118 Mod 4 (Airway, Acid) Flashcards
1
Q
What Does Sharkfin Wave form Indicate
A
Bronchospasm/Bronchoconstriction
Difficulty during the exhalation phase with incomplete alveolar emptying
COPD, asthma
2
Q
What does this Capno waveform indicate?
A
Hypoventilation,
Resp Depression (narc/opiate)
Vent Rate too Slow
Longer-than-normal intervals between waveforms
Acidic Capno - over 45
3
Q
What does this Capno waveform indicate?
A
Hyperventilation
Shorter-than-normal intervals between waveforms
Alk Capno - below 35
4
Q
What does this Capno waveform indicate?
A
Rebreathing
waveforms never return to 0mmHg
5
Q
What is the normal Capno ETCO2 Range?
Which is ALK or ACID?
A
(ALK) 35 - 45 (ACID)
below 35 hyperventilation
above 45 hypoventilation
6
Q
What are the Phases of the waveform?
A
Phase 1 (AB) Respiratory Baseline - initial exhalation
Phase 2 (BC) EXPIRATORY Upslope
Phase 3 (CD) Alveolar Plateau
Phase 4 (DE) INSPIRATORY Downstroke
7
Q
What are the 3 primary buffer systems in order of speed
A
1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)
8
Q
Name
Airway sound
Indication
Treatment
A
Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET
9
Q
What are 4 signs of acidosis
A
CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin
10
Q
Acidosis is an ___________ in H+ Ions
Alkalosis is a ____________ in H+ Ions
A
Acid - increase in Ions - pH down
Alk - decrease in Ions - pH up
11
Q
Miller Blade does what?
Mac Blade does what?
A
Miller - made so tip will extended beneath the epiglottis and LIFT it up
Mac - tip placed IN vallecula, indirectly lifting the epiglottis
12
Q
What are 4 important intubation landmarks?
A
- Epiglottis
2.Glottic opening - Vocal cords
- Arrytenoid cartillage (both sides)
13
Q
What is Boyle’s Law
A
Pressure of a gas is inversely proportional to its volume
the pressure outside is higher than air pressure inside (thorax)
14
Q
Name the parts
A
A. Vallecula
B. Epiglottis
C. Vocal Cords
D. PIRIFORM Fossae
E. Arytenoid/Corniculate
15
Q
Name the parts
A
A. Hard Palate
B. Oral Cavity
C. Tongue
D. Larynx
E. Thyroid Cartilage
F. Cricoid Cartilage
G. Nasopharynx
H. Soft Palate
I. Oropharynx
J. Epiglottis
K. Esophagus
L. Trachea
16
Q
Define Hypoxic Drive
A
Brain (CSF) starts using oxygen chemoreceptors to control breathing instead of normally CO2 receptors
usually end-stage COPD
17
Q
The Brain metabolizes
____ % of the body’s glucose
and
_____% of Total Body O2
A
25% of the body’s glucose
and
20% of total body O2
18
Q
What are the 3 vital centers of the Medulla?
A
- Cardiac - HR, strength of contraction
- Vasomotor - dia of blood vessels, BP
- Respiratory - w/ PONS, cough/swallow
19
Q
What does Surfactant do?
A
It reduces surface tension &
keeps alveoli expanded
20
Q
What is the normal total lung capacity of an adult man?
what is it broken into (4) ?
A
6,000mL total
- Inspiratory - 3,000 mL
- Expiratory - 1,200 mL
- Residual - 1,200 mL
- Tidal Volume - 500mL
21
Q
What is Tidal volume?
A
The amount of air that is moved into or out of the lungs during a single breath.
22
Q
What is Dead Space?
A
The area of the lung that has little or no gas exchange
usually 150mL
23
Q
Define Oxygenation
A
loading oxygen ONTO HEMOGLOBIN in the blood stream
24
Q
Define Respiration
A
Actual GAS EXCHANGE of oxygen and CO2 in the alveoli
25
Define Ventilation
PHYSICAL act of MOVING air in/out of lungs
26
Which cervical nerves control the diaphragm
C3 thru C5 keep the diaphragm alive
27
The diaphragm is both a ________ and _________ muscle
voluntary (skeletal)
and
involuntary (smooth)
28
The most air inhalation occurs when the diaphragm is ______________
contracted
(for negative pressure)
29
Oxygenation _____________ occur without ventilation.
Ventilation is possible _________ Oxygenation.
Oxygenation __cannot__ occur without ventilation.
Ventilation IS possible _without_ Oxygenation.
30
Sedative drug and Dose (used for RSI)
Ketamine IV/IO
2mg/kg over 1 min
31
Paralytic and Dose
(Dep and Non-Dep)
Dep-
SUCCS 1.5mg/kg IV/IO (rapid)
Non-Dep -
VECURONIUM 0.1mg/kg IV/IO
32
Dose for Midazolam as a sedative (RSI)
18-68 y/o - 5mg IV/IM
69 (or over) - 2.5mg IV/IM
consult for repeat dose
33
What is the Placement and Technique of the KING airway?
Preoxygenate Patient
Neutral Position
Tip past base of tongue/aligned w/ Teeth
inflate
Capno to confirm
34
How can you tell proper size for PED ETT
1. (Age in years /4) + 4
2. size of patient pinky
35
What does DOPE stand for
Dislodged
Obstruction
Pneumothorax
Equipment Malfunction
36
When can a cricothyrotomy be performed?
a. “Can’t Intubate, Can’t Ventilate”
37
When do you do a Cricothyrotomy?
a. Airway obstruction (FBAO, epiglottitis, anaphylaxis, upper airway burns)
b. Inability to open Pt’s mouth
c. Massive maxillofacial trauma
38
When would you do a Nasotracheal Tube?
(Don't do when (2)
Gag reflex (or AMS w Gag)
Respiratory failure due to
COPD, Asthma PE
Don't do when
Head trauma, bloodthinners
39
Define KUSSMAULS
a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)
40
Define CHEYNE-STOKES
Fast, SHALLOW, followed by slow, heavier and/or moments of apnea
41
How can you tell Pneumo or Hemothorax
Pneumo - hyper-resonance to percussion
Hemothorax - hypo-resonance
42
Define Cystic Fibrosis
Gene mutation, thick mucus, chronic infection, and inflammatory response
43
Define Carpopedal Spasms
Hands and feet become clenched
Respiratory alkalosis
Hyperventilation Capno CO below 35
44
Signs of PNEUMONIA
and
Treatment
Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness
Crackles
Treatment:
CPAP, Supportive care
45
Causes of
LOW pressure alarm on vents
and
HIGH pressure alarm on vents
LOW:
Circuit becomes DISCONNECTED
LEAK in the vent
Poorly FIT mask
HIGH:
King,
WATER in the vent,
Increase mucus/secretions
Blocking AIRWAY, bronchospasm, coughing/bucking
46
CPAP vs BiPAP Differences
CPAP:
Increases PRESSURE IN lungs, opens collapsed alveoli
PUSHES O2 across alveolar membrane, and forces interstitial fluid back into the pulmonary circulation
BiPAP:
Two Pressures (Ins iPAP/ Exp ePAP)
iPAP higher pressure for bases
ePAP lower pressure to keep bases open
47
When do we give CPAP?
(and don't)
Indications:
Alert and Oriented, Pulse Ox below 90%
for: CHF, PE, asthma, pneumonia, COPD
Contra:
Unresponsive, can't sit up, resp arrest
Nausea/vomit
Hypotensive BP below 90
Trauma
Recent GI Surgery
48
What is ARDS
and signs of
Acute Respiratory Distress Syndrome
Severe shortness of breath, labored and unusually rapid breathing, hypotension, confusion, and extreme tiredness
49
What 2 Resp Emergencies
are VENTILATION related
1. Hemo/Pneumo - air collecting in the chest cavity
2., Flail Chest - lungs can't fill with broken rib
50
Where does EXTERNAL respiration occur?
Alveoli
and
pulmonary CAPILLARIES
51
Where does INTERNAL respiration occur?
CELLS
and
BLOOD VESSELS
52
Define RHINORRHEA
What conditions may be associated
Thin, clear nasal discharge
Asthma,
Pneumonia,
Chronic BRONCHITIS,
COVID, RSV
(wet respiratory conditions)
53
What is V/Q Mismatch?
A failure to match ventilation and Perfusion
54
What are the 2 types of Respirations (which EXTERNAL or INTERNAL) ?
1. PULMONARY Resp is EXTERNAL (alveoli)
2. CELLULAR Resp is INTERNAL (in cells)
55
Early signs of Hypoxia
Late signs of Hypoxia
Early:
Restlessness, Irritability, Tachy, Anxiety
Late:
AMS, Weak pulse, CYANOSIS, dyspnea
56
Define Epiglottis
flap closes over the trachea during swallowing.
57
Define Intrinsic and Extrinsic
Intrinsic (internal)
extrinsic (external)
pertaining to airway obstructions
58
What are medications that suppress the CNS (breathing)
Opiates
Opioids
Benzos
59
What is FiO2
Its the percentage of oxygen in inhaled air (inspired)
60
Define Biots
(caused by)
An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)
61
Define BURP
Backward,
Upward,
Rightward
Pressure
to improve the laryngoscopic view of the glottis
(also called external laryngeal manipulation)
62
Anoxia
Absence of oxygen
63
Dissociative anesthetic
A medication that distorts the perception of sight and sound and induces a feeling of detachment from environment and self.
64
What does LEMON mean, stand for
Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility
65
Define Peak Expiratory Flow
Estimate of the extent of bronchoconstriction, to determine if therapy is working
66
Paralytics are also known as
neuromuscular blocking agents
67
Decrease the number of H+ (hydrogen) ions the more __________
Alkaline
Raises the PH
68
What is a normal
PH range
Co2 Range
7.35-7.45
35-45
22-26
69
Removal of Acids is performed by
Lungs and Kidneys
70
What regulates the bicarbonate buffer
the kidneys
71
What is the ratio of buffers to acids (bicarb to carbonic)
1:20
72
CPAP does not change (this airway measurement)
Tidal Volume
73
What are the two Mech Vent methods
Non-invasive - cpap, bipap
Invasive - et tube, sg airway device (positive pressure vent)
volume control - basic
pressure control - advance
74
What are the types of Resp Failure
Type 1 - hypoxemic - PaO2 less 60 - fail to oxygenate
Type 2 - hypercapnic - PaCo2 more that 45 - fail to vent (fail to remove CO2)
can overlap and have combination
75
How do you treat type 1 resp failure
Increase FiO2 100% = 1.0 (Room air = 0.21)
Increase Mean airpressure
increase oxygen supply
76
How do you treat type 2 resp failure
Increase patient minute ventilation (ve)
(increase resp rate or tidal vol - v1)
set tidal vol based on body weight
77
ET suction landmark for adults and peds
Sternal notch for adults
Xfoid Process for Peds
78
What is the adult dose of Ketamine
(what is it for)
For severe agitation -
IV or IO
1 mg/kg over 1-2 max 100mg repeat x1
IM: 4mg/kg MAX 400mg
(for pain different dose)
79
Magnesium Sulfate
(whats it for)
For Bronchospasm -
IV/IO 1-2g in 50-100mL
80
What cells line the airways and produce mucous
Goblet Cells
81
How does blood PH level effect breathing
acidic - stimulates breathing
alkalotic - slows breathing
82
Alveoli function best when they are
partially inflated
83
What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)
Hering-Breuer Reflex
84
What hand does suction go in?
What hand does Laryngoscope go in?
What hand does ET Tube go in?
Suction - Right
Larygno - Left
ET tube - Right
85
How can you assess gag reflex
Use eyelash reflex
86
Name 4 uses of CAPNO
detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent
87
A decreased tidal vol and decreased resp rate would show ____________ on ETCO2
Increased CO2
because of hypo vent
88
For NO D Sat how much would O2 would you give an 9 y/o patient
below 6 y/o - 6ltrs
+1 for every year after 6
9y/o = 9 ltrs
up to age 15
89
What is PEEP and Define it
Positive End Expiratory Pressure
The amount of pressure that the patient exhales against
90
Define poor lung compliance
increased resistance during ventilation attempts
91
Term for positional dyspnea
Orthopnea
difficulty breathing while laying down
sign of heart failure or lung disease
92
What happens to PH when the bicarb levels decrease
What does the body do?
The PH decreases and becomes more acidic
The body compensates with INCREASE in resp rate
93
What happens to PH when the bicarb levels increase
The PH Increases and become alkalotic but the bodys resp rate Decreases.
94
Define PACO2
its the partial pressure of co2 in ARTERIAL blood
95
Mainstream vs Sidestream Capno
Sidestream (what is used most) - pulls the gas off and measures it there
Mainstream measures the gas inline
96
What is the Adult/ped dead space
Infant/neonate dead space
Adult/ped - 6.6mL
(et tube greater than 4.5mm)
Infant/Neo - 0.5mL
97
What is the max for capno NC
5lpm (adult and ped)
cannot use for nodesat
cannot use for neonatal
98
If the ETCO2 is high (greater than 45mmHG)
what should you do?
INCREASE your ventilatory rate
the patient is holding on to too much co2
99
if the ETCO2 is low (lower than 35mmHG)
what should you do?
DECREASE your ventilatory rate
the patient needs to save more co2
100
A sudden increase in ETCO2 with cardiac arrest indicates what
ROSC
return of spontaneous circulation
101
What is the dip at the top of the wave form called (during exhalation)
Curare Cleft
during phase 3 C-D plateu
can be sign of bucking the tube, spontaneous resp effort (movement of the diaphragm)
recovering from paralytics
(needs more sedation)
102
ph 7.6
co2 28
HCO2 29
Mixed Alkalosis
ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk
103
ph 7.44
co2 37
hco3 25
normal
no acid/base disturbance
104
What do the lungs regulate
production of carbonic acid
combining carbon dioxide and water
105
What are normal levels for arterial blood gas measurement and what does each one measure
ph 7.35 - 7.45 - serum pH
co2 35 - 45 mmHg - partial pressure of co2 in blood (respiratory system)
hco3 22-26 mEq/L - bicarb level in blood (renal METABOLIC system)
106
Ph 7.2
CO2 37
HCO3 21
Metabolic Acidosis
uncompensated (no change in co2, resp)
7.2 - ph under 7.35 acid
co2 normal
21 - hco3 under 22 acid (metabolic)
107
ph 7.6
co2 42
hco3 30
Metabolic Alkalosis
uncompensated (no change in co2, resp)
7.6 - ph over 7.45 alk
co2 normal
30 - hco3 over 26 (metabolic)
108
The Renal system is also known as the
Metabolic System
(HCO3 measures it)
109
What defines Uncompensated
No change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
110
What defines Partially Compensated
A change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
111
What defines Corrected
pH back to normal
even though the other two are messed up
Co2 vs HCO3
112
pH 7.1
co2 26
hco3 19
7.1 acid
27 low alk (system thats compensating)
19 acid META
Partially Compensated Metabolic Acidosis
113
pH 7.6
co2 25
hco3 20
7.6 alk
co2 25 low alk RESP
hco3 20 acid (system that's compensating)
Partially Compensated Respiratory Alkalosis
114
For PED needle cric what size syringe and what size ET tube cap do you use
3 cc syringe
and 7 ET tube cap
115
What defines a COMPENSATED
the co2 and the hco3 are opposite
but
the pH level is normal but FAVORING one side
so because its still normal is not partially.
116
pH 7.42
Co2 24
hco3 19
Compensated Respiratory
Alkalosis
117
Increase of H+ makes it more
Decrease of H+ makes it more
increase - acidic
decrease - alk
118
pH is used to express the ______ of a solution
acidity
119
Hydrogen value falls
what does this indicate
alkalosis
120
a acidic chem solution has a pH
a alk chem solution has a pH
ACIDIC <7 less than
ALK >7 greater than
121
Resp of 4
ETC02 is 54
Respiratory Acidosis
Immediate BVM
ET- maybe (gag reflex?)
Normal vent rate
if bvm is working give IV med
bvm not working give IN
122
7.51
co2 42
hco3 29
Uncompensated
Metabolic
Alkalosis
123
7.16
co2 51
Hco3 25
Uncompensated
respiratory
Acidosis
124
What vol-control mode of vent kicks on when a patient takes a spontaneous breath with full tidal volume
assist control
125
What are two volume control modes of vent
Assist control AC
CMV
SIMV
Pressure support
126
How does the blood move from heart to the lungs
The Pulmonary Artery
127
What is Polycythemia
Excessive red blood cell production
128
How many lobes are in the L and R lungs
L - 2
R - 3
129
Mild Hypoxia leads to __________
then
Severe Hypoxia leads to _____________
tachycardia
then
bradycardia
130
The Diaphragm _________ during inhalation
flattens
131
Hypoventilation causes
Acidosis
co2 goes up causing pH to go down
132
What is Atelectasis
Colapse of the aveoli
133
What is Guillain-Barre Syndrome?
134
What are signs of DKA
kaussmals
high bgl
135
What is PND
Paroxysmal Nocturnal Dyspnea
a sign of COPD
caused by either LH failure or COPD
cant lay flat to sleep fluid pools in the lungs
136
How does an Emphysema patient present
Pink Puffer
Barrel chest, pursed-lips, tachypnea
137
How does a Chronic Bronchitis patient present
Sleeps upright
Productive cough - waste basket full of used tissues, secretions
138
Define Pulsus Paradoxus
distal pulse disappears with deep breathing in and returns with breath out
139
Grunting is a _______ airway obstruction
lower
140
Pink frothy sputum is an indication of
Heart failure
141
Define Ataxic Respiration
irregular breathing
142
For the Stethoscope
Diaphragm is for
Bell is for
Diaphragm is for High pitch
Bell is for low pitch
143
What is % for good O2
92-98%
144
Two most common UPPER ped airway emergencies
Croup and Pneumonia
145
What do you suspect
Hours to Days onset
Weakness
Fever
Productive cough
Pneumonia
146
Which cranial nerve is major for the parasympathetic nervous system
X the vagus nerve
147
CPAP is NOT considered _______________
is NOT positive pressure ventilation
148
Define Poiseuille Law
As the diameter of a tube decreases, the resistance to flow increases
149
What are two forms of COPD
Emphysema
Chronic Bronchitis
(Lower airway disease)
150
Emphysema vs Chronic Bronchitis
Emphysema - from damage alveoli have less area for gas exchange
Bronchitis - Sputum production for more than 2 years, productive cough (BLUE BLOATERS)
151
What is the nickname for Chronic Bronchitis
Blue Bloaters
High Co2
152
What is the nickname for Emphysema
Pink Puffers
Barrel chest, cant sleep at night, purse lips
High co2
153
What is Cystic Fibrosis and Treatment
Chronic Production of Mucous
Supportive care O2
154
Treatment for Epiglotitis
BVM,and poss ET tube (1-2 sizes smaller)
Limit agitation
155
Treatment for Croup
IM Epi
Dex - corticosteroids
Neb Epi
IF ET needed use 0.5-1mm smaller
156
What Does Sharkfin Wave form Indicate
Bronchospasm/Bronchoconstriction
Difficulty during the exhalation phase with incomplete alveolar emptying
COPD, asthma
157
What does this Capno waveform indicate?
Hypoventilation,
Resp Depression (narc/opiate)
Vent Rate too Slow
Longer-than-normal intervals between waveforms
Acidic Capno - over 45
158
What does this Capno waveform indicate?
Hyperventilation
Shorter-than-normal intervals between waveforms
Alk Capno - below 35
159
What is the normal Capno ETCO2 Range?
Which is ALK or ACID?
(ALK) 35 - 45 (ACID)
below 35 hyperventilation
above 45 hypoventilation
160
What are the Phases of the waveform?
Phase 1 (AB) Respiratory Baseline - initial exhalation
Phase 2 (BC) EXPIRATORY Upslope
Phase 3 (CD) Alveolar Plateau
Phase 4 (DE) INSPIRATORY Downstroke
161
161
What are the 3 primary buffer systems in order of speed
1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)
162
Name
Airway sound
Indication
Treatment
Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET
163
What are 4 signs of acidosis
CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin
164
Acidosis is an ___________ in H+ Ions
Alkalosis is a ____________ in H+ Ions
Acid - increase in Ions - pH down
Alk - decrease in Ions - pH up
165
What are 4 important intubation landmarks?
1. Epiglottis
2.Glottic opening
3. Vocal cords
4. Arrytenoid cartillage (both sides)
166
What is the normal total lung capacity of an adult man?
what is it broken into (4) ?
6,000mL total
1. Inspiratory - 3,000 mL
2. Expiratory - 1,200 mL
3. Residual - 1,200 mL
4. Tidal Volume - 500mL
167
What is Tidal volume?
The amount of air that is moved into or out of the lungs during a single breath.
168
Define Oxygenation
loading oxygen ONTO HEMOGLOBIN in the blood stream
169
Define Respiration
Actual GAS EXCHANGE of oxygen and CO2 in the alveoli
170
Define Ventilation
PHYSICAL act of MOVING air in/out of lungs
171
The most air inhalation occurs when the diaphragm is ______________
contracted
(for negative pressure)
172
Sedative drug and Dose (used for RSI)
Ketamine IV/IO
2mg/kg over 1 min
173
Paralytic and Dose
(Dep and Non-Dep)
Dep-
SUCCS 1.5mg/kg IV/IO (rapid)
Non-Dep -
VECURONIUM 0.1mg/kg IV/IO
174
Dose for Midazolam as a sedative (RSI)
18-68 y/o - 5mg IV/IM
69 (or over) - 2.5mg IV/IM
consult for repeat dose
175
How can you tell proper size for PED ETT
1. (Age in years /4) + 4
2. size of patient pinky
176
What does DOPE stand for
Dislodged
Obstruction
Pneumothorax
Equipment Malfunction
177
Define KUSSMAULS
a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)
178
Define CHEYNE-STOKES
Fast, SHALLOW, followed by slow, heavier and/or moments of apnea
179
Signs of PNEUMONIA
and
Treatment
Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness
Crackles
Treatment:
CPAP, Supportive care
180
Causes of
LOW pressure alarm on vents
and
HIGH pressure alarm on vents
LOW:
Circuit becomes DISCONNECTED
LEAK in the vent
Poorly FIT mask
HIGH:
King,
WATER in the vent,
Increase mucus/secretions
Blocking AIRWAY, bronchospasm, coughing/bucking
181
When do we give CPAP?
(and don't)
Indications:
Alert and Oriented, Pulse Ox below 90%
for: CHF, PE, asthma, pneumonia, COPD
Contra:
Unresponsive, can't sit up, resp arrest
Nausea/vomit
Hypotensive BP below 90
Trauma
Recent GI Surgery
182
Where does EXTERNAL respiration occur?
Alveoli
and
pulmonary CAPILLARIES
183
Where does INTERNAL respiration occur?
CELLS
and
BLOOD VESSELS
184
What is FiO2
Its the percentage of oxygen in inhaled air (inspired)
185
Define Biots
(caused by)
An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)
186
What does LEMON mean, stand for
Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility
187
Decrease the number of H+ (hydrogen) ions the more __________
Alkaline
Raises the PH
188
What is a normal
PH range
Co2 Range
7.35-7.45
35-45
22-26
189
What regulates the bicarbonate buffer
the kidneys
190
What is the ratio of buffers to acids (bicarb to carbonic)
1:20
191
What are the types of Resp Failure
Type 1 - hypoxemic - PaO2 less 60 - fail to oxygenate
Type 2 - hypercapnic - PaCo2 more that 45 - fail to vent (fail to remove CO2)
can overlap and have combination
192
How do you treat type 1 resp failure
Increase FiO2 100% = 1.0 (Room air = 0.21)
Increase Mean airpressure
increase oxygen supply
193
How do you treat type 2 resp failure
Increase patient minute ventilation (ve)
(increase resp rate or tidal vol - v1)
set tidal vol based on body weight
194
Magnesium Sulfate
(whats it for)
For Bronchospasm -
IV/IO 1-2g in 50-100mL
195
What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)
Hering-Breuer Reflex
196
Name 4 uses of CAPNO
detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent
197
A decreased tidal vol and decreased resp rate would show ____________ on ETCO2
Increased CO2
because of hypo vent
198
For NO D Sat how much would O2 would you give an 9 y/o patient
below 6 y/o - 6ltrs
+1 for every year after 6
9y/o = 9 ltrs
up to age 15
199
What happens to PH when the bicarb levels decrease
What does the body do?
The PH decreases and becomes more acidic
The body compensates with INCREASE in resp rate
200
What happens to PH when the bicarb levels increase
The PH Increases and become alkalotic but the bodys resp rate Decreases.
201
Define PACO2
its the partial pressure of co2 in ARTERIAL blood
202
If the ETCO2 is high (greater than 45mmHG)
what should you do?
INCREASE your ventilatory rate
the patient is holding on to too much co2
203
if the ETCO2 is low (lower than 35mmHG)
what should you do?
DECREASE your ventilatory rate
the patient needs to save more co2
204
What is the dip at the top of the wave form called (during exhalation)
Curare Cleft
during phase 3 C-D plateu
can be sign of bucking the tube, spontaneous resp effort (movement of the diaphragm)
recovering from paralytics
(needs more sedation)
205
ph 7.6
co2 28
HCO2 29
Mixed Alkalosis
ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk
206
ph 7.44
co2 37
hco3 25
normal
no acid/base disturbance
207
What are normal levels for arterial blood gas measurement and what does each one measure
ph 7.35 - 7.45 - serum pH
co2 35 - 45 mmHg - partial pressure of co2 in blood (respiratory system)
hco3 22-26 mEq/L - bicarb level in blood (renal METABOLIC system)
208
Ph 7.2
CO2 37
HCO3 21
Metabolic Acidosis
uncompensated (no change in co2, resp)
7.2 - ph under 7.35 acid
co2 normal
21 - hco3 under 22 acid (metabolic)
209
ph 7.6
co2 42
hco3 30
Metabolic Alkalosis
uncompensated (no change in co2, resp)
7.6 - ph over 7.45 alk
co2 normal
30 - hco3 over 26 (metabolic)
210
The Renal system is also known as the
Metabolic System
(HCO3 measures it)
211
What defines Uncompensated
No change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
212
What defines Partially Compensated
A change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
213
What defines Corrected
pH back to normal
even though the other two are messed up
Co2 vs HCO3
214
pH 7.1
co2 26
hco3 19
7.1 acid
27 low alk (system thats compensating)
19 acid META
Partially Compensated Metabolic Acidosis
215
pH 7.6
co2 25
hco3 20
7.6 alk
co2 25 low alk RESP
hco3 20 acid (system that's compensating)
Partially Compensated Respiratory Alkalosis
216
What defines a COMPENSATED
the co2 and the hco3 are opposite
but
the pH level is normal but FAVORING one side
so because its still normal is not partially.
217
pH 7.42
Co2 24
hco3 19
Compensated Respiratory
Alkalosis
218
Increase of H+ makes it more
Decrease of H+ makes it more
increase - acidic
decrease - alk
219
Resp of 4
ETC02 is 54
Respiratory Acidosis
Immediate BVM
ET- maybe (gag reflex?)
Normal vent rate
if bvm is working give IV med
bvm not working give IN
220
7.51
co2 42
hco3 29
Uncompensated
Metabolic
Alkalosis
221
How does the blood move from heart to the lungs
The Pulmonary Artery
222
The Diaphragm _________ during inhalation
flattens
223
How does an Emphysema patient present
Pink Puffer
Barrel chest, pursed-lips, tachypnea
224
How does a Chronic Bronchitis patient present
Sleeps upright
Productive cough - waste basket full of used tissues, secretions
225
Grunting is a _______ airway obstruction
lower
226
Pink frothy sputum is an indication of
Heart failure
227
What do you suspect
Hours to Days onset
Weakness
Fever
Productive cough
Pneumonia
228
Emphysema vs Chronic Bronchitis
Emphysema - from damage alveoli have less area for gas exchange
Bronchitis - Sputum production for more than 2 years, productive cough (BLUE BLOATERS)
229
What is the nickname for Chronic Bronchitis
Blue Bloaters
High Co2
230
What is the nickname for Emphysema
Pink Puffers
Barrel chest, cant sleep at night, purse lips
High co2
231
Treatment for Epiglotitis
BVM,and poss ET tube (1-2 sizes smaller)
Limit agitation
232
Treatment for Croup
IM Epi
Dex - corticosteroids
Neb Epi
IF ET needed use 0.5-1mm smaller
