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37 Cards in this Set

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Egans book and workbook, equipbook by white and basic clinical competencies by white

Score 20% tests, 20%quizzes homework, lab skills 10%, PPS 5%, 45% final

Assignment 1 white clinical lab competencies


Chapter 21 page 450 to 455

Egan fundamentals of respiratory care


Chapter 9 page 189 to 197


Chapter 36 page 737 to 743


Egan workbook


Chapter 36 page 245 to 246

WHat is critical care

Critical care: the specialized care of patients whose conditions are life threatening and who require comprehensive care and constant monitoring, usually in intensive care units, also know as intensive care


ICU, SICU, NICU, PICU, CICU

Rapid Response or CODE BLUE

Immediate help

picture of facial with bones and sinuses

cross section of head and upper airway


Concha is a space or cavity, its cartilage material that lightens up the head


For example middle nasal concha or turbinate

Upper respiratory Tract (URT)

Defined as airways starting at the nose, extending to the trachea


URT is composed of


:Nasal cavities and sinuses


:Oral cavity


:Pharynx


:Larynx


Nasal cavity

External nares give entrance into cavities


Vestibules contain gross hairs working as filter


Concha or turbinates: 3 shelf like bones projecting from the lateral walls of the septum


:Function: increase surface area of filtering


:Warming


:humidifying of inhaled gases

Nasal cavity

Contain olfactory Cells providing sense of smell


Surface fluid is provided by goblet cells and submucosal glands(produce most) in cavity and sinuses


SInuses

Hollow spaces in the facial bones


Four sets of sinuses


:Frontal, ethmoid, sphenoid, maxillary


Function of sinuses


:Reduce weight of head


:Strengthen skull


:Modify voice during phonation

Oral Cavity (part of the URT upper respiratoory tract)

Forms common passage for air, food and fluids


Tip of soft palate, uvula, marks posterior aspect of cavity


:Posterior portion of tongue has nerve endings triggering gag reflex to protect airway

Picture of oral cavity

Palatine tonsil, tounge, lips and more, need to be able to visualize these

Pharynx

Oral and nasal cavities open into the pharynx:Nasopharynx (from nasal cavity to uvula)::Adenoids lie right where many particles impact


::Eustachian tubes link to middle ear


:Oropharynx (from uvula to tip of epiglottis)


::Palatine tonsils (removed in tonsillectomy)

Pharynx

Oral and nasal cavities open into the pharynx


:Laryngopharynx (tip of epiglottis to larynx)


::anatomic location where respiratory and digestive tracts divide


Larynx

Contains nine cartilages


:Thyroid (adams apple) (largest one)


:Cricoid cartilage fall just below thyroid cartilage



Epiglottis attaches to the thyroid cartilage


:Closes laryngeal opening during swallowing


:Creates tight seal to prevent liquids and food from entering respiratory tract


:Swallowing


::Muscular contractions resulting in early vocal cord closure and downward epiglottis movement


Larynx

Epiglotting attaches to thyroid cartilage


:Folds connecting epiglottis and tongue form space called "vallecula"


::Key landmark for oral intubation



3 paired cartilages involved in phonation (speaking)


are the arytenoid, corniculate, and cuneiform


Patent(open) Upper airway

Relative positions of oral cavity, pharynx, and larynx and major determinant of patency, particularly in unconscious patient


:Head tilts forward, partial or total occlusion can occur


:Extend head into "sniff position" to open airway and facilitate artificial airway insertion


Lower respiratory tract

Everything distal to larynx


Made up of conducting airways and respiratory airways


Conducting airways: first 15 generations


:purpose: convey or transport gas from the URT to area of gas exhange (lung parenchyma)

Lower respiratory Tract

Respiratory airways


:MIcroscopic airways distal to conducting zone


:Participate in gas exchange with blood


:respiratory bronchiole


:Terminal bronchiole


:Alveolar duct


:Alveolar sacs (clusters)

Trachea and bronchi

Trachea: extends below cricoid cartilage to sternal angle(where main stem bronchi bifurcate)


Anterior and sides supported by 16 to 20 C shaped cartilaginous rings


Trachealis muscle connects tips of C shaped cartilage and form posterior wall


Trachea and bronchi

Right and left mainstem bronchi bifurcate at carina


Right bronchus branches at 20 to 30 degree angle


:Due to angle, most foreign aspirate goes to the right lower lobe


Left bronchus branches at 45 to 55 degree angle


Lobar and segmental pulmonary anatomy

Each lung is divided into lobes and segments


Right lung has 3 lobes and 10 segments


Left lung has 2 lobes and 8 or 10 segments


Lobar segmental pulmonary anatomy

Each segment is supplied by segmental brochus


These further divide numerous times until conducting airways end in terminal bronchioles


:All airways up to this point constitute anatomic deadspace (or conducting airways)


::2 ml/kg of lean body weight, typically 150 ml (quiz)

Airway Care The adult trachea is 12 inches, not 12 cm like book says

Tracheobronchial aspiration


Intubation


Artificial airways


:Nasopharyngeal


:Oropharyngeal


:Esophageal obturator laryngeal airway


:Endotracheal tube


:tracheostomy tube

Tracheobronchial aspiration

Suctioning: subatmospheric pressure is applied to the trachea, mainstem bronchi, or oropharynx for the evacuation of secretions


Gas is evacuated from the airway and is replaced with room air


Goals for suctioning or (tracheal bronchial aspiration)

Aid bronchial hygiene (number 1 goal)


Therapeutic support for patients with artificial airways(cant cough and we secrete more mucous/sputum so need to suction it out)


Improve the efficiency of ventilation


Indications for suctioning

Endotracheal or tracheostomy tube placement that interferes with normal clearance mechanisms


Inability to cough effectively and clear rhonchi(breath sound caused by secretions in the upper airway)


Dysphagia(difficulty swallowing)


Obstruction of airway by secretions


Hazards of suctioning

Hypoxemia (number 1) Sucks out O2 rich air and pulls in room air


Mucosal damage


Arrhythmias


Hypotension


Atelectasis (airway collapse)

Hazards of suctioning: hypoxemia

O2 rich Gas is evacuated from the airway and is replaced with room air


Room air enters around the catheter: bernoulli


Apnea during suctioning may lead to hypoxemia and arrhythmias


Hazards of suctioning: mucosal damage

Excessive mucosal Pressure


Suctioning elevates and tears the mucosa


Causes hemorrhage and erosion


1.36cm per mmhg


Hazards of suctioning arrhythmias

Vagal stimulation caused by tracheal irritation


Hypoxemia leading to myocardial hypoxia leading to arrhythias


Hazards of suctioning hypotension

Bradycardia resulting from vagal stimulation (hitting the carina)and prolonged coughing


High intrathoracic pressure


Hazards of suctioning hypotension

Decrease venous return (pre load)


:Leads to decrease cardiac output (starlings law)


:Decrease blood pressure


:Increase ICP

Hazards of suctioning Atelectasis(collapsed airway)

With atelectasis you also have lower FRC


Suctioning applied during catheter advancement or not retracted a bit following full insertion


Catheter is too large for the artificial airway


:Too large for diameter of airway(not enough entrainment of bernouli, or replacement gas)


:Results in inadequate room air entrainment around catheter

Hazards of suctioning

Hypoxemia, mucosal damage, arrhythmias, hypotension, atelectasis

Techniques for suctioning

Sterile technique should always be used with an artificial airway (below the trachea)


For oral care, you can use aseptic technique


:Double glove


:dispose of catheter and gloves in lined container: red


Aseptic techniques for oropharyngeal or nasopharyngeal suctioning


Techniques for suctioning

Suction should never be applied when the catheter is being advanced


Following full advanced of the catheter, retract it a short distance before suction is applied


Intermittent suction should be applied as the catheter is withdrawn


Procedure should never exceed 15 secs

Suctioning

Application of negative pressure to airways through collecting tube


Suctioning of trachea and bronchi usually done through endotracheal tube or tracheostomy tube



Two types


Normal suction catheter, thin catheter with a thumb control valve and connector for vacuum


The other has a tip, its hard non pliable plastic, yankaur suction apparatus or tonsil tip suction apparatus, its used for larger secretions such as vomit