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62 Cards in this Set
- Front
- Back
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What structures are responsible for substantially increasing the surface area of the nasal cavity? |
Conchae or turbinate's |
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What type of epithelium covers the posterior 2/3 of the nasal mucosa? |
Respiratory Mucosa = pseudostratified ciliated columnar epithelium with mucus secreting glands |
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What are the main functions of the nose? |
humidification heating filtering |
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What size particles do not gain entry into the lower airways due to the filtering of the nose? |
Particles >5 microns |
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When an ET tube is in place and a patient is mechanically ventilated, what function of the nose is lost? |
Air condition function of the nose is lost, and unmodified cool, dry gas directly enters the trachea |
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What lymphoid tissues are present in the pharynx? |
Pharyngeal (adenoid) tonsils Palatine tonsils Lingual tonsils |
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There are no water droplets condensed on the inner surface of a ventilator's inspiratory tube, secretions are thick and difficult to suction, what is the best therapy t resolve this situation? |
Add heated humidification to the ventilator circuit |
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What are the goals of humidification in mechanical ventilation regarding temp and relative humidity? |
-Duplicate heat and humidity in nonintubated trachea -32-34 degrees Celsius -100% relative humidity |
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What pairs of reflexes is responsible for preventing aspiration of foreign materials into the lungs? |
Pharyngeal and laryngeal reflexes |
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How is a seal formed between the ET tube and tracheal wall to minimize aspiration of pharyngeal contents? |
Inflation of the endotracheal tube cuff |
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Aspiration of pharyngeal contents makes mechanically ventilated patients susceptible to? |
Ventilator associated pneumonia (VAP) |
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In deeply unconscious patients what is the most common threat to upper airway patency? |
Soft tissue obstruction |
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What signs are most suggestive of complete airway obstruction? |
-Strong inspiratory efforts without sound or air movement -Soft tissue between ribs and sternum sucked inward -Intercostal and suprasternal retractions |
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What describes the sniffing position? |
-Extended neck with chin pulled anteriorly -Pulls tongue forward out of airway -Aligns oral and nasal cavities with pharynx-larynx axis -Opens airway for facilitation of intubation |
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What structure us an important landmark for insertion of an ET tube into the trachea? |
Vallecula |
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Characteristics of individuals with sleep apnea |
-Short necks -Receding lower jaws (retrognathia) -Large tongues (macroglossia) -Obese -Snore -Daytime sleepiness and fatigue |
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What is the most efficacious treatment for patients with OSA? |
CPAP |
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Inflammation of what anatomic structure is considered a life-threatening condition? |
Epiglottis |
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What is the narrowest portion of the airway in an infant? |
Cricoid ring |
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Where should the incision be made for an emergency airway? |
Tracheostomies are located 1-3cm below the cricoid cartilage in the cricothyroid membrane |
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What is the narrowest space that an ETT will go through in an adult? |
Glottis |
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What sound is associated with high velocity air flowing through a narrowed glottis? |
Stridor |
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What is the diagnosis of the classic thumb sign on a lateral soft tissue x-ray? |
Epigglotitis |
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What mechanism explains why drowning victims have little water in their lungs? |
Laryngospasm |
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Characteristics of the trachea |
-Begins at 6th cervical vertebrae -In adults extends 11cm -Ends 5th thoracic vertebrae -Divides left and right mainstem bronchi at Carina |
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What happens if the ETT is inserted too far? |
If the endotracheal tube is inserted to far it enters the right mainstem bronchus, diminished breath sounds will be heard on the left side of the lungs |
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What term describes a volume of gas that is approximately 150ml in the average adult that does not participate in gas exchange? |
Anatomical dead space |
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If water content and humidity is affected what will happen to the mucous sheet? |
-Dehydrated -Thick -Immobile |
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If during normal breathing inspired air only reaches 50% relative humidity at 37C, what will be the humidity deficit as air passes through the trachea? |
22mg deficit |
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What conditions are associated with neutrophilic infiltration of the airways? |
Chronic inflammation (CF, chronic bronchitis, asthma, emphysema, cigarette smokers) causes neutrophils to invade the airways |
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What group of cells accounts for most of the alveolar surface? |
Type I cells constitute most of the alveolar surface |
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What group of cells contain the lamellar bodies? |
Type II cells contain the Lamellar Bodies |
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What group of cells engulf microorganisms and foreign material in the alveolus? |
Alveolar macrophages |
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IN the presence of high inspired O2 concentrations, which substances produce alveolar injury? |
Oxygen toxicity = overproduction of toxic oxygen radicals in the presence of high inspired oxygen concentrations |
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Why is the left hemidiaphragm slightly lower than the right? |
Heart pushes down the left half of the diaphragm Liver props up the right half of the diaphragm |
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Term that describes the presence of fluid in the pleural space as a result of inflammation? |
Pleural effusion |
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What is an anatomic shunt? |
Refers to the mixing of unoxygenated venous blood from the bronchial circulation mixing with oxygenated blood in the pulmonary veins, which is then pumped into the aorta and systemic arterie |
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What is the impact of an anatomic shunt? |
Systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas, giving rise to the P(A-a)O2 (alveolar to arterial O2 pressure difference |
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Which nervous system innervates the lungs? |
Autonomic nervous system sensory and motor nerves |
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What is true of phrenic nerves? 1. Norepinephrine 2. Acetylcholine 3. Dopamine 4. Adrenalin |
acetylcholine and norepinephrine |
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What respiratory muscles will be compromised by C2 and C3 vertebrae injury? |
diaphragm, external and internal intercostals, and abdominals |
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3/4ths of all parasympathetic fibers are in which cranial nerve? |
Vagus nerve (cranial nerve X) |
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What is the only natural mechanism for sympathetic bronchodilation? |
Epinephrine |
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What structures are innervated by parasympathetic postganglionic fibers? |
airway muscle, mucous glands, and pulmonary blood vessels |
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What is the effect of parasympathetic stimulation on airway secretions? |
Increases the viscosity of airway secretions |
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Why are anticholinergics less useful than adrenergic bronchodilators in treating small airway constriction? |
Because cholinergic innervation is the greatest in large airways, while adrenergic bronchodilators are equally effective in large and small airways |
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What are the typical locations of pulmonary B2 receptors? |
-airway smooth muscle, -airway epithelium, -vascular smooth muscle, and -submucosal glands |
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What agents should be considered for asthmatics admitted to the ER? |
B2 agonists Anticholinergics Sympathomimetics Alpha adrenergics |
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What type of agent is racemic epinephrine? |
Alpha 1 adrenergic drug |
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What forms of NO2 are useful identifying the early forms of asthma? |
eNOS |
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What reflex causes smooth muscle relaxation and bronchodilation after a deep inspiration? |
Hering Breuer Reflex |
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Bronchoconstriction caused by irritants is produced by the stimulation of what structures? |
Rapidly adapting (irritant) receptors |
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Sequence of events for generating a cough: |
-Diaphragm contracts, causing deep inspiration -Slight inspiratory pause -Muscles in larynx close glottis, sealing upper airway -Abdominal expiratory muscles contract forcefully -Glottis suddenly opens, explosively releasing gas |
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How many ribs articulate with the thoracic vertebrae? |
The 12 thoracic vertebrae articulate with all 12 ribs (but not all ribs connect with the sternum anteriorly) |
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What is the name of the landmark for the carina that is the junction of the manubrium, body of the sternum, and second rib? |
Angle of Louis |
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During CPR, care must be taken not to compress what part of the sternum? |
Xiphoid process |
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What is the primary muscle of respiration during quiet breathing? |
Diaphragm |
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What are the accessory muscles of respiration? |
-sternomastoids, -pectoralis major, and -abdominals |
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What are the only accessory muscles of expiration? |
Abdominals |
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What mechanism causes the most significant thoracic cavity enlargement during inspiration? |
Downward movement of the diaphragm |
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If the lungs fail to empty due to weakened elastic recoil or high Raw, what will change on the chest radiograph? |
Flattening of the diaphragm |
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What are strong inspiratory efforts that create enough subatmospheric pressure in the thoracic cavity that suck the intercostals inward called? |
Intercostal retractions |
