AIRWAY COMPRØMISE!!!!!!!!!!!!!!!!!!!!!! Flashcards
What is going on in a patient with poor ventilation?
Blood is flowing, but does not become adequately oxygenated by the lungs. Typically caused by an obstruction or defect
What is going on in a patient with poor perfusion?
Patient is ventilating normally, but blood is not adequately reaching the lungs for blood/air transfer. Typically caused by a Pulmonary embolism or a decrease in cardiac output.
What is the difference between Hypoxemia and Hypoxia?
Hypoxemia - Decrease in O2 in the blood - typically asymptomatic
Hypoxia - Significant loss of O2 in the blood to cause symptoms.
What can cause Hypoxemia?
Diseases in the respiratory system (COPD, Chronic Bronchitis)
Alteration in circulatory function
Dysfunction of neurological system
How can Hypoxemia occur?
Hypoventilation
Impaired diffusion of gases
Inadequate circulation of blood through pulmonary capillaries
Which of the Following can Occur in Hypoxemia? Why? A/ Metabolic Alkalosis B/ Metabolic Acidosis C/ Respiratory Acidosis D/ Respiratory Alkalosis
Metabolic Acidosis
Anaerobic metabolism that builds up lactic acid levels -> leading to metabolic acidosis. (Typically not until PaO2 falls below 60%)
What occurs in the mild-moderate-chronic stages of hypoxemia?
Mild
- Tachycardia
- Peripheral vasoconstriction
- Diaphoresis
- Mild increase in BP
Moderate
- Restlessness
- Agitation
- Euphoria
- Impaired Judgment
- Delirium
- Stupor
- Coma (late sign)
Chronic
- May be insidious onset and attributed to other causes
- Increased ventilation
- Pulmonary vasoconstriction
- Increased production of RBCs
- Cyanosis
What is Hypercapnia? What causes it?
Increase in CO2 levels within the body (Acidosis).
Caused by: Abnormalities in airway/alveoli CNS suppression (Decreased drive to breathe) Limited chest wall expansion Neuromuscular conditions
What are the clinical manifestations of Hypercapnia?
Respiratory Acidosis
Impaired Kidney/cardiovascular/NS functioning
Would you give a patient with Hypercapnia a CPAP machine?
Yes
What is a pneumothorax? Differentiate between primary and secondary spontaneous types.
*Presence of air in the pleural space with a partial or complete lung collapse
Primary
- Ruptured Bleb (Alveoli)
(Typically occurs in Tall boys)
Secondary
- Caused by underlying lung disease (More serious)
- Can be caused by injury
Differentiate between a Traumatic pneumothorax and a Tension pnuemothorax
Traumatic
- Penetrating or non-penetrating wound that allows air to enter or leave.
- May be accompanied by a hemothorax
Tension
- Air can enter but cannot leave
- LIFE THREATENING
- Compression of great vessels/heart/lungs
- Mediastinal shift occurs
Which is more common in a pneumothorax….
Hypotension
Hypertension
Hypotension
Typically due to a loss of fluids/blood
What is a hemothorax? Differentiate between a minimal - moderate - large hemothorax
Blood present in the pleural cavity -> secondary to injury, surgery, malignancy, or rupture of vessel
Minimal - 300-500cc, usually corrects itself
Moderate - 500-100cc, signs of lung compression, drainage needed with fluid replacement. Surgery may be indicated.
Large - 1000cc or more, bleeding from intercostal space or artery. Requires IMMEDIATE drainage and fluid replacement and surgery.
What are some clinical manifestations of a hemothorax
- Hypoxemia
- Decreased ventilation
- Increased effort in breathing
- Tachypnea
- Decreased air entry
- Hypovolemia possible
What is atelectasis (AT-te-lect-ta-sis)
Incomplete lung expansion due to obstruction/compression/loss of surfactant
Harvey, a 5”2 obese Cat whisperer comes onto your unit having difficulty breathing, is cyanotic, and has decreased chest expansion. With an X-ray, you notice a tracheal and mediastinal shift, but no sign of trauma to the chest. There are also signs that he has a loss of surfactant. What is wrong with Harvey?
Atelectasis - Collapsed lung with Ø presence of air in pleural space.
Not a spontaneous pneumothorax because HArvey is SHort and Fat. The loss of surfactant is a clinical sign of atelectasis
Clint, a 56 year old basket-weaver comes onto your floor with a HR of 138, chest pain, hypotension, an open wound in his chest wall, and noticeable amounts of blood in his pleural cavity. Whats up with Clint?
Hemothorax… probably a Large one too 1000cc or more.
What are the advantages of an Endotracheal tube?
Protects against aspiration
Allows suctioning of tracheal/bronchial secretions
Provides route for mechanical ventilation/oxygenation
Airway can be secured rapidly
What are some indications for an Endotracheal tube?
Upper airway obstruction
Apnea
High risk of aspiration
Ineffective clearance of airway
Respiratory Distress
When is a Nasal Endotracheal tube indicated over a oral one?
When a suspected neck or head injury has occurred - secure spine and deplete the need for a head tilt.
When would a tracheotomy endotracheal tube be indicated?
When an artificial airway is expected to be needed over the long term.
What has happened if CO2 is detected in a patient with an Endotracheal tube?
Tube has been placed in the esophagus
Reinsertion required. Batteries not included.*
What are some complications of intubation?
Bronchospasms Laryngospasms Aspiration Tooth damage Injury to lips/mouth/vocal cords Hypoxemia Tracheal stenosis, erosion or necrosis
What should you do if the tube has been incorrectly placed?
CALL FOR HELP
Stay with patient and maintain patent airway***
Support ventilation and use Bag-valve-mask (BVM) with 10% O2 if needed
What pressure should and ET tube remain at while in the patient? A/ 20-30mmHg B/ 25-30mmHg C/ 20-25mmHg D/ 30-35mmHg
C/ 20-25mmHg
What are some clinical signs of respiratory distress?
Use of accessory muscles
Hypoventilation with dusky skin
Hyperventilation with numbness and tingling
Which of the following is False about ET tubes?
A/ Suction when secretions are visible in the tube
B/ Suction ET tube Routinely
C/ Dysrhythmias can occur due to suctioning
D/ Suction pressure should not exceed 120mmHg
B/ DO NOT suction routinely, only as needed.
*Risk of injury
How can you manage thick mucous secretions in patients with ET tubes?
Provide adequate hydration/humidification
What might be some indications for mechanical ventilation?
*Anything that impedes ability to ventilate on their own.
- Acute respiratory failure
- Respiratory depression from CNS
- Neuromuscular disorders (MS, ALS, etc).
A positive pressure mechanical ventilator does what?
Provides pressure during inspiration, increasing tidal volume.
Forces lungs to take in more air
What is a controlled ventilation?
A machine that delivers a predetermined rate and volume of gas independent of client’s effort
Does all the breathing for them.
What is the KEY criteria for the use of a CPAP machine?
Patient MUST have their own spontaneous ventilation.
Must be able to breathe on their own.
What can cause I high-pressure alarm in an ET tube?
Secretions
Pt. biting the tube
Coughing/anxiety -> sedatives
What can cause a low pressure alarm in an ET tube?
Break/leak in system.
How often do you assess cardiopulmonary status in a patient with an ET tube?
q2h-q4h
