Airway Management Flashcards
Apnea
(Apneic)
A complete absence of breathing in a patient.
The temporary cessation of breathing, especially during sleep or in the event of a medical / traumatic emergency.
Treatments include:
— High-flow O2 — Positive Pressure Ventilation (PPV) — Bag-Valve Mask (BVM) — CPAP (Continuous Positive Airway Pressure)
Aspiration
Inhaling foreign material such as vomitus or blood into the lungs.
Commonly seen with Pneumonia and/or a failure from the Epiglottis with a vomitus patient.
Treatments include:
— Suctioning (15 seconds; 2 minutes on-air) — Aggressively manage patient airway — Maintain adequate circulation
COPD
Chronic Obstructive Pulmonary Disease.
A progressive “umbrella” condition of Chronic Bronchitis, Emphysema, and/or Asthma.
Treatments include:
— Albuterol (2.5mg / 3mL INH) — Bronchodilators / Beta-antagonists — CPAP (Continuous Positive Airway Pressure)
Gurgling
The sound of fluid in the upper airway, which indicates a need for immediate suctioning.
Treatments include:
— Suctioning (15 seconds; 2 minutes on-air) — Aggressively manage patient airway — Maintain adequate circulation
Hypoxia
Deficient in oxygen, also congruent with a shortage of oxygen in the body.
Minute Volume
The amount of air moved during one minute.
— Average Adult Minute Volume: 5-8 LPM
Rales / Crackles
Lung sounds which indicate fluid in the lower airways.
Commonly seen in Congestive Heart Failure (CHF) patients.
Treatments include:
— High Flow O2 Administration — Assisted Ventilation (BVM) — Inhaled Steroid Medications
Retractions
The visible sinking in the chest wall with inspiration and the patient with respiratory difficulty.
Noticeable above the clavicle (collarbone), between the ribs, and below the ribs.
Snoring
Hey sound heard in the upper airway which is usually caused by the tongue falling backward into the throat canal.
This indicates the need to immediately open the airway.
Treatments include:
— Suctioning (15 seconds; 2 minutes on-air) — Aggressively manage patient airway — Maintain adequate circulation
Stridor
A high-pitched sound heard in the upper airway.
Commonly caused by an upper airway obstruction.
Treatments include:
— Anti-inflammatory Medications
— Nebulizer Therapy
— Epinephrine (Nebulizer)
Tidal Volume
The amount of air moved during 1 respiratory breath.
— Average Adult (M): 500 mL / minute — Average Adult (F): 400 mL / minute
Wheezing
A lung sound caused by constriction of the lower airways, and most easily heard during exhalation.
Commonly seen in Asthmatics and COPD (Chronic Obstructive Pulmonary Disease) patients.
Treatments include:
— Albuterol (inhaled beta antagonist)
— Inhaler Medications
— Nebulizer Therapy
— Humidifiers
Vesicular Breathing
Breath sounds which are soft, low-pitched sounds that care providers can hear throughout the lungs, primarily when a person inhales.
They are normal breaths, but some abnormal sounds may occur if a person has an illness or chronic condition.
Breathing sounds heard when auscultating over lung tissues.
Bronchial Breathing
Breath sounds which are loud, harsh breathing sounds with a midrange pitch.
Care providers usually associate the sounds with exhalation, as their expiratory length is longer than their inspiratory length.
Bronchial breath sounds are normal as long as they occur over the trachea while the person is breathing out.
Hypoxemic Respiratory Failure
(Type I)
Also known as Hypoxemia, is a condition that occurs when you do not have enough O2 in the blood stream.
Treatments include:
— O2 Administration
— Nasal Canula
— Assisted Ventilation (BVM)
Hypercapnic Respiratory Failure
(Type II)
Also known as Hypercapnia, is a condition that occurs when you have too much CO2 in the blood stream.
Treatments include:
— Positive Pressure Ventilation (PPV)
— Assisted Ventilation (BVM)
— CPAP
Rhonchi
Also called low-pitched wheezes or coarse crackles, are nonrepetitive, nonmusical, low-pitched sounds frequently produced during early inspiration and expiration that usually are a sign of turbulent airflow through secretions in large airways.
Commonly caused by fluids entering the upper airway.
Treatments include:
— Albuterol (inhaled beta antagonist)
— Bronchodilators
— Inhalers
Holosystolic Murmur
A noticeable sound when you have an issue with a heart valve or the wall between your heart’s lower chambers (ventricles).
While auscultating a heartbeat, a care provider will also hear an abnormal sound of blood that isn’t flowing smoothly.
Commonly occurs with:
— Ventricular Septal Defects (VSD)
— Mitral & Tricuspid Regurgitation
Obstructive Sleep Apnea
The intermittent complete blockage of airflow during sleep.
Obstructive sleep apnea is seen in all age groups, but the frequency increases with age and obesity.
Albuterol
(Albuterol Sulfate)
Also known as Salbutamol, and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs.
It is a short-acting β₂ adrenergic receptor agonist (beta blocker) which works by causing relaxation of airway smooth muscle.
NOTE: Albuterol administration is done with 2.5 mg* / 3 mL
Aortic Regurgitation
(Early Diastolic Decrescendo Murmur)
A condition in which the Aortic heart valve doesn’t properly close.
In aortic insufficiency, blood flows backwards into the heart instead of pumping out.
This requires the heart to pump harder, which over time can lead to heart failure.
Nasal Canula
A device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help.
This device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils, and from which a mixture of air and oxygen.
Flow Rate — 1-6 LPM
O2 Provided — 22-44% O2
Mouth-to-Mask
(Pocket Mask)
The Pocket Mask, also known as a CPR mask, is a device used to safely deliver rescue breaths during a cardiac arrest or respiratory arrest.
Provides more Tidal Volume than, and is not to be confused with a Bag Valve Mask (BVM).
Flow Rate — 15 LPM (when supplied O2)
O2 Provided — Up to 55% O2
Nebulizer
A drug delivery device used to administer medication in the form of a mist inhaled into the lungs.
Nebulizers commonly treat:
— Asthma
— Cystic Fibrosis
— COPD
Flow Rate — 6-8 LPM
O2 Provided — 60-80% O2
Bag Valve Mask
(BVM)
Sometimes known by the proprietary name “Ambu bag”, Manual Resuscitator, or “Self-inflating bag”, is a hand-held device commonly used to provide Positive Pressure Ventilation (PPV) to patients who are not breathing, or not breathing adequately.
NOTE: Allow BVM reservoir bag to completely fill prior to patient application.
Flow Rate — 15 LPM
O2 Provided — 90-95% O2
CPAP
Continuous Positive Airway Pressure (CPAP) is a form of positive airway pressure ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person.
WARNING: Do not use for patients with:
— Hypotensive Patients
— Basilar Fractures / Head Traumas
— Vomitus Patients
Flow Rate — 60 LPM
O2 Provided — 98% O2
Flow Restricted, O2 Powered Ventilation Device(s)
(Manually Triggered Ventilation Device)
A Flow Restricted, O2 Powered Ventilation Device (FROPVD), also referred to as a Manually Triggered Ventilation Device (MTVD), is used to assist ventilation in apneic or hypoventilating patients, although these devices can also be used to provide supplemental oxygen to breathing patients.
Flow Rate — 15 LPM
O2 Provided — 90-95% O2
PPV
(Positive Pressure Ventilation)
Positive pressure ventilation is a form of respiratory therapy that involves the delivery of air or a mixture of oxygen combined with other gases by positive pressure into the lungs.
The process of using a mask or, more commonly, a ventilator to deliver breaths and to decrease the work of breathing in a critically ill patient.
PPV is delivered in one of two forms:
— Non-invasive PPV (either through a mask)
— Invasive PPV (endotracheal tube)
Metabolism
The process by which energy is made available for the body to use.
Diffusion
A passive process in which molecules move from an area of higher concentration to an area of lower concentration.
Osmosis
The movement of water molecules from a solution with a high concentration of water molecules to a solution with a lower concentration of water molecules, through a cell’s partially permeable membrane.
King LTS-D Airway
An airway rescue device similar to the blind insertion airway device (Combitube), with proximal and distal balloon cuffs designed to occlude the Oropharynx and Esophagus.
CO2 Dectector
(Colormetric)
Colorimetric CO2 detectors visually indicate the presence of exhaled carbon dioxide.
They are designed to connect between an Endotracheal tube (ETT) and a resuscitation bag to aid in the verification of proper ETT placement upon intubation.
NOTE:
— Yellow is good CO2 reading (adequate O2)
— Purple is bad CO2 reading (CO2 toxicity)
Pleural Rubs / Creaking
The sound has been described as “grating,” “creaky,” or similar to “the sound made by walking on fresh snow.”
Pleural rubs can be caused by several different etiologies, which include any condition that results in pleural effusion, pleurisy, or serositis.
Treatments include:
— Albuterol (inhaled beta antagonist)
— Ibuprofen
— Antibiotics
Crowing
A high pitched sound heard in the upper airway.
Most commonly causes by an upper airway obstruction.
NO DESAT
“Nasal Oxygen During Efforts Securing A Tube.”
With NO DESAT, the provider initiates oxygen via a nasal cannula at 15 Lpm during the preoxygenation phase.
The same nasal cannula is left on at 15 Lpm throughout the intubation.
Denitrogenation
(Nitrogen Washout)
The concept of a nitrogen washout, or denitrogenation, is that the patient has been breathing ambient air, which is 79% nitrogen, prior to the provider’s interventions.
By ventilating the patient with high-flow oxygen, the provider is displacing the nitrogen in the lungs and maximizing the amount of available oxygen.
Intubation
