118 Mod 4 (Airway, Acid) Flashcards
What Does Sharkfin Wave form Indicate
Bronchospasm/Bronchoconstriction
Difficulty during the exhalation phase with incomplete alveolar emptying
COPD, asthma
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
What does this Capno waveform indicate?
Hyperventilation
Shorter-than-normal intervals between waveforms
Alk Capno - below 35
What does this Capno waveform indicate?
Rebreathing
waveforms never return to 0mmHg
What is the normal Capno ETCO2 Range?
Which is ALK or ACID?
(ALK) 35 - 45 (ACID)
below 35 hyperventilation
above 45 hypoventilation
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
What are the 3 primary buffer systems in order of speed
1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)
Name
Airway sound
Indication
Treatment
Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET
What are 4 signs of acidosis
CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin
Acidosis is an ___________ in H+ Ions
Alkalosis is a ____________ in H+ Ions
Acid - increase in Ions - pH down
Alk - decrease in Ions - pH up
Miller Blade does what?
Mac Blade does what?
Miller - made so tip will extended beneath the epiglottis and LIFT it up
Mac - tip placed IN vallecula, indirectly lifting the epiglottis
What are 4 important intubation landmarks?
- Epiglottis
2.Glottic opening - Vocal cords
- Arrytenoid cartillage (both sides)
What is Boyle’s Law
Pressure of a gas is inversely proportional to its volume
the pressure outside is higher than air pressure inside (thorax)
Name the parts
A. Vallecula
B. Epiglottis
C. Vocal Cords
D. PIRIFORM Fossae
E. Arytenoid/Corniculate
Name the parts
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
Define Hypoxic Drive
Brain (CSF) starts using oxygen chemoreceptors to control breathing instead of normally CO2 receptors
usually end-stage COPD
The Brain metabolizes
____ % of the body’s glucose
and
_____% of Total Body O2
25% of the body’s glucose
and
20% of total body O2
What are the 3 vital centers of the Medulla?
- Cardiac - HR, strength of contraction
- Vasomotor - dia of blood vessels, BP
- Respiratory - w/ PONS, cough/swallow
What does Surfactant do?
It reduces surface tension &
keeps alveoli expanded
What is the normal total lung capacity of an adult man?
what is it broken into (4) ?
6,000mL total
- Inspiratory - 3,000 mL
- Expiratory - 1,200 mL
- Residual - 1,200 mL
- Tidal Volume - 500mL
What is Tidal volume?
The amount of air that is moved into or out of the lungs during a single breath.
What is Dead Space?
The area of the lung that has little or no gas exchange
usually 150mL
Define Oxygenation
loading oxygen ONTO HEMOGLOBIN in the blood stream
Define Respiration
Actual GAS EXCHANGE of oxygen and CO2 in the alveoli
Define Ventilation
PHYSICAL act of MOVING air in/out of lungs
Which cervical nerves control the diaphragm
C3 thru C5 keep the diaphragm alive
The diaphragm is both a ________ and _________ muscle
voluntary (skeletal)
and
involuntary (smooth)
The most air inhalation occurs when the diaphragm is ______________
contracted
(for negative pressure)
Oxygenation _____________ occur without ventilation.
Ventilation is possible _________ Oxygenation.
Oxygenation __cannot__ occur without ventilation.
Ventilation IS possible without Oxygenation.
Sedative drug and Dose (used for RSI)
Ketamine IV/IO
2mg/kg over 1 min
Paralytic and Dose
(Dep and Non-Dep)
Dep-
SUCCS 1.5mg/kg IV/IO (rapid)
Non-Dep -
VECURONIUM 0.1mg/kg IV/IO
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
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
How can you tell proper size for PED ETT
- (Age in years /4) + 4
- size of patient pinky
What does DOPE stand for
Dislodged
Obstruction
Pneumothorax
Equipment Malfunction
When can a cricothyrotomy be performed?
a. “Can’t Intubate, Can’t Ventilate”
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
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
Define KUSSMAULS
a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)
Define CHEYNE-STOKES
Fast, SHALLOW, followed by slow, heavier and/or moments of apnea
How can you tell Pneumo or Hemothorax
Pneumo - hyper-resonance to percussion
Hemothorax - hypo-resonance
Define Cystic Fibrosis
Gene mutation, thick mucus, chronic infection, and inflammatory response
Define Carpopedal Spasms
Hands and feet become clenched
Respiratory alkalosis
Hyperventilation Capno CO below 35
Signs of PNEUMONIA
and
Treatment
Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness
Crackles
Treatment:
CPAP, Supportive care
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
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
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
What is ARDS
and signs of
Acute Respiratory Distress Syndrome
Severe shortness of breath, labored and unusually rapid breathing, hypotension, confusion, and extreme tiredness
What 2 Resp Emergencies
are VENTILATION related
- Hemo/Pneumo - air collecting in the chest cavity
2., Flail Chest - lungs can’t fill with broken rib
Where does EXTERNAL respiration occur?
Alveoli
and
pulmonary CAPILLARIES
Where does INTERNAL respiration occur?
CELLS
and
BLOOD VESSELS
Define RHINORRHEA
What conditions may be associated
Thin, clear nasal discharge
Asthma,
Pneumonia,
Chronic BRONCHITIS,
COVID, RSV
(wet respiratory conditions)
What is V/Q Mismatch?
A failure to match ventilation and Perfusion
What are the 2 types of Respirations (which EXTERNAL or INTERNAL) ?
- PULMONARY Resp is EXTERNAL (alveoli)
- CELLULAR Resp is INTERNAL (in cells)
Early signs of Hypoxia
Late signs of Hypoxia
Early:
Restlessness, Irritability, Tachy, Anxiety
Late:
AMS, Weak pulse, CYANOSIS, dyspnea
Define Epiglottis
flap closes over the trachea during swallowing.
Define Intrinsic and Extrinsic
Intrinsic (internal)
extrinsic (external)
pertaining to airway obstructions
What are medications that suppress the CNS (breathing)
Opiates
Opioids
Benzos
What is FiO2
Its the percentage of oxygen in inhaled air (inspired)
Define Biots
(caused by)
An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)
Define BURP
Backward,
Upward,
Rightward
Pressure
to improve the laryngoscopic view of the glottis
(also called external laryngeal manipulation)
Anoxia
Absence of oxygen
Dissociative anesthetic
A medication that distorts the perception of sight and sound and induces a feeling of detachment from environment and self.
What does LEMON mean, stand for
Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility
Define Peak Expiratory Flow
Estimate of the extent of bronchoconstriction, to determine if therapy is working
Paralytics are also known as
neuromuscular blocking agents
Decrease the number of H+ (hydrogen) ions the more __________
Alkaline
Raises the PH
What is a normal
PH range
Co2 Range
7.35-7.45
35-45
22-26
Removal of Acids is performed by
Lungs and Kidneys
What regulates the bicarbonate buffer
the kidneys
What is the ratio of buffers to acids (bicarb to carbonic)
1:20
CPAP does not change (this airway measurement)
Tidal Volume
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
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
How do you treat type 1 resp failure
Increase FiO2 100% = 1.0 (Room air = 0.21)
Increase Mean airpressure
increase oxygen supply
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
ET suction landmark for adults and peds
Sternal notch for adults
Xfoid Process for Peds
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)
Magnesium Sulfate
(whats it for)
For Bronchospasm -
IV/IO 1-2g in 50-100mL
What cells line the airways and produce mucous
Goblet Cells
How does blood PH level effect breathing
acidic - stimulates breathing
alkalotic - slows breathing
Alveoli function best when they are
partially inflated
What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)
Hering-Breuer Reflex
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
How can you assess gag reflex
Use eyelash reflex
Name 4 uses of CAPNO
detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent
A decreased tidal vol and decreased resp rate would show ____________ on ETCO2
Increased CO2
because of hypo vent
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
What is PEEP and Define it
Positive End Expiratory Pressure
The amount of pressure that the patient exhales against
Define poor lung compliance
increased resistance during ventilation attempts
Term for positional dyspnea
Orthopnea
difficulty breathing while laying down
sign of heart failure or lung disease
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
What happens to PH when the bicarb levels increase
The PH Increases and become alkalotic but the bodys resp rate Decreases.
Define PACO2
its the partial pressure of co2 in ARTERIAL blood
Mainstream vs Sidestream Capno
Sidestream (what is used most) - pulls the gas off and measures it there
Mainstream measures the gas inline
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
What is the max for capno NC
5lpm (adult and ped)
cannot use for nodesat
cannot use for neonatal
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
if the ETCO2 is low (lower than 35mmHG)
what should you do?
DECREASE your ventilatory rate
the patient needs to save more co2
A sudden increase in ETCO2 with cardiac arrest indicates what
ROSC
return of spontaneous circulation
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)
ph 7.6
co2 28
HCO2 29
Mixed Alkalosis
ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk
ph 7.44
co2 37
hco3 25
normal
no acid/base disturbance
What do the lungs regulate
production of carbonic acid
combining carbon dioxide and water
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)
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)
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)
The Renal system is also known as the
Metabolic System
(HCO3 measures it)
What defines Uncompensated
No change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
What defines Partially Compensated
A change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
What defines Corrected
pH back to normal
even though the other two are messed up
Co2 vs HCO3
pH 7.1
co2 26
hco3 19
7.1 acid
27 low alk (system thats compensating)
19 acid META
Partially Compensated Metabolic Acidosis
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
For PED needle cric what size syringe and what size ET tube cap do you use
3 cc syringe
and 7 ET tube cap
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.
pH 7.42
Co2 24
hco3 19
Compensated Respiratory
Alkalosis
Increase of H+ makes it more
Decrease of H+ makes it more
increase - acidic
decrease - alk
pH is used to express the ______ of a solution
acidity
Hydrogen value falls
what does this indicate
alkalosis
a acidic chem solution has a pH
a alk chem solution has a pH
ACIDIC <7 less than
ALK >7 greater than
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
7.51
co2 42
hco3 29
Uncompensated
Metabolic
Alkalosis
7.16
co2 51
Hco3 25
Uncompensated
respiratory
Acidosis
What vol-control mode of vent kicks on when a patient takes a spontaneous breath with full tidal volume
assist control
What are two volume control modes of vent
Assist control AC
CMV
SIMV
Pressure support
How does the blood move from heart to the lungs
The Pulmonary Artery
What is Polycythemia
Excessive red blood cell production
How many lobes are in the L and R lungs
L - 2
R - 3
Mild Hypoxia leads to __________
then
Severe Hypoxia leads to _____________
tachycardia
then
bradycardia
The Diaphragm _________ during inhalation
flattens
Hypoventilation causes
Acidosis
co2 goes up causing pH to go down
What is Atelectasis
Colapse of the aveoli
What is Guillain-Barre Syndrome?
What are signs of DKA
kaussmals
high bgl
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
How does an Emphysema patient present
Pink Puffer
Barrel chest, pursed-lips, tachypnea
How does a Chronic Bronchitis patient present
Sleeps upright
Productive cough - waste basket full of used tissues, secretions
Define Pulsus Paradoxus
distal pulse disappears with deep breathing in and returns with breath out
Grunting is a _______ airway obstruction
lower
Pink frothy sputum is an indication of
Heart failure
Define Ataxic Respiration
irregular breathing
For the Stethoscope
Diaphragm is for
Bell is for
Diaphragm is for High pitch
Bell is for low pitch
What is % for good O2
92-98%
Two most common UPPER ped airway emergencies
Croup and Pneumonia
What do you suspect
Hours to Days onset
Weakness
Fever
Productive cough
Pneumonia
Which cranial nerve is major for the parasympathetic nervous system
X the vagus nerve
CPAP is NOT considered _______________
is NOT positive pressure ventilation
Define Poiseuille Law
As the diameter of a tube decreases, the resistance to flow increases
What are two forms of COPD
Emphysema
Chronic Bronchitis
(Lower airway disease)
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)
What is the nickname for Chronic Bronchitis
Blue Bloaters
High Co2
What is the nickname for Emphysema
Pink Puffers
Barrel chest, cant sleep at night, purse lips
High co2
What is Cystic Fibrosis and Treatment
Chronic Production of Mucous
Supportive care O2
Treatment for Epiglotitis
BVM,and poss ET tube (1-2 sizes smaller)
Limit agitation
Treatment for Croup
IM Epi
Dex - corticosteroids
Neb Epi
IF ET needed use 0.5-1mm smaller
What Does Sharkfin Wave form Indicate
Bronchospasm/Bronchoconstriction
Difficulty during the exhalation phase with incomplete alveolar emptying
COPD, asthma
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
What does this Capno waveform indicate?
Hyperventilation
Shorter-than-normal intervals between waveforms
Alk Capno - below 35
What is the normal Capno ETCO2 Range?
Which is ALK or ACID?
(ALK) 35 - 45 (ACID)
below 35 hyperventilation
above 45 hypoventilation
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
What are the 3 primary buffer systems in order of speed
1 Bicarbonate (Chemical) Buffer
2. Respiratory
3. Renal (kidneys)
Name
Airway sound
Indication
Treatment
Wheezing - asthma - Neb/Dex
Crackles - pneum, HF, Ashtma
Rhonchi - Pneum,
Stridor - upper (serious) may ET
What are 4 signs of acidosis
CNS Depression
Bradypnea - slow respirations
Nausea Vomiting Headache
Warm, Flushed Skin
Acidosis is an ___________ in H+ Ions
Alkalosis is a ____________ in H+ Ions
Acid - increase in Ions - pH down
Alk - decrease in Ions - pH up
What are 4 important intubation landmarks?
- Epiglottis
2.Glottic opening - Vocal cords
- Arrytenoid cartillage (both sides)
What is the normal total lung capacity of an adult man?
what is it broken into (4) ?
6,000mL total
- Inspiratory - 3,000 mL
- Expiratory - 1,200 mL
- Residual - 1,200 mL
- Tidal Volume - 500mL
What is Tidal volume?
The amount of air that is moved into or out of the lungs during a single breath.
Define Oxygenation
loading oxygen ONTO HEMOGLOBIN in the blood stream
Define Respiration
Actual GAS EXCHANGE of oxygen and CO2 in the alveoli
Define Ventilation
PHYSICAL act of MOVING air in/out of lungs
The most air inhalation occurs when the diaphragm is ______________
contracted
(for negative pressure)
Sedative drug and Dose (used for RSI)
Ketamine IV/IO
2mg/kg over 1 min
Paralytic and Dose
(Dep and Non-Dep)
Dep-
SUCCS 1.5mg/kg IV/IO (rapid)
Non-Dep -
VECURONIUM 0.1mg/kg IV/IO
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
How can you tell proper size for PED ETT
- (Age in years /4) + 4
- size of patient pinky
What does DOPE stand for
Dislodged
Obstruction
Pneumothorax
Equipment Malfunction
Define KUSSMAULS
a. Fast, DEEP breaths—trying to remove CO2
b. Metabolic acidosis (DKA)
Define CHEYNE-STOKES
Fast, SHALLOW, followed by slow, heavier and/or moments of apnea
Signs of PNEUMONIA
and
Treatment
Signs:
Long-term symptoms, productive cough, FEVER, CP worsened by coughing, chills, weakness
Crackles
Treatment:
CPAP, Supportive care
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
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
Where does EXTERNAL respiration occur?
Alveoli
and
pulmonary CAPILLARIES
Where does INTERNAL respiration occur?
CELLS
and
BLOOD VESSELS
What is FiO2
Its the percentage of oxygen in inhaled air (inspired)
Define Biots
(caused by)
An IRREGULAR breathing pattern rate and depth, with periods of apnea (caused by ICP)
What does LEMON mean, stand for
Look
Evauate 3-3-2 rule
Mallampati
Obstruction
Neck Mobility
Decrease the number of H+ (hydrogen) ions the more __________
Alkaline
Raises the PH
What is a normal
PH range
Co2 Range
7.35-7.45
35-45
22-26
What regulates the bicarbonate buffer
the kidneys
What is the ratio of buffers to acids (bicarb to carbonic)
1:20
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
How do you treat type 1 resp failure
Increase FiO2 100% = 1.0 (Room air = 0.21)
Increase Mean airpressure
increase oxygen supply
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
Magnesium Sulfate
(whats it for)
For Bronchospasm -
IV/IO 1-2g in 50-100mL
What causes a person to cough if too deep a breath is taken (prevents lungs from over inflating)
Hering-Breuer Reflex
Name 4 uses of CAPNO
detection of ROSC
Effective CPR
Correct Airway placement
Detect hypo/hyper vent
A decreased tidal vol and decreased resp rate would show ____________ on ETCO2
Increased CO2
because of hypo vent
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
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
What happens to PH when the bicarb levels increase
The PH Increases and become alkalotic but the bodys resp rate Decreases.
Define PACO2
its the partial pressure of co2 in ARTERIAL blood
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
if the ETCO2 is low (lower than 35mmHG)
what should you do?
DECREASE your ventilatory rate
the patient needs to save more co2
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)
ph 7.6
co2 28
HCO2 29
Mixed Alkalosis
ph over 7.45 alk
co2 under 35 alk
hco2 over 26 alk
ph 7.44
co2 37
hco3 25
normal
no acid/base disturbance
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)
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)
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)
The Renal system is also known as the
Metabolic System
(HCO3 measures it)
What defines Uncompensated
No change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
What defines Partially Compensated
A change in the opposite system
Resp vs metabolic/renal
Co2 vs HCO3
What defines Corrected
pH back to normal
even though the other two are messed up
Co2 vs HCO3
pH 7.1
co2 26
hco3 19
7.1 acid
27 low alk (system thats compensating)
19 acid META
Partially Compensated Metabolic Acidosis
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
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.
pH 7.42
Co2 24
hco3 19
Compensated Respiratory
Alkalosis
Increase of H+ makes it more
Decrease of H+ makes it more
increase - acidic
decrease - alk
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
7.51
co2 42
hco3 29
Uncompensated
Metabolic
Alkalosis
How does the blood move from heart to the lungs
The Pulmonary Artery
The Diaphragm _________ during inhalation
flattens
How does an Emphysema patient present
Pink Puffer
Barrel chest, pursed-lips, tachypnea
How does a Chronic Bronchitis patient present
Sleeps upright
Productive cough - waste basket full of used tissues, secretions
Grunting is a _______ airway obstruction
lower
Pink frothy sputum is an indication of
Heart failure
What do you suspect
Hours to Days onset
Weakness
Fever
Productive cough
Pneumonia
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)
What is the nickname for Chronic Bronchitis
Blue Bloaters
High Co2
What is the nickname for Emphysema
Pink Puffers
Barrel chest, cant sleep at night, purse lips
High co2
Treatment for Epiglotitis
BVM,and poss ET tube (1-2 sizes smaller)
Limit agitation
Treatment for Croup
IM Epi
Dex - corticosteroids
Neb Epi
IF ET needed use 0.5-1mm smaller
