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Paramedic > 118 Mod 4 (Airway, Acid) > Flashcards

118 Mod 4 (Airway, Acid) Flashcards

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1
Q

What Does Sharkfin Wave form Indicate

A

Bronchospasm/Bronchoconstriction

Difficulty during the exhalation phase with incomplete alveolar emptying

COPD, asthma

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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

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3
Q

What does this Capno waveform indicate?

A

Hyperventilation

Shorter-than-normal intervals between waveforms

Alk Capno - below 35

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4
Q

What does this Capno waveform indicate?

A

Rebreathing

waveforms never return to 0mmHg

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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

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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

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7
Q

What are the 3 primary buffer systems in order of speed

A

1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)

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8
Q

Name
Airway sound
Indication
Treatment

A

Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET

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9
Q

What are 4 signs of acidosis

A

CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin

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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

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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

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12
Q

What are 4 important intubation landmarks?

A
  1. Epiglottis
    2.Glottic opening
  2. Vocal cords
  3. Arrytenoid cartillage (both sides)
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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)

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14
Q

Name the parts

A

A. Vallecula
B. Epiglottis
C. Vocal Cords

D. PIRIFORM Fossae
E. Arytenoid/Corniculate

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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

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16
Q

Define Hypoxic Drive

A

Brain (CSF) starts using oxygen chemoreceptors to control breathing instead of normally CO2 receptors

usually end-stage COPD

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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

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18
Q

What are the 3 vital centers of the Medulla?

A
  1. Cardiac - HR, strength of contraction
  2. Vasomotor - dia of blood vessels, BP
  3. Respiratory - w/ PONS, cough/swallow
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19
Q

What does Surfactant do?

A

It reduces surface tension &
keeps alveoli expanded

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20
Q

What is the normal total lung capacity of an adult man?

what is it broken into (4) ?

A

6,000mL total

  1. Inspiratory - 3,000 mL
  2. Expiratory - 1,200 mL
  3. Residual - 1,200 mL
  4. Tidal Volume - 500mL
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21
Q

What is Tidal volume?

A

The amount of air that is moved into or out of the lungs during a single breath.

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22
Q

What is Dead Space?

A

The area of the lung that has little or no gas exchange

usually 150mL

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23
Q

Define Oxygenation

A

loading oxygen ONTO HEMOGLOBIN in the blood stream

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24
Q

Define Respiration

A

Actual GAS EXCHANGE of oxygen and CO2 in the alveoli

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25
Q

Define Ventilation

A

PHYSICAL act of MOVING air in/out of lungs

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26
Q

Which cervical nerves control the diaphragm

A

C3 thru C5 keep the diaphragm alive

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27
Q

The diaphragm is both a ________ and _________ muscle

A

voluntary (skeletal)

and

involuntary (smooth)

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28
Q

The most air inhalation occurs when the diaphragm is ______________

A

contracted

(for negative pressure)

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29
Q

Oxygenation _____________ occur without ventilation.

Ventilation is possible _________ Oxygenation.

A

Oxygenation __cannot__ occur without ventilation.

Ventilation IS possible without Oxygenation.

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30
Q

Sedative drug and Dose (used for RSI)

A

Ketamine IV/IO

2mg/kg over 1 min

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31
Q

Paralytic and Dose

(Dep and Non-Dep)

A

Dep-

SUCCS 1.5mg/kg IV/IO (rapid)

Non-Dep -

VECURONIUM 0.1mg/kg IV/IO

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32
Q

Dose for Midazolam as a sedative (RSI)

A

18-68 y/o - 5mg IV/IM

69 (or over) - 2.5mg IV/IM

consult for repeat dose

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33
Q

What is the Placement and Technique of the KING airway?

A

Preoxygenate Patient
Neutral Position
Tip past base of tongue/aligned w/ Teeth
inflate
Capno to confirm

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34
Q

How can you tell proper size for PED ETT

A
  1. (Age in years /4) + 4
  2. size of patient pinky
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35
Q

What does DOPE stand for

A

Dislodged
Obstruction
Pneumothorax
Equipment Malfunction

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36
Q

When can a cricothyrotomy be performed?

A

a. “Can’t Intubate, Can’t Ventilate”

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37
Q

When do you do a Cricothyrotomy?

A

a. Airway obstruction (FBAO, epiglottitis, anaphylaxis, upper airway burns)
b. Inability to open Pt’s mouth
c. Massive maxillofacial trauma

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38
Q

When would you do a Nasotracheal Tube?

(Don’t do when (2)

A

Gag reflex (or AMS w Gag)
Respiratory failure due to
COPD, Asthma PE

Don’t do when
Head trauma, bloodthinners

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39
Q

Define KUSSMAULS

A

a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)

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40
Q

Define CHEYNE-STOKES

A

Fast, SHALLOW, followed by slow, heavier and/or moments of apnea

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41
Q

How can you tell Pneumo or Hemothorax

A

Pneumo - hyper-resonance to percussion

Hemothorax - hypo-resonance

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42
Q

Define Cystic Fibrosis

A

Gene mutation, thick mucus, chronic infection, and inflammatory response

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43
Q

Define Carpopedal Spasms

A

Hands and feet become clenched

Respiratory alkalosis

Hyperventilation Capno CO below 35

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44
Q

Signs of PNEUMONIA

and

Treatment

A

Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness

Crackles

Treatment:
CPAP, Supportive care

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45
Q

Causes of

LOW pressure alarm on vents

and

HIGH pressure alarm on vents

A

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

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46
Q

CPAP vs BiPAP Differences

A

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

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47
Q

When do we give CPAP?

(and don’t)

A

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

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48
Q

What is ARDS

and signs of

A

Acute Respiratory Distress Syndrome

Severe shortness of breath, labored and unusually rapid breathing, hypotension, confusion, and extreme tiredness

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49
Q

What 2 Resp Emergencies
are VENTILATION related

A
  1. Hemo/Pneumo - air collecting in the chest cavity

2., Flail Chest - lungs can’t fill with broken rib

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50
Q

Where does EXTERNAL respiration occur?

A

Alveoli

and

pulmonary CAPILLARIES

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51
Q

Where does INTERNAL respiration occur?

A

CELLS

and

BLOOD VESSELS

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52
Q

Define RHINORRHEA

What conditions may be associated

A

Thin, clear nasal discharge

Asthma,
Pneumonia,
Chronic BRONCHITIS,
COVID, RSV
(wet respiratory conditions)

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53
Q

What is V/Q Mismatch?

A

A failure to match ventilation and Perfusion

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54
Q

What are the 2 types of Respirations (which EXTERNAL or INTERNAL) ?

A
  1. PULMONARY Resp is EXTERNAL (alveoli)
  2. CELLULAR Resp is INTERNAL (in cells)
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55
Q

Early signs of Hypoxia

Late signs of Hypoxia

A

Early:
Restlessness, Irritability, Tachy, Anxiety

Late:
AMS, Weak pulse, CYANOSIS, dyspnea

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56
Q

Define Epiglottis

A

flap closes over the trachea during swallowing.

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57
Q

Define Intrinsic and Extrinsic

A

Intrinsic (internal)
extrinsic (external)

pertaining to airway obstructions

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58
Q

What are medications that suppress the CNS (breathing)

A

Opiates
Opioids
Benzos

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59
Q

What is FiO2

A

Its the percentage of oxygen in inhaled air (inspired)

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60
Q

Define Biots

(caused by)

A

An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)

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61
Q

Define BURP

A

Backward,
Upward,
Rightward
Pressure

to improve the laryngoscopic view of the glottis

(also called external laryngeal manipulation)

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62
Q

Anoxia

A

Absence of oxygen

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63
Q

Dissociative anesthetic

A

A medication that distorts the perception of sight and sound and induces a feeling of detachment from environment and self.

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64
Q

What does LEMON mean, stand for

A

Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility

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65
Q

Define Peak Expiratory Flow

A

Estimate of the extent of bronchoconstriction, to determine if therapy is working

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66
Q

Paralytics are also known as

A

neuromuscular blocking agents

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67
Q

Decrease the number of H+ (hydrogen) ions the more __________

A

Alkaline

Raises the PH

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68
Q

What is a normal
PH range
Co2 Range

A

7.35-7.45
35-45
22-26

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69
Q

Removal of Acids is performed by

A

Lungs and Kidneys

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70
Q

What regulates the bicarbonate buffer

A

the kidneys

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71
Q

What is the ratio of buffers to acids (bicarb to carbonic)

A

1:20

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72
Q

CPAP does not change (this airway measurement)

A

Tidal Volume

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73
Q

What are the two Mech Vent methods

A

Non-invasive - cpap, bipap

Invasive - et tube, sg airway device (positive pressure vent)
volume control - basic
pressure control - advance

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74
Q

What are the types of Resp Failure

A

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

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75
Q

How do you treat type 1 resp failure

A

Increase FiO2 100% = 1.0 (Room air = 0.21)

Increase Mean airpressure

increase oxygen supply

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76
Q

How do you treat type 2 resp failure

A

Increase patient minute ventilation (ve)
(increase resp rate or tidal vol - v1)

set tidal vol based on body weight

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77
Q

ET suction landmark for adults and peds

A

Sternal notch for adults

Xfoid Process for Peds

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78
Q

What is the adult dose of Ketamine

(what is it for)

A

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)

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79
Q

Magnesium Sulfate

(whats it for)

A

For Bronchospasm -

IV/IO 1-2g in 50-100mL

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80
Q

What cells line the airways and produce mucous

A

Goblet Cells

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81
Q

How does blood PH level effect breathing

A

acidic - stimulates breathing

alkalotic - slows breathing

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82
Q

Alveoli function best when they are

A

partially inflated

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83
Q

What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)

A

Hering-Breuer Reflex

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84
Q

What hand does suction go in?

What hand does Laryngoscope go in?

What hand does ET Tube go in?

A

Suction - Right

Larygno - Left

ET tube - Right

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85
Q

How can you assess gag reflex

A

Use eyelash reflex

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86
Q

Name 4 uses of CAPNO

A

detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent

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87
Q

A decreased tidal vol and decreased resp rate would show ____________ on ETCO2

A

Increased CO2

because of hypo vent

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88
Q

For NO D Sat how much would O2 would you give an 9 y/o patient

A

below 6 y/o - 6ltrs

+1 for every year after 6

9y/o = 9 ltrs

up to age 15

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89
Q

What is PEEP and Define it

A

Positive End Expiratory Pressure

The amount of pressure that the patient exhales against

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90
Q

Define poor lung compliance

A

increased resistance during ventilation attempts

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91
Q

Term for positional dyspnea

A

Orthopnea

difficulty breathing while laying down

sign of heart failure or lung disease

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92
Q

What happens to PH when the bicarb levels decrease

What does the body do?

A

The PH decreases and becomes more acidic

The body compensates with INCREASE in resp rate

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93
Q

What happens to PH when the bicarb levels increase

A

The PH Increases and become alkalotic but the bodys resp rate Decreases.

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94
Q

Define PACO2

A

its the partial pressure of co2 in ARTERIAL blood

95
Q

Mainstream vs Sidestream Capno

A

Sidestream (what is used most) - pulls the gas off and measures it there

Mainstream measures the gas inline

96
Q

What is the Adult/ped dead space

Infant/neonate dead space

A

Adult/ped - 6.6mL
(et tube greater than 4.5mm)

Infant/Neo - 0.5mL

97
Q

What is the max for capno NC

A

5lpm (adult and ped)

cannot use for nodesat

cannot use for neonatal

98
Q

If the ETCO2 is high (greater than 45mmHG)

what should you do?

A

INCREASE your ventilatory rate

the patient is holding on to too much co2

99
Q

if the ETCO2 is low (lower than 35mmHG)

what should you do?

A

DECREASE your ventilatory rate

the patient needs to save more co2

100
Q

A sudden increase in ETCO2 with cardiac arrest indicates what

A

ROSC

return of spontaneous circulation

101
Q

What is the dip at the top of the wave form called (during exhalation)

A

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
Q

ph 7.6
co2 28
HCO2 29

A

Mixed Alkalosis

ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk

103
Q

ph 7.44
co2 37
hco3 25

A

normal

no acid/base disturbance

104
Q

What do the lungs regulate

A

production of carbonic acid

combining carbon dioxide and water

105
Q

What are normal levels for arterial blood gas measurement and what does each one measure

A

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
Q

Ph 7.2
CO2 37
HCO3 21

A

Metabolic Acidosis

uncompensated (no change in co2, resp)

7.2 - ph under 7.35 acid
co2 normal
21 - hco3 under 22 acid (metabolic)

107
Q

ph 7.6
co2 42
hco3 30

A

Metabolic Alkalosis

uncompensated (no change in co2, resp)

7.6 - ph over 7.45 alk
co2 normal
30 - hco3 over 26 (metabolic)

108
Q

The Renal system is also known as the

A

Metabolic System

(HCO3 measures it)

109
Q

What defines Uncompensated

A

No change in the opposite system

Resp vs metabolic/renal

Co2 vs HCO3

110
Q

What defines Partially Compensated

A

A change in the opposite system

Resp vs metabolic/renal

Co2 vs HCO3

111
Q

What defines Corrected

A

pH back to normal

even though the other two are messed up

Co2 vs HCO3

112
Q

pH 7.1
co2 26
hco3 19

A

7.1 acid
27 low alk (system thats compensating)
19 acid META

Partially Compensated Metabolic Acidosis

113
Q

pH 7.6
co2 25
hco3 20

A

7.6 alk
co2 25 low alk RESP
hco3 20 acid (system that’s compensating)

Partially Compensated Respiratory Alkalosis

114
Q

For PED needle cric what size syringe and what size ET tube cap do you use

A

3 cc syringe
and 7 ET tube cap

115
Q

What defines a COMPENSATED

A

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
Q

pH 7.42
Co2 24
hco3 19

A

Compensated Respiratory
Alkalosis

117
Q

Increase of H+ makes it more

Decrease of H+ makes it more

A

increase - acidic

decrease - alk

118
Q

pH is used to express the ______ of a solution

A

acidity

119
Q

Hydrogen value falls

what does this indicate

A

alkalosis

120
Q

a acidic chem solution has a pH

a alk chem solution has a pH

A

ACIDIC <7 less than

ALK >7 greater than

121
Q

Resp of 4
ETC02 is 54

A

Respiratory Acidosis

Immediate BVM
ET- maybe (gag reflex?)

Normal vent rate

if bvm is working give IV med

bvm not working give IN

122
Q

7.51
co2 42
hco3 29

A

Uncompensated
Metabolic
Alkalosis

123
Q

7.16
co2 51
Hco3 25

A

Uncompensated
respiratory
Acidosis

124
Q

What vol-control mode of vent kicks on when a patient takes a spontaneous breath with full tidal volume

A

assist control

125
Q

What are two volume control modes of vent

A

Assist control AC
CMV
SIMV
Pressure support

126
Q

How does the blood move from heart to the lungs

A

The Pulmonary Artery

127
Q

What is Polycythemia

A

Excessive red blood cell production

128
Q

How many lobes are in the L and R lungs

A

L - 2

R - 3

129
Q

Mild Hypoxia leads to __________

then

Severe Hypoxia leads to _____________

A

tachycardia

then

bradycardia

130
Q

The Diaphragm _________ during inhalation

A

flattens

131
Q

Hypoventilation causes

A

Acidosis

co2 goes up causing pH to go down

132
Q

What is Atelectasis

A

Colapse of the aveoli

133
Q

What is Guillain-Barre Syndrome?

A
134
Q

What are signs of DKA

A

kaussmals
high bgl

135
Q

What is PND

A

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
Q

How does an Emphysema patient present

A

Pink Puffer

Barrel chest, pursed-lips, tachypnea

137
Q

How does a Chronic Bronchitis patient present

A

Sleeps upright
Productive cough - waste basket full of used tissues, secretions

138
Q

Define Pulsus Paradoxus

A

distal pulse disappears with deep breathing in and returns with breath out

139
Q

Grunting is a _______ airway obstruction

A

lower

140
Q

Pink frothy sputum is an indication of

A

Heart failure

141
Q

Define Ataxic Respiration

A

irregular breathing

142
Q

For the Stethoscope

Diaphragm is for

Bell is for

A

Diaphragm is for High pitch

Bell is for low pitch

143
Q

What is % for good O2

A

92-98%

144
Q

Two most common UPPER ped airway emergencies

A

Croup and Pneumonia

145
Q

What do you suspect

Hours to Days onset
Weakness
Fever
Productive cough

A

Pneumonia

146
Q

Which cranial nerve is major for the parasympathetic nervous system

A

X the vagus nerve

147
Q

CPAP is NOT considered _______________

A

is NOT positive pressure ventilation

148
Q

Define Poiseuille Law

A

As the diameter of a tube decreases, the resistance to flow increases

149
Q

What are two forms of COPD

A

Emphysema
Chronic Bronchitis

(Lower airway disease)

150
Q

Emphysema vs Chronic Bronchitis

A

Emphysema - from damage alveoli have less area for gas exchange

Bronchitis - Sputum production for more than 2 years, productive cough (BLUE BLOATERS)

151
Q

What is the nickname for Chronic Bronchitis

A

Blue Bloaters

High Co2

152
Q

What is the nickname for Emphysema

A

Pink Puffers

Barrel chest, cant sleep at night, purse lips

High co2

153
Q

What is Cystic Fibrosis and Treatment

A

Chronic Production of Mucous

Supportive care O2

154
Q

Treatment for Epiglotitis

A

BVM,and poss ET tube (1-2 sizes smaller)

Limit agitation

155
Q

Treatment for Croup

A

IM Epi
Dex - corticosteroids
Neb Epi

IF ET needed use 0.5-1mm smaller

156
Q

What Does Sharkfin Wave form Indicate

A

Bronchospasm/Bronchoconstriction

Difficulty during the exhalation phase with incomplete alveolar emptying

COPD, asthma

157
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

158
Q

What does this Capno waveform indicate?

A

Hyperventilation

Shorter-than-normal intervals between waveforms

Alk Capno - below 35

159
Q

What is the normal Capno ETCO2 Range?

Which is ALK or ACID?

A

(ALK) 35 - 45 (ACID)

below 35 hyperventilation

above 45 hypoventilation

160
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

161
Q
A
161
Q

What are the 3 primary buffer systems in order of speed

A

1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)

162
Q

Name
Airway sound
Indication
Treatment

A

Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET

163
Q

What are 4 signs of acidosis

A

CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin

164
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

165
Q

What are 4 important intubation landmarks?

A
  1. Epiglottis
    2.Glottic opening
  2. Vocal cords
  3. Arrytenoid cartillage (both sides)
166
Q

What is the normal total lung capacity of an adult man?

what is it broken into (4) ?

A

6,000mL total

  1. Inspiratory - 3,000 mL
  2. Expiratory - 1,200 mL
  3. Residual - 1,200 mL
  4. Tidal Volume - 500mL
167
Q

What is Tidal volume?

A

The amount of air that is moved into or out of the lungs during a single breath.

168
Q

Define Oxygenation

A

loading oxygen ONTO HEMOGLOBIN in the blood stream

169
Q

Define Respiration

A

Actual GAS EXCHANGE of oxygen and CO2 in the alveoli

170
Q

Define Ventilation

A

PHYSICAL act of MOVING air in/out of lungs

171
Q

The most air inhalation occurs when the diaphragm is ______________

A

contracted

(for negative pressure)

172
Q

Sedative drug and Dose (used for RSI)

A

Ketamine IV/IO

2mg/kg over 1 min

173
Q

Paralytic and Dose

(Dep and Non-Dep)

A

Dep-

SUCCS 1.5mg/kg IV/IO (rapid)

Non-Dep -

VECURONIUM 0.1mg/kg IV/IO

174
Q

Dose for Midazolam as a sedative (RSI)

A

18-68 y/o - 5mg IV/IM

69 (or over) - 2.5mg IV/IM

consult for repeat dose

175
Q

How can you tell proper size for PED ETT

A
  1. (Age in years /4) + 4
  2. size of patient pinky
176
Q

What does DOPE stand for

A

Dislodged
Obstruction
Pneumothorax
Equipment Malfunction

177
Q

Define KUSSMAULS

A

a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)

178
Q

Define CHEYNE-STOKES

A

Fast, SHALLOW, followed by slow, heavier and/or moments of apnea

179
Q

Signs of PNEUMONIA

and

Treatment

A

Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness

Crackles

Treatment:
CPAP, Supportive care

180
Q

Causes of

LOW pressure alarm on vents

and

HIGH pressure alarm on vents

A

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
Q

When do we give CPAP?

(and don’t)

A

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
Q

Where does EXTERNAL respiration occur?

A

Alveoli

and

pulmonary CAPILLARIES

183
Q

Where does INTERNAL respiration occur?

A

CELLS

and

BLOOD VESSELS

184
Q

What is FiO2

A

Its the percentage of oxygen in inhaled air (inspired)

185
Q

Define Biots

(caused by)

A

An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)

186
Q

What does LEMON mean, stand for

A

Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility

187
Q

Decrease the number of H+ (hydrogen) ions the more __________

A

Alkaline

Raises the PH

188
Q

What is a normal
PH range
Co2 Range

A

7.35-7.45
35-45
22-26

189
Q

What regulates the bicarbonate buffer

A

the kidneys

190
Q

What is the ratio of buffers to acids (bicarb to carbonic)

A

1:20

191
Q

What are the types of Resp Failure

A

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
Q

How do you treat type 1 resp failure

A

Increase FiO2 100% = 1.0 (Room air = 0.21)

Increase Mean airpressure

increase oxygen supply

193
Q

How do you treat type 2 resp failure

A

Increase patient minute ventilation (ve)
(increase resp rate or tidal vol - v1)

set tidal vol based on body weight

194
Q

Magnesium Sulfate

(whats it for)

A

For Bronchospasm -

IV/IO 1-2g in 50-100mL

195
Q

What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)

A

Hering-Breuer Reflex

196
Q

Name 4 uses of CAPNO

A

detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent

197
Q

A decreased tidal vol and decreased resp rate would show ____________ on ETCO2

A

Increased CO2

because of hypo vent

198
Q

For NO D Sat how much would O2 would you give an 9 y/o patient

A

below 6 y/o - 6ltrs

+1 for every year after 6

9y/o = 9 ltrs

up to age 15

199
Q

What happens to PH when the bicarb levels decrease

What does the body do?

A

The PH decreases and becomes more acidic

The body compensates with INCREASE in resp rate

200
Q

What happens to PH when the bicarb levels increase

A

The PH Increases and become alkalotic but the bodys resp rate Decreases.

201
Q

Define PACO2

A

its the partial pressure of co2 in ARTERIAL blood

202
Q

If the ETCO2 is high (greater than 45mmHG)

what should you do?

A

INCREASE your ventilatory rate

the patient is holding on to too much co2

203
Q

if the ETCO2 is low (lower than 35mmHG)

what should you do?

A

DECREASE your ventilatory rate

the patient needs to save more co2

204
Q

What is the dip at the top of the wave form called (during exhalation)

A

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
Q

ph 7.6
co2 28
HCO2 29

A

Mixed Alkalosis

ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk

206
Q

ph 7.44
co2 37
hco3 25

A

normal

no acid/base disturbance

207
Q

What are normal levels for arterial blood gas measurement and what does each one measure

A

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
Q

Ph 7.2
CO2 37
HCO3 21

A

Metabolic Acidosis

uncompensated (no change in co2, resp)

7.2 - ph under 7.35 acid
co2 normal
21 - hco3 under 22 acid (metabolic)

209
Q

ph 7.6
co2 42
hco3 30

A

Metabolic Alkalosis

uncompensated (no change in co2, resp)

7.6 - ph over 7.45 alk
co2 normal
30 - hco3 over 26 (metabolic)

210
Q

The Renal system is also known as the

A

Metabolic System

(HCO3 measures it)

211
Q

What defines Uncompensated

A

No change in the opposite system

Resp vs metabolic/renal

Co2 vs HCO3

212
Q

What defines Partially Compensated

A

A change in the opposite system

Resp vs metabolic/renal

Co2 vs HCO3

213
Q

What defines Corrected

A

pH back to normal

even though the other two are messed up

Co2 vs HCO3

214
Q

pH 7.1
co2 26
hco3 19

A

7.1 acid
27 low alk (system thats compensating)
19 acid META

Partially Compensated Metabolic Acidosis

215
Q

pH 7.6
co2 25
hco3 20

A

7.6 alk
co2 25 low alk RESP
hco3 20 acid (system that’s compensating)

Partially Compensated Respiratory Alkalosis

216
Q

What defines a COMPENSATED

A

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
Q

pH 7.42
Co2 24
hco3 19

A

Compensated Respiratory
Alkalosis

218
Q

Increase of H+ makes it more

Decrease of H+ makes it more

A

increase - acidic

decrease - alk

219
Q

Resp of 4
ETC02 is 54

A

Respiratory Acidosis

Immediate BVM
ET- maybe (gag reflex?)

Normal vent rate

if bvm is working give IV med

bvm not working give IN

220
Q

7.51
co2 42
hco3 29

A

Uncompensated
Metabolic
Alkalosis

221
Q

How does the blood move from heart to the lungs

A

The Pulmonary Artery

222
Q

The Diaphragm _________ during inhalation

A

flattens

223
Q

How does an Emphysema patient present

A

Pink Puffer

Barrel chest, pursed-lips, tachypnea

224
Q

How does a Chronic Bronchitis patient present

A

Sleeps upright
Productive cough - waste basket full of used tissues, secretions

225
Q

Grunting is a _______ airway obstruction

A

lower

226
Q

Pink frothy sputum is an indication of

A

Heart failure

227
Q

What do you suspect

Hours to Days onset
Weakness
Fever
Productive cough

A

Pneumonia

228
Q

Emphysema vs Chronic Bronchitis

A

Emphysema - from damage alveoli have less area for gas exchange

Bronchitis - Sputum production for more than 2 years, productive cough (BLUE BLOATERS)

229
Q

What is the nickname for Chronic Bronchitis

A

Blue Bloaters

High Co2

230
Q

What is the nickname for Emphysema

A

Pink Puffers

Barrel chest, cant sleep at night, purse lips

High co2

231
Q

Treatment for Epiglotitis

A

BVM,and poss ET tube (1-2 sizes smaller)

Limit agitation

232
Q

Treatment for Croup

A

IM Epi
Dex - corticosteroids
Neb Epi

IF ET needed use 0.5-1mm smaller

Paramedic (24 decks)

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