissue and what out of the way?

Back 75

The epiglottis

Front 76

The only fulcrum in the a Pt's mouth are _______, which is why you want to lift instead of flexing the wrist while using the laryngoscope blade.

Back 76

Upper incisors

Front 77

Needle cricothyrotomy inserts what gauge needle into the trachea at the cricothyroid membrane?

Back 77

14 gauge

Front 78

To avoid hypoxia during intubation, limit each intubation attempt to no more than ____ seconds.

Back 78

30 seconds

Front 79

What does a open cricothyrotomy insert into the trachea?

Back 79

either an endotracheal tube or tracheostomy tube through an incision in the cricothyroid membrane.

Front 80

*Absence of chest rise
*Absence of breath sounds
*Gurgling sounds over epigastrium
*Distention of Abdomen
*Absence of condensation in tube
*Persistence of air leak
*Cyanosis
*Phonation (noise made by vocal cords)
* No color change w/colormetric CO2 detector
*falling pulse ox
are all indicators of ______

Back 80

Esophageal Intubation

Front 81

What is barotrauma?

Back 81

injury caused by pressure within an enclosed space.

Front 82

If you inserted ETT to far, most likely the tube will enter the _____ mainstem

Back 82

Right

Front 83

What does stenosis mean?

Back 83

narrowing or constriction

Front 84

The average depth of ETT for men is ____ cm and for women is ____ cm

Back 84

men: 23cm
women: 21 cm

Front 85

What is the only indication for a surgical airway?

Back 85

The inability to establish an airway by any other method.

Front 86

Any tear in the lung parenchyma can cause a _____.

Back 86

Pneumothorax

Front 87

What is the opening in anterior neck that connects the trachea with ambient air?

Back 87

Stoma

Front 88

*more difficulty in ventilating
* diminished unilateral breath sounds
* hypoxia w/hypotension
* distended neck veins
*deviated trachea
these are all signs/markings of

Back 88

Tension Pneumothorax
(the trachea will deviate away from the side of the pneumothorax)

Front 89

Suction means?

Back 89

To remove with a vacuum type device

Front 90

The most widely preferred and most commonly used path for endotracheal intubation is ______?

Back 90

Orotracheal Intubation

Front 91

Two types of suctioning catheters are?

Back 91

Hard and Soft

Front 92

During Orotracheal Intubation, what are the landmarks for the blades Mac vs Miller

Back 92

Mac Blade- distal end at the base of the tongue in the vallecula
Miller Blade- distal end is under the epiglottis

Front 93

A high pressure regulator is used to transfer oxygen from what?

Back 93

Tank to Tank

Front 94

The most reliable method of confirming correct ETT placement is ?

Back 94

Direct visualization of the ETT passing through the vocal cords

Front 95

A pressure regulator used for delivering oxygen to the patients?

Back 95

Therapy regulator

Front 96

When using a Check ball to confirm ETT placement, resistance to air withdrawl or the creation of a vacumn is a sign of _____

Back 96

Esophageal Intubation

Front 97

A nasal cannula is placed at the?

Back 97

nares

Front 98

It is ideal to verify and document at least ____ different indicators of proper tube replacement

Back 98

3 different indicators

Front 99

A venturi mask is a high flow mask that uses a venturi system to deliver what kind of oxygen concentrations?

Back 99

relatively precise oxygen concentrations

Front 100

BURP is a maneuver to enhance visualization of the vocal cords, BURP is an acronym for?

Back 100

B- backward
U- upward
R- rightward
P- pressure

Front 101

A venturi mask is useful with what kind of patients?

Back 101

COPD

Front 102

What is an advantage and a limitation for Transillumination Intubation

Back 102

Advantage- you can perform ET intubation w/out manipulating a trauma PT's head/neck
Limitation- Bright ambient light makes the transillumination difficult to see

Front 103

On a simple face mask, what percentage of oxygen do you get?

Back 103

40 to 60% usually flow at 6-10 lpm

Front 104

What are some advantages of digital intubation

Back 104

*does not require manipulation of head or neck
* does not require visualization
* helpful when facial injuries distort Pt's anatomy
*helpful when you can't suction blood/vomitus for a proper view of airway

Front 105

A simple face mask has what on the sides of mask?

Back 105

side ports allow room air to enter the mask and dillute the oxygen concentration during inspiration.

Front 106

What is your most immediate concern with every patient?

Back 106

Maintaining a patent airway and adequate oxygenation and ventilation

Front 107

Partial rebreather mask has side ports that are covered by what?

Back 107

One way discs, these masks are used for moderate to high oxygen concentrations.

Front 108

Glasgow Coma Score of ___ or less is a sign of Altered Mental Status and an indication for ?

Back 108

RSI
Rapid-sequence Intubation

Front 109

Maximum flow rate on a partial rebreather mask is?

Back 109

10 lpm

Front 110

The most preferred neuromuscular blocking agent (paralytic) for emergenc RSI is

Back 110

Succinylcholine

Front 111

Nonrebreather mask has a reservoir bag with what in it?

Back 111

oxygen ready to inhale

Front 112

Application of the Sellick maneuver will help to prevent

Back 112

Aspiration

Front 113

What provides the highest concentration of oxygen?

Back 113

Non rebreather at 80 to 95% at 15lpm

Front 114

Ture of False
During RSI you want to paralyze the PT before you administer a sedative.

Back 114

False
Sedate then paralyze

Front 115

Effective ventilatory support requires a tidal volume of what?

Back 115

800 ml over 10 to 12 breaths per minute

Front 116

The preferred laryngoscope blade for most pediatric PT's is

Back 116

Straight (Miller) blade

Front 117

If doing mouth to mouth ventilations, what percentage of oxygen is the pt getting?

Back 117

17%

Front 118

What are 2 ways to measure an ETT for pediatrics

Back 118

1- (Age in years+16) / 4
2- match diameter to the child's smallest finger

Front 119

BVM is a self inflating bag with how many valves?

Back 119

2 one way valves

Front 120

Do you want to use a cuffed or uncuffed ETT with infants and children under 8 yoa, and why?

Back 120

Uncuffed because the narrowing of the child's cricoid cartilage forms a suitable cuff

Front 121

What percentage of oxygen does a BVM give when not hooked up to oxygen?

Back 121

21% and 60-70% hooked up to oxygen. 90-95% when BVM has an adjunct oxygen reservoir or corrugated tubing

Front 122

The depth of insertion of the distal tip for pediatric ETT should be ___ to ___ cm below the vocal cords.

Back 122

2-3 cm below

Front 123

What device uses a push button or lever?

Back 123

Demand valve device

Front 124

Laryngoscopy and passage of ETT are likely to cause a vagal response. What are signs of a vagal response

Back 124

Dramatic slowing of heart rate
Decrease cardiac output
Decrease in Blood Pressure

Front 125

What age is the pediatric BVM preferred?

Back 125

8 years old

Front 126

What are some situations whereNasotracheal Intubation are not recommended
(6)

Back 126

*suspected nasal fractures
* suspected basilar skull fracture
* significant deviated nasal septum or nasal obstruction
* cardiac/respiratory arrest
* unresponsive PT

Front 127

Adult BVM capacity is how many mL.

Back 127

1500 and pediatric is 450 mL

Front 128

True or False
Blind Nasotrachael Intubation requires the PT to be breathing

Back 128

True

Front 129

A demand valve device can operate at what highest flow rate?

Back 129

40 lpm maximum.

Front 130

What are some high risks of Extubation in the field

Back 130

Laryngospasm
Involuntary closure of the epiglottis
may prohibit successful reintubation

Front 131

What is the most important part of documentation?

Back 131

Documenting your airway management