AIRWAY Flashcards
Ventilation
Physical act of moving air in and out of the lungs
Oxygenation
Loading oxygen molecules onto hemoglobin in bloodstream
Respiration
Exchange of oxygen and carbon dioxide in alveoli and tissues of body
Another name for internal respiration is…
Cellular respiration
Another name for external respiration
Pulmonary respiration
During exhalation, ____ signal _____ as chest expands, which _____ respiration
Stretch receptor; apneustic center; inhibits
Inhalation/Exhalation Feedback Loop
which prevents overinflation of lungs
Herring-Breuer Reflex
What is FiO2, fraction of inspired oxygen?
% O2 in inhaled air
Hyperventilate
Rapid / Deep
CO2 elimination exceeds production
PaCO2 decrease
Hypocapnia
Resp Alkalosis
Hypoventilate
Slow and Shallow
CO2 production exceeds elimination
PaCO2 increase
Hypercapnia
Resp Acidosis
Difference in O2 level,
high altitude vs closed space
Decreased PaO2 vs
Decreased amt of O2
METABOLIC ACIDOSIS
primary; pH; compensation
Ex. Hypoglycemia
HCO3 decrease
pH decrease
pCO2 decrease
METABOLIC ALKALOSIS
primary; pH; compensation
Ex. Hyperglycemia
HCO3 increase
pH increase
pCO2 increase
RESPIRATORY ACIDOSIS
primary; pH; compensation
Ex. hypoventilate
pCO2 increase
pH decrease
HCO3 increase
RESPIRATORY ALKALOSIS
primary; pH; compensation
Ex. hyperventilate
pCO2 decrease
pH increase
HCO3 decrease
Tracheal / Bronchial sound
Higher/louder pitch/intensity
Auscultate on trachea/sternum
Abnormal if heard elsewhere
Bronchiovesicular sound
Midrange pitch/intensity
1:1
Throughout but most at upper 1/3 chest
Vesicular sound
Low pitch/intensity
3:1
Throughout but mostly at base
Wheezing
Continuous, HIGH pitch
“Whistle” due to constricted lower airway
Heard during in, ex, both
Asthma, COPD, …
Rhonchi
Continuous, LOW pitch
“snoring/rumbling/gurgling” fluid in larger lower airways
During in, ex, both
@center of chest most prominent
Can clear by coughing
COPD, cystic fibrosis, pneumonia, …
Crackles sounds
Discontinuous, LOW pitch
“crackle/popping/bubbling” fluid in smaller lower airways
During early/late inspiration
Severe P.E., pneumonia, chronic bronchitis, …
Stridor sounds
Loud, HIGH pitch
During inspiration
@upper airway above glottis
Upper airway obstruction
Pleural Friction Rub sound
“stepping over snow, cat purr”
LOW pitch, Both In & Out
@one spot
Cheyne-Stokes Respirations
apnea, gradual increase, gradual decrease, apnea
due to cardiac insult —> brainstem insult
Or during none-REM sleep
Kussmaul Respirations
deep, shallow —> deep, labored, gasping
sweet odor
seen in diabetic ketoacidosis
Biot (Ataxic) Respirations
irregular pattern, rate, depth with intermittent apneas
due to increased ICP
Agonal Gasps
slow, shallow, irregular or occasional gasping breath
Due to cerebral anoxia; may be seen when cardiac arrest
(brain sending signal even after heart stopped)
Normal Arterial pH
7.35-7.45
Normal Arterial PaO2
80-100mmHg
Normal Arterial PaCO2
35-45mmHg
SaO2
> 95%
LEMON
Look externally
Evaluate 3-3-2
Mallampati classification
Obstruction
Neck mobility
Things to consider for L from LEMON
short thick neck, morbid obesity, dental conditions
Things to consider for E from LEMON
- Mouth opening 3 fingerbreadths
- 3 fingerbreadths tip of chin to hyoid bone
- 2 fingerbreadth from hyoid bone to thyroid notch
Things to consider for M from LEMON
Class I: posterior pharynx fully visible
Class II: posterior pharynx partially exposed
Class III: only base of uvula exposed; no post pharynx
Class IV: no structure visible
Things to consider for O from LEMON
anything that can interfere with intubation: foreign body, obesity, hematoma, masses, dentures, etc
Things to consider for N from LEMON
goal is sniffing position (tripod)
Trauma? Elderly?
Murphy’s Eye
Secondary hole at the side of the far end of ET tube to allow ventilation even if bevel gets occluded
ET Tube for female
7.0 7.5 8.0
ET Tube for male
7.5 8.0 8.5
Et Tube for peds
2.5 3.0 3.5
No cuff
Which finger to help determine right ET Tube?
Pinky finger to pick their nose
Why no cuff on ET Tube for peds?
Their glottis to cricoid ring is funnel shaped; narrowing down distally
Vallecula
Notch between the tongue and epiglottis
Depressed with tip of laryngoscope blade to lift the epiglottis up out of the way