Airway Flashcards
The primary objective of managing a patients airway is what?
To ensure optimal ventilation
How long does it take for airway or ventilatory problems to create injury or death in the brain?
4-6 minutes
What is the primary function of the respiratory system?
Provide a conduit for oxygen to enter the body and CO2 to exit the body
Respiration is what?
The process by which the body exchanges gases in the alveoli
What does the upper airway consist of?
Nose, Nasal cavities, oral cavities, pharynx, and larynx
What is the function of the upper airway?
To filter, warm, and humidify the air, protecting the surfaces of the lower respiratory tract
What does mucus do?
A secretion that lubricates and traps fine particulate matter that may enter the airway.
What are the three parts of the pharynx?
Nasopharynx, Oropharynx, and Laryngopharynx
What divides the nasal cavity into halves?
Nasal Septum
Eustachian tubes are what?
Auditory tubes from the ears
The anterior oropharynx includes what?
lips, cheeks, teeth, tongue, and hard and soft palates.
The posterior oropharynx includes what?
It opens into the oropharynx, which extends down to the epiglottis
How many teeth do adults have?
32
What is the leading cause airway obstruction in an unresponsive patient?
The tongue
What does the hyoid bone attach to and do?
It attaches to the tongue and is its primary anchor along with supporting the trachea and larynx by means of several ligaments
What is the uvula?
Fleshy tissue resembling a grape that hangs down from the middle of the soft palate.
What ends and what begins at the Uvula?
The nasopharynx ends at the uvula and the oropharynx begins.
Stimulation of the posterior pharynx triggers what?
The gag reflex
The adenoids are also called what?
Pharyngeal tonsils
The laryngopharynx helps in what what and extends from what part to what part?
It functions in respirations and digestion and extends from the epiglottis to the glottis
What is the leaflike structure composed of cartilage that serves as the gatekeeper into the larynx and prevents food from entering the lower airway?
Epiglottis
What means little valley and is a landmark between the base of the tongue and the epiglottis?
Vallecula
What joins the pharynx to the trachea prevents food and foreign substance from entering the trachea and houses the vocal chords?
Larynx
What composes the true vocal chords and the space between them?
The glottis
Pressure on the cricoid cartilage that occludes the esophagus reducing the risk of aspiration is called what?
Sellick maneuver or cricoid pressure
The membrane in between the cricoid cartilage and the thyroid cartilage is a fibrous membrane called?
Cricothyroid membrane
What does the lower airway consist of?
Trachea, Bronchial Tree, primary bronchi, secondary bronchi, bronchioles, lungs, and alveoli
Approximately how long is the trachea in an adult before it bifurcates into the right and left bronchi?
10-12cm
What is the point where the trachea divides?
Carina
The point of entry for the bronchial vessels, bronchi, and nerves in each lung is called?
The hilum
What lubricates the alveoli, decreasing surface tension and facilitating ease of expansion?
Surfactant
Alveolar collapse is called what?
Atelectasis
What lines the surface of the lungs?
The Pleura
In pediatric patients what should be done differently when ventilating?
Padding under the torso because of a large head.
Hyperextension and hyperflexion can occlude an airway because cartilaginous rings of the trachea do not fully develop until 8 yrs old.
The tongue occupies greater space in the oral cavity.
In infants the epiglottis is large, long and U-shaped.
The larynx in the ped. is located at C1-C4 as opposed to an adult where it is located at C4-C7.
The child has two separate channels one for food and one for air. The epiglottis can pass behind the soft palate and lock into the nasopharynx. This connection is constant except in crying and disease. At age 7 the epiglottis no longer attaches to the soft palate and is located at C3-C5.
The Diaphragm is horizontal in infants and results in decreased contraction efficiency.
Intercostal muscles are immature and fatigue easily.
Flexibility to ribs is much greater and can result in organ injury without rib fracture.
Peds. have fewer and smaller alveoli.
The short trachea of a child may result in right bronchi intubation or removal of the endotracheal tube also called?
Extubation
The mechanical process of moving air into and out of the lungs is called?
Ventilation
Where does the primary stimulus to breathe come from?
The Medulla oblongota
What prevents the overinflation of the lungs in a conscious, spontaneously breathing person?
The Hering-Breuer reflex
Each combination of inspiration and expiration is called what?
The respiratory cycle
Normal Tidal volume in an adult male is what?
500mL
What is Tidal volume for an infant?
8mL/kg
The exchange of gases between a living organism and its environment is called?
Respiration
The exchange of gases between the alveoli of the lungs and the red blood cells traveling through the pulmonary capillaries is called what?
External respiration
Gases exchanged between blood cells and tissues is called what?
Internal respiration
The pressure exerted by each individual gas in a mixture is called?
Partial pressure
What four main gases are found in the earths atmosphere?
Nitrogen, Oxygen, Water Vapor, and CO2
When hemoglobin has oxygen molecules bound to it what is it called?
oxyhemoglobin
A non-invasive way of measuring the percentage of oxygen bound to hemoglobin is what?
Pulse oximetry
Oxygen saturation above what number is considered normal?
98%
How much of venous hemoglobin is bound with CO2?
33%
What refers to a decreased amount of oxygen saturated hemoglobin in the blood stream?
Hypoxemia
What refers to a decreased amount of oxygen in the tissues?
Hypoxia
What is the most common cause of Hypoxia?
Hypoxemia
What is the earliest indication of hypoxia?
restlessness and anxiety
Why does cyanosis occur?
Circulating deoxygenated blood
Cyanosis occurs at what concentration?
5mg/dl or less
What is the initial management of hypoxia?
Providing supplemental oxygen or increasing ventilation
Any condition that results in hypoventilation increases what?
CO2 levels in the blood or hypercarbia
Any condition that results in hyperventilation leads to what?
hypocarbia or blowing off to much CO2
If the medulla fails to send signals for respiration what is the secondary control center?
The pons or apneustic center (control of inspiration) and pneumotaxic center (control of expiration)
Receptors designed to monitor O2 and CO2 in the body are called?
chemoreceptors
What is responsible for respiratory center stimulation?
CSF circulating in the brain and its pH balance
When the body is desensitized to high levels of CO2 a backup regulatory mechanism that responds to levels of oxygen in the blood is called?
Hypoxic drive
Cricoid cartilage starts what?
The trachea
Cricoid cartilage is the only what of the tracheal cartilage?
full ring
Look at box 14-1 on page?
476
The patient sits upright and leans forward, supported by his or her arms, with the neck slightly extended, chin projected, and mouth open which helps maximize airflow through the lower airways is called?
Tripod position
Sitting up with head at a 45 degree angle is called?
Semi-Fowlers
An uncomfortable awareness of one’s breathing is called?
Dyspnea
A total lack of oxygen available to the tissues is called?
Anoxia
Geographic landmarks for the chest include what?
Clavicles, Nipples, angle of Louis, suprasternal notch, and costal angle
A depression that is easily felt at the base of the anterior aspect of the neck, just above the angle of Louis is called?
Suprasternal notch
The angle formed by the margins of the ribs at the sternum is called?
Costal angle
When dyspnea is relieved by a change in position it is called?
Orthopnea
A portion of the chest appears to move in the opposite direction of the rest of the chest is called?
Paradoxic motion
The affected part of the chest in paradoxical movement is called the?
Flail segment
Patients with emphysema commonly exhale how?
with pursed lips
The resistance of the patients lung tissue to ventilation is called?
compliance
The primary goal of auscultation is what?
To determine if lung sounds are present and equal bilaterally.
Look at box 14-2 and 14-3 and 14-4
page 482, pg 483
4 basic drugs that are used for respiratory are?
O2, Albuterol 2.5-5mg, Ipratropium 0.25-0.5mg, Methylpredinoslone (Solu-Medrol) 40-80mg
4 drugs for Respiratory that are new are?
- Hydrocorisone sodium Chloride 100-500mg IV,IO,IM Ped 2-4mg/kg,
- Aminophylline- bronchodilator Loading dose 5mg/kg IV,IO over 20-30 min and infusion 0.4mg/kg/hr Ped dose is same
- Mag Sulfate- smooth muscle relaxer 1.2-2gmIV,IO over 20 min. Ped. 25-50mg/kg IV,IO over 20 min.
- Racemic Epi/Epi 0.5ml neb 1-3 inhalations add 3ml of dilutant to neb 0.5mg Epi1/1000 +3ml NS
A whistling sound heard on inspiration and/or expiration resulting from constriction or obstruction of the pharynx, trachea, or bronchi is called?
Wheezing
When fluid accumulates in the smaller airway passages, air passing through the fluid creates a moist crackling or popping sound heard on inspiration is called?
Crackles
Secondary to inflammation and mucous or fluid in the larger airway passages, rattles, or rhonchi, are descriptive of airway congestion heard on inspiration are called?
Rattles
A protective mechanism usually induced by mucosal irritation; the forceful, spastic expiration experienced during aids in the clearance of the bronchi and bronchioles is called
Coughing
A reflex caused by irritation of the posterior pharynx that can result in vomiting is called?
Gagging
Involuntary and periodic slow, deep breath followed by a prolonged expiratory phase is called?
Sighing
Intermittent spasm of the diaphragm that results in sudden inspiration with spastic closure of the glottis is called?
Hiccup
The purpose of the primary assessment is to seek out and find what?
all life threats, recognize that the following assessment parameters are highly significant and warrant quick attention: Altered LOC, Cyanosis, Absent breath sounds, stridor, One-to two-word dyspnea (represents poor minute volume, and use of accessory muscles
A respiratory rate that is persistently slower than normal for age is called?
Bradypnea
A respiratory rate that is persistently faster than normal for age is called?
Tachypnea
A respiratory pattern characterized by rapid, deep breathing is called?
Hyperpnea
A respiratory pattern associated with an obstruction in the pulmonary tree; the breathing rate increases to overcome resistance in getting air out, the respiratory effort becomes more shallow, the volume of trapped air increases, and the lungs inflate is called?
Air trapping
A pattern of gradually increasing rate and depth of breathing that tapers to slower and shallower breathing with a period of apnea before the cycle repeats itself is called?
Cheyne-Stokes respirations
Deep, gasping respirations that may be slow or rapid is called?
Kussmaul respirations
Irregular respirations varying in rate and depth and interrupted with periods of apnea is called?
Biot’s respirations
Similar to Kussmaul respirations; characterized as deep, rapid breathing is called?
Central Neurogenic hyperventilation
Slow, shallow, irregular respirations resulting from anoxic brain injury is called?
Agonal respirations
What is the equation to calculate how many minutes are remaining in your air tank?
Minute remaining= Tank pressure (psi)x0.28/flow (L/min)
At 6 to 10L/min, simple face mask can provide an inspired oxygen concentration of approximately?
40-60%
What are the three classifications of airway obstructions?
complete obstruction, partial obstruction with poor air exchange, partial obstruction with good air exchange.
What are common causes leading to obstruction in the airway?
tongue, foreign bodies, laryngeal spasm and edema, trauma, and aspiration
What is the purpose of suctioning?
To remove vomitous, saliva, blood, or other material from the patient’s airway
To improve gas exchange by allowing air to pass to the lower airway
To prevent atelectasis
There are essentially two types of catheters, what are they?
Rigid(hard, tonsil tip, or Yankauer catheters) or soft (whistle tip, flexible, or French catheters)
How long should you suction in adults, children, and newborns?
Adults 10-15 seconds
Children no longer than 10 seconds
Newborn no longer than 3-5 seconds
per attempt
Possible suctioning complications are?
Hypoxia Dysrhythmias Increased intracranial pressure Local swelling Hemorrhage Tracheal ulceration Tracheal infection Bronchospasm Bradycardia and hypotension from vagal stimulation Tachycardia Hypertension
Oral airways have what range of sizes?
0-6
Forcing air into the lungs is called?
Positive pressure ventilation
Forcing air into the stomach instead of the lungs is called?
Gastric distension
A bag mask device used without supplemental oxygen delivers what %age of oxygen to the patient?
21% or room air
A bag mask device used with supplemental oxygen set at a flow rate of 15L/min. when an oxygen reservoir is not used delivers what %age of oxygen to the patient?
Approximately 40-60%
A bag mask device used with supplemental oxygen set at a flow rate of 15L/min. when an oxygen reservoir is used delivers what %age of oxygen to the patient?
90-100%
The number one reason a bag valve mask doesn’t work or causes difficulty for good ventilation is what?
A good seal on the mask to face
When troubleshooting a BVM you should?
Reposition the head
Check the seal of the mask
Check airway obstruction
Settings on an Automatic transport ventilator are?
Tidal volume
Ventilatory rate
Inspiratory time
ATV’s should not be used in patients with what?
increased airway resistance
Asthma
ARDS (adult respiratory distress)
Presence of a pneumothorax
500-600ml of volume to make the chest rise with each breath delivered should be set to what per kg in people other than adult males?
6-7ml/kg
In ATV’s the ventilation rate is what in normal adults and what in adults in cardiac arrest with an advanced airway placed?
10-12 in normal adults
8-10 with advanced airway placed
What does a FROPVD stand for?
Flow restricted, oxygen-powered ventilation device
A surgical opening into the trachea between the tracheal rings is called?
Tracheostomy
The surgical opening created in the anterior neck is called?
Tracheal stoma
The most common complications with tracheostomy tubes is what?
dislodgment of the tube
obstruction of the tube
infection
Normal respiratory rates by age are what for the following: Infant (1-12months) Toddler (1-3years) Preschooler (4-5 years) School-age (6-12 years) Adolescent (13-18 years) Adult (18 years and older)
Infant (1-12months)- 30-60 Toddler (1-3years)- 24-40 Preschooler (4-5 years)- 22-34 School-age (6-12 years)- 18-30 Adolescent (13-18 years)- 12-16 Adult (18 years and older)- 12-20
Normal respiratory rates by age are what for the following: Infant (1-12months) Toddler (1-3years) Preschooler (4-5 years) School-age (6-12 years) Adolescent (13-18 years) Adult (18 years and older)
Infant (1-12months)- 30-60 Toddler (1-3years)- 24-40 Preschooler (4-5 years)- 22-34 School-age (6-12 years)- 18-30 Adolescent (13-18 years)- 12-16 Adult (18 years and older)- 12-20
An advanced airway procedure in which a tube is placed directly into the trachea is called?
ET intubation
An instrument used to assist in visualization of a number of anatomic markers, such as teeth, tongue, epiglottis, vocal cords, and the glottic opening is called?
Laryngoscope
Generally when is ET intubation indicated in patients?
Patients with apnea, existing or impending respiratory failure, or the inability to protect the airway
A relatively stiff but flexible metal rod covered by plastic and inserted into an ET tube is called?
Stylet
The stylet should be recessed how much in the ET tube?
1/2 inch
In tracheal intubations the patient should be oxygenated for how long?
30 seconds to one minute
Do not exceed what amount of time from ventilation to ventilation for what?
each intubation attempt
Advance the ET tube how far past the vocal chords?
til the proximal end of the cuff is 1/2 inch to 1 inch past the vocal chords
Advance the ET tube how far past the vocal chords?
til the proximal end of the cuff is 1/2 inch to 1 inch past the vocal chords
What are some possible complications in ET intubations?
Bleeding Laryngospasm Vocal chord damage Mucosal necrosis Barotrauma Aspiration Cuff leak Esophageal intubation Right main stem intubation Tube occlusion by patient biting tube Laryngeal or tracheal edema Hypoxia from prolonged or unsuccessful intubation Dysrhythmias Trauma to face ICP
Sizes for tubes when intubating a child are calculated how?
Age/4+4=uncuffed tube size
The proper depth of an ET tube is approximately 3x the depth of the tube size. For a tube that is 7 what is the depth?
21
The uses of medications to sedate and paralyze a patient to achieve ET intubation rapidly is called?
RSI or Rapid-sequence intubation
What are the possible indications for RSI?
- Excessive work of breathing, which may lead to fatigue and respiratory failure
- Combative patients requiring airway control
- Uncontrolled seizure activity
- Functional or anatomic airway obstruction
- Head trauma and Glasgow Coma Scale score less than 8
- Severe asthma
- Inadequate central nervous system control of ventilation
What are the possible indications for RSI?
- Excessive work of breathing, which may lead to fatigue and respiratory failure
- Combative patients requiring airway control
- Uncontrolled seizure activity
- Functional or anatomic airway obstruction
- Head trauma and Glasgow Coma Scale score less than 8
- Severe asthma
- Inadequate central nervous system control of ventilation
The mallampati scale refers to what?
The size of the tongue compared to the size of the opening of the mouth
How many fingers should fit between the lower and upper incisors in RSI?
3
Adjunctive medications or agents are what?
Initial medications administered during RSI to minimize physiologic responses sometimes associated with intubation
What two drugs are commonly given in RSI
Atropine an anticholinergic or Lidocaine which diminishes cough and gag reflexes and diminishes ICP
Does the sedative get administered before or after the paralytic in RSI?
before
An emergency procedure performed to allow rapid entrance to the airway (by way of the cricothyroid membrane) for temporary oxygenation is called?
Cricothyrotomy
Conditions in which Cricothyrotomy is indicated are?
Intubation is difficult or impossible Complete upper airway obstruction Laryngeal fracture Craniofacial abnormalities Respiratory arrest or near arrest Delayed or inability to ventilate in any other way
Conditions in which Cricothyrotomy is contraindicated are?
Ability to ventilate by less aggressive means
Inability to identify landmarks
Primary laryngeal injury
Infralaryngeal obstruction
At what age is a cricothryotomy absolutely contraindicated and what age is relatively contraindicated?
5 years and younger is absolutely contraindicated
5-8 is relatively contraindicated
SPO2 stands for what?
Saturation of peripheral oxygen
A contraindication for a combitube is esophageal varices, true or false?
true
