Airway Flashcards
1
Q
The primary objective of managing a patients airway is what?
A
To ensure optimal ventilation
2
Q
How long does it take for airway or ventilatory problems to create injury or death in the brain?
A
4-6 minutes
3
Q
What is the primary function of the respiratory system?
A
Provide a conduit for oxygen to enter the body and CO2 to exit the body
4
Q
Respiration is what?
A
The process by which the body exchanges gases in the alveoli
5
Q
What does the upper airway consist of?
A
Nose, Nasal cavities, oral cavities, pharynx, and larynx
6
Q
What is the function of the upper airway?
A
To filter, warm, and humidify the air, protecting the surfaces of the lower respiratory tract
7
Q
What does mucus do?
A
A secretion that lubricates and traps fine particulate matter that may enter the airway.
8
Q
What are the three parts of the pharynx?
A
Nasopharynx, Oropharynx, and Laryngopharynx
9
Q
What divides the nasal cavity into halves?
A
Nasal Septum
10
Q
Eustachian tubes are what?
A
Auditory tubes from the ears
11
Q
The anterior oropharynx includes what?
A
lips, cheeks, teeth, tongue, and hard and soft palates.
12
Q
The posterior oropharynx includes what?
A
It opens into the oropharynx, which extends down to the epiglottis
13
Q
How many teeth do adults have?
A
32
14
Q
What is the leading cause airway obstruction in an unresponsive patient?
A
The tongue
15
Q
What does the hyoid bone attach to and do?
A
It attaches to the tongue and is its primary anchor along with supporting the trachea and larynx by means of several ligaments
16
Q
What is the uvula?
A
Fleshy tissue resembling a grape that hangs down from the middle of the soft palate.
17
Q
What ends and what begins at the Uvula?
A
The nasopharynx ends at the uvula and the oropharynx begins.
18
Q
Stimulation of the posterior pharynx triggers what?
A
The gag reflex
19
Q
The adenoids are also called what?
A
Pharyngeal tonsils
20
Q
The laryngopharynx helps in what what and extends from what part to what part?
A
It functions in respirations and digestion and extends from the epiglottis to the glottis
21
Q
What is the leaflike structure composed of cartilage that serves as the gatekeeper into the larynx and prevents food from entering the lower airway?
A
Epiglottis
22
Q
What means little valley and is a landmark between the base of the tongue and the epiglottis?
A
Vallecula
23
Q
What joins the pharynx to the trachea prevents food and foreign substance from entering the trachea and houses the vocal chords?
A
Larynx
24
Q
What composes the true vocal chords and the space between them?
A
The glottis
25
Pressure on the cricoid cartilage that occludes the esophagus reducing the risk of aspiration is called what?
Sellick maneuver or cricoid pressure
26
The membrane in between the cricoid cartilage and the thyroid cartilage is a fibrous membrane called?
Cricothyroid membrane
27
What does the lower airway consist of?
Trachea, Bronchial Tree, primary bronchi, secondary bronchi, bronchioles, lungs, and alveoli
28
Approximately how long is the trachea in an adult before it bifurcates into the right and left bronchi?
10-12cm
29
What is the point where the trachea divides?
Carina
30
The point of entry for the bronchial vessels, bronchi, and nerves in each lung is called?
The hilum
31
What lubricates the alveoli, decreasing surface tension and facilitating ease of expansion?
Surfactant
32
Alveolar collapse is called what?
Atelectasis
33
What lines the surface of the lungs?
The Pleura
34
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.
35
The short trachea of a child may result in right bronchi intubation or removal of the endotracheal tube also called?
Extubation
36
The mechanical process of moving air into and out of the lungs is called?
Ventilation
37
Where does the primary stimulus to breathe come from?
The Medulla oblongota
38
What prevents the overinflation of the lungs in a conscious, spontaneously breathing person?
The Hering-Breuer reflex
39
Each combination of inspiration and expiration is called what?
The respiratory cycle
40
Normal Tidal volume in an adult male is what?
500mL
41
What is Tidal volume for an infant?
8mL/kg
42
The exchange of gases between a living organism and its environment is called?
Respiration
43
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
44
Gases exchanged between blood cells and tissues is called what?
Internal respiration
45
The pressure exerted by each individual gas in a mixture is called?
Partial pressure
46
What four main gases are found in the earths atmosphere?
Nitrogen, Oxygen, Water Vapor, and CO2
47
When hemoglobin has oxygen molecules bound to it what is it called?
oxyhemoglobin
48
A non-invasive way of measuring the percentage of oxygen bound to hemoglobin is what?
Pulse oximetry
49
Oxygen saturation above what number is considered normal?
98%
50
How much of venous hemoglobin is bound with CO2?
33%
51
What refers to a decreased amount of oxygen saturated hemoglobin in the blood stream?
Hypoxemia
52
What refers to a decreased amount of oxygen in the tissues?
Hypoxia
53
What is the most common cause of Hypoxia?
Hypoxemia
54
What is the earliest indication of hypoxia?
restlessness and anxiety
55
Why does cyanosis occur?
Circulating deoxygenated blood
56
Cyanosis occurs at what concentration?
5mg/dl or less
57
What is the initial management of hypoxia?
Providing supplemental oxygen or increasing ventilation
58
Any condition that results in hypoventilation increases what?
CO2 levels in the blood or hypercarbia
59
Any condition that results in hyperventilation leads to what?
hypocarbia or blowing off to much CO2
60
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)
61
Receptors designed to monitor O2 and CO2 in the body are called?
chemoreceptors
62
What is responsible for respiratory center stimulation?
CSF circulating in the brain and its pH balance
63
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
64
Cricoid cartilage starts what?
The trachea
65
Cricoid cartilage is the only what of the tracheal cartilage?
full ring
66
Look at box 14-1 on page?
476
67
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
68
Sitting up with head at a 45 degree angle is called?
Semi-Fowlers
69
An uncomfortable awareness of one's breathing is called?
Dyspnea
70
A total lack of oxygen available to the tissues is called?
Anoxia
71
Geographic landmarks for the chest include what?
Clavicles, Nipples, angle of Louis, suprasternal notch, and costal angle
72
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
73
The angle formed by the margins of the ribs at the sternum is called?
Costal angle
74
When dyspnea is relieved by a change in position it is called?
Orthopnea
75
A portion of the chest appears to move in the opposite direction of the rest of the chest is called?
Paradoxic motion
76
The affected part of the chest in paradoxical movement is called the?
Flail segment
77
Patients with emphysema commonly exhale how?
with pursed lips
78
The resistance of the patients lung tissue to ventilation is called?
compliance
79
The primary goal of auscultation is what?
To determine if lung sounds are present and equal bilaterally.
80
Look at box 14-2 and 14-3 and 14-4
page 482, pg 483
81
4 basic drugs that are used for respiratory are?
O2, Albuterol 2.5-5mg, Ipratropium 0.25-0.5mg, Methylpredinoslone (Solu-Medrol) 40-80mg
82
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
83
A whistling sound heard on inspiration and/or expiration resulting from constriction or obstruction of the pharynx, trachea, or bronchi is called?
Wheezing
84
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
85
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
86
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
87
A reflex caused by irritation of the posterior pharynx that can result in vomiting is called?
Gagging
88
Involuntary and periodic slow, deep breath followed by a prolonged expiratory phase is called?
Sighing
89
Intermittent spasm of the diaphragm that results in sudden inspiration with spastic closure of the glottis is called?
Hiccup
90
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
91
A respiratory rate that is persistently slower than normal for age is called?
Bradypnea
92
A respiratory rate that is persistently faster than normal for age is called?
Tachypnea
93
A respiratory pattern characterized by rapid, deep breathing is called?
Hyperpnea
94
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
95
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
96
Deep, gasping respirations that may be slow or rapid is called?
Kussmaul respirations
97
Irregular respirations varying in rate and depth and interrupted with periods of apnea is called?
Biot's respirations
98
Similar to Kussmaul respirations; characterized as deep, rapid breathing is called?
Central Neurogenic hyperventilation
99
Slow, shallow, irregular respirations resulting from anoxic brain injury is called?
Agonal respirations
100
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)
101
At 6 to 10L/min, simple face mask can provide an inspired oxygen concentration of approximately?
40-60%
102
What are the three classifications of airway obstructions?
complete obstruction, partial obstruction with poor air exchange, partial obstruction with good air exchange.
103
What are common causes leading to obstruction in the airway?
tongue, foreign bodies, laryngeal spasm and edema, trauma, and aspiration
104
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
105
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)
106
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
107
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
```
108
Oral airways have what range of sizes?
0-6
109
Forcing air into the lungs is called?
Positive pressure ventilation
110
Forcing air into the stomach instead of the lungs is called?
Gastric distension
111
A bag mask device used without supplemental oxygen delivers what %age of oxygen to the patient?
21% or room air
112
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%
113
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%
114
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
115
When troubleshooting a BVM you should?
Reposition the head
Check the seal of the mask
Check airway obstruction
116
Settings on an Automatic transport ventilator are?
Tidal volume
Ventilatory rate
Inspiratory time
117
ATV's should not be used in patients with what?
increased airway resistance
Asthma
ARDS (adult respiratory distress)
Presence of a pneumothorax
118
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
119
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
120
What does a FROPVD stand for?
Flow restricted, oxygen-powered ventilation device
121
A surgical opening into the trachea between the tracheal rings is called?
Tracheostomy
122
The surgical opening created in the anterior neck is called?
Tracheal stoma
123
The most common complications with tracheostomy tubes is what?
dislodgment of the tube
obstruction of the tube
infection
124
```
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
```
125
```
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
```
126
An advanced airway procedure in which a tube is placed directly into the trachea is called?
ET intubation
127
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
128
Generally when is ET intubation indicated in patients?
Patients with apnea, existing or impending respiratory failure, or the inability to protect the airway
129
A relatively stiff but flexible metal rod covered by plastic and inserted into an ET tube is called?
Stylet
130
The stylet should be recessed how much in the ET tube?
1/2 inch
131
In tracheal intubations the patient should be oxygenated for how long?
30 seconds to one minute
132
Do not exceed what amount of time from ventilation to ventilation for what?
each intubation attempt
133
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
134
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
135
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
```
136
Sizes for tubes when intubating a child are calculated how?
Age/4+4=uncuffed tube size
137
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
138
The uses of medications to sedate and paralyze a patient to achieve ET intubation rapidly is called?
RSI or Rapid-sequence intubation
139
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
140
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
141
The mallampati scale refers to what?
The size of the tongue compared to the size of the opening of the mouth
142
How many fingers should fit between the lower and upper incisors in RSI?
3
143
Adjunctive medications or agents are what?
Initial medications administered during RSI to minimize physiologic responses sometimes associated with intubation
144
What two drugs are commonly given in RSI
Atropine an anticholinergic or Lidocaine which diminishes cough and gag reflexes and diminishes ICP
145
Does the sedative get administered before or after the paralytic in RSI?
before
146
An emergency procedure performed to allow rapid entrance to the airway (by way of the cricothyroid membrane) for temporary oxygenation is called?
Cricothyrotomy
147
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
```
148
Conditions in which Cricothyrotomy is contraindicated are?
Ability to ventilate by less aggressive means
Inability to identify landmarks
Primary laryngeal injury
Infralaryngeal obstruction
149
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
150
SPO2 stands for what?
Saturation of peripheral oxygen
151
A contraindication for a combitube is esophageal varices, true or false?
true
