Airway Management And Ventilation Flashcards
What is the sellick maneuver?
Compressing the cricoid cartilage that occludes the esophagus resulting in reduced gastric distention during ventilation and placement of an endotracheal tube.
What is the total lung capacity in an average adult male?
6L
What is the normal tidal volume in an adult male?
5-7 mL/kg
Approximately 500mL
What is the normal tidal volume for pediatric patients?
6-8 mL/kg
What is alveolar air?
The amount of gas that reaches the alveoli with each breath.
What is the formula for alveolar air?
Tidal volume➖dead space volume
It is approximately 350mL
What are the two phases of ventilation?
Inspiration
Expiration
What is the nervous system mechanism that terminates inhalation and prevents lung over-expansion?
Hering-Breuer reflex
What is external (pulmonary) respiration?
Exchange of gases between the lungs and the blood cells in the pulmonary capillaries
What is internal (cellular) respiration?
Exchange of gases between blood cells and tissues
What is a minute volume?
The amount of air moved in and out of the lungs in one minute
(Tidal volume ➖ dead space volume)✖️respiratory rate
The amount of air that can be forced from the lungs in a single forced exhalation is called what?
Functional reserve capacity
What is residual volume?
The air that remains after maximal expiration
What is the residual volume of an average male?
1200 mL
What is inspiratory reserve volume?
The amount of air you can inhale after a normal inhalation
What are the two motor nerves of respiration?
Phrenic nerves
Intercostal nerves
What do the phrenic nerves do?
Innervates the diaphragm
What do the intercostal nerves do?
Innervates the external intercostal muscles (muscles between the ribs)
What is the percentage of oxygen that makes up hemoglobin?
97%
What is the remaining oxygen that is dissolved in plasma called?
Partial pressure of oxygen (PaO2 , PO2)
What is a byproduct of cellular respiration?
Carbon dioxide
What are three conditions that decrease the surface area of the alveoli?
COPD
Pneumonia
Pulmonary edema
What is intrapulmonary shunting?
If the alveoli are not functional, carbon dioxide and oxygen will not be allowed to diffuse. Therefore the blood will bypass the alveoli and will return to the left side of the heart and in an unoxygenated state
What is Dalton’s law?
The total pressure exerted equals the sum of the partial pressures of the components of that gas, or the pressure exerted by a specific atmospheric gas
What is the total pressure of air at sea level?
About 760 mm Hg (760 torr)
What connects the medulla and the respiratory muscles?
The vagus nerve
What three things does the medullary respiratory centers control?
Rate
Depth
Rhythm
…Of breathing
What is the secondary control center of respiration if the medulla fails to initiate respiration?
The apneustic center of the pons
How does the apneustic center influence the respiratory rate?
By increasing the number of inspirations per minute
What does the pneumotaxic center inhibit?
Inhibits the influence of inspiration
Where are peripheral chemoreceptors that measure the amount of CO2 (Paco2) and arterial blood located?
The carotid bodies and the aortic arch
What two nerves send signals to the respiratory center if CO2 levels change?
Glossopharyngeal nerve (9th cranial nerve) Vagus nerve (10th cranial nerve)
What do central chemoreceptors constantly monitor?
The pH of cerebrospinal fluid
Where are central chemoreceptors located?
Adjacent to the respiratory centers in the medulla
What is the average rate of respirations for an adult?
12-20 breaths/min
What is the average of the respiration rate for children?
15-30 breaths/min
What is the average respiration rate for infants?
25-50 breaths/min
What are four causes of respiratory distress?
Upper/lower airway obstruction
Inadequate ventilation
Impairment of respiratory muscles
Impairment of nervous system
What is orthopnea?
Positional dyspnea (difficulty breathing while supine)
What is pulsus paradoxus?
When the systolic blood pressure drops more than 10 mmHg with inspiration and/or a change in quality or even disappearance of a pulse
What two patients generally have pulsus paradoxus?
Patients with decompensating COPD
Severe pericardial tamponade
An increase in intrathoracic pressure could indicate what?
Pulsus paradoxus
What is atelectasis?
A condition of airless or collapsed alveoli
What are Cheyne-Stokes respirations?
A gradual increase of rate and tidal volume followed by a gradual decrease
What are Cheyne-Stokes respirations associated with?
Brain stem insult
What are Kussmaul respirations?
Deep gasping respirations
What two things are Kussmaul respirations associated with commonly?
Common diabetic coma and keto acidosis
What are Biot respirations?
Irregular pattern, rate, and volume with intermittent periods of apnea
What are Biot respirations commonly caused by?
Increased intracranial pressure
What is central neurogenic hyperventilation?
Deep, rapid respirations similar to Kussmaul respirations
What’s is central neurogenic hyperventilation commonly caused by?
Increased intracranial pressure
What are agonal respirations?
Slow, shallow, irregular respirations or occasional gasping breaths
What are agonal respirations a result of?
Results from brain anoxia. The heart has stopped but the brain continues to send signals to the muscles of respiration
What is hyperkalemia?
High potassium levels
What three things does atelectasis cause?
Pulmonary shunting
Ventilation perfusion mismatching
Possibly hypoxemia
What is aspiration?
Vomit or foreign body’s in the lungs
What is lung compliance?
The ability of the alveoli to expand when air is drawn in during inhalation
How do you measure the length of a suction catheter?
Measure from the corner of the lips to the earlobe to the xiphoid process
What are 2 kinds of suctioning catheters?
Ridged/hard tips (Yankauer, tonsil tip)
Non ridged/soft tips (French, whistle tip)
Where do you insert ridged tip catheters?
Oropharynx
Where can you insert nonridged tip catheters (French,whistle tip)
Oropharynx
Nasopharynx
Endotracheal tube
How long do you suction an adult?
15 seconds
How long do you suction a child?
10 seconds
How long do you suction an infant?
5 seconds
How much oxygen do M cylinders contain?
3450L
How much oxygen do D (super D) cylinders contain?
400L
What are the two most common laryngoscope blades?
Straight blades (Miller) Curved blades (Macintosh)
What laryngoscope blade is popular with intubating children?
Wisconsin blade
What is the narrowest portion of the pediatric airway?
The cricoid ring
What are the size ranges for laryngoscope blades?
Range from size 0-4
What size laryngoscope blades do children and infants use?
Sizes 0,1, and 2
What size laryngoscope blades do adults use?
Sizes 3,4
In endotracheal intubation what does the stylet do?
It enables you to guide the tip of the tube over the arytenoid cartilage even if you cannot see the entire glottic opening
In endotracheal intubation what two things does Magill forceps do?
Used to remove instructions from the airway under direct visualization
Guide the tip of the ET tube through the glottic opening if you are unable to get the proper angle with simple manipulation of the tube
What size endotracheal to do you use for an average adult females?
7.0-8.0
What size endotracheal tube do you use for an average adult male?
7.5-8.5
What is Murphy’s eye?
The opening on the side of the endotracheal tube at its distal end
It prevents occlusion of the tube with secretions
What position do you place the patient in endotracheal intubation?
“Sniffing position”
What does Burp in the Burp maneuver stand for?
Backward
Upward
Rightward
Pressure
What is the Burp maneuver?
If you are having difficulty seeing the glottic opening take your right hand and locate the lower third of the thyroid cartilage by applying backward upward and rightward pressure you can often move the larynx into view
What is the gum bougie?
A flexible device that is rigid enough to be able to be easily directed through the glottic opening but flexible enough so it doesn’t cause damage to the tracheal walls
What does condensation on the endotracheal tube indicate?
Correct placement in the trachea
How does a capnographer indicate correct tube placement?
It attaches between the ET tube and BVM device and contains colorimetric paper which turns yellow during exhalation
What are adenoids?
Lymph tissues in the mouth and nose that filter bacteria
What is the bone that the brain sits on just above the palate?
Cribriform plate
What is the narrowest part of the adult trachea?
The glottic opening
What is the hilum?
Part of an organ where structures such as blood vessels and nerves enter
Well are four differences in the upper airway for pediatric patients
Proportionately larger tongue
Proportionately smaller jaw which makes tongue encroach upon the airway
Smaller narrower airways
Floppy U shaped epiglottis
What are five differences in pediatric lower airways?
Larynx is more superior Larynx is funnel shaped Narrowest part is cricoid ring (until 10) Softer trachea Smaller narrower airways
What are two differences in pediatric chest walls?
Ribs and cartilage are softer so they can’t optimally contribute to lung expansion
Rely more heavily on diaphragm for breathing
What is expiratory reserve?
Amount of air that can be expired after a relaxed expiration
What is FiO2?
Percentage if oxygen in inspired air
What means cyanosis around the lips?
Circumoral
What are 6 airway obstructions?
Tongue Foreign body obstruction Laryngeal spasm Laryngeal edema Fractured larynx Aspiration
How many liters of oxygen do you give for albuteral with a nebulizer?
6L
How much oxygen do you administer albuterol with an NRB?
10L
What is the concentration of albuterol?
.083%
What’s the dose of albuterol?
2.5mg/3ml in a concentration of .083%
How many liters of air should a fixed suctioning unit generate?
40L/min
How much should a fixed suctioning unit vacuum when the tubing is clamped?
300mmHG
How many liters of oxygen do flow restricted, oxygen powered ventilation devices deliver? (FROPVD)
40 L/min at a fixed flow rate
Operates at or below 30cm of water to prevent gastric inflation
(when the patient breaths in a trigger goes off to give off oxygen)
What are two kinds of multilumen airways?
Pharyngeotracheal lumen airways (PtL)
Combitube
What flow meter gauge is not affected by gravity?
Bourdon-gauge flow-meter?
What’s the purpose of pin-indexing system?
Prevent oxygen cylinders from being connected to carbon dioxide cylinders. Ect..
How much oxygen will a simple face mask deliver?
40%-60% at 10 L/min
How much oxygen do nasal cannula’ deliver?
24%-44%
How much oxygen do non rebreather masks deliver?
Up to 90%
How much oxygen do BVM device with reservoir deliver?
Nearly 100%
Why do you clear out an oxygen tank before putting it in service?
To get dust out of the tank
What is an antagonist to apneustic control center?
Pneumotaxic center
Which oxygen device allows a specific concentration of oxygen to be delivered?
Venturi mask
What three things do oxygen humidifiers help with?
Croup
Epiglottitis
Bronchiolitis
What is the narrowing of the stoma called?
Stenosis of the stoma
What are four things you check if a patient’s airway decreases?
Displacement
Obstruction
Pneumothorax
Equipment failure
What does DOPE stand for regarding airway quality?
Displacement
Obstruction
Pneumothorax
Equipment failure
What is the the anatomical space between the base of the tongue and the epiglottis? It also is an important landmark for endotracheal intubation.
The vallecula
In endotracheal intubation what is the average tube depth at the teeth for adult males?
22 cm
In endotracheal intubation what is the average tube depth at the teeth for adult females?
21 cm
What is the formula for selecting endotracheal tube size for pediatrics? (2)
(Age➕16)➗4
Or
(Age➗4)➕4
What are 4 contraindications of combitubes?
Can’t use in children
Esophageal disease or trauma
After swallowing a caustic
Pt’s 7ft
Which cuff so you inflate first with combitubes?
Proximal cuff (big one) Then distal cuff (small one)
What is the normal CO2 level in patients with adequate ventilation and Perfusion?
35-45 mmHg
What is the cause if a patient has less than 35 mmHg of CO2?
Hyperventilation (blowing off too much CO2)
“Alkalodic”
What is the cause if a patient has more than 45 mmHg of CO2?
Hypoventilation (patient holding in too much CO2)
“Acidotic”
What causes the “shark fin” capnography reading?
Resistance while exhaling. (COPD, Asthma)
What is minute volume formula?
(Tidal volume➖dead space)✖️respiratory rate
What are four advantages of Combitubes?
Rapid insertion
Doesn’t require sniffing position
No face mask needed to seal
No special equipment needed
What are four disadvantages of combitubes?
Impossible to suction trachea tube is in esophagus
Cant be used in children
Unconscious pts only
Difficult to intubate around
What are three indications for endotracheal intubation?
Present or impending respiratory failure
Apnea
Inability of patient to protect own airway
What are three advantages of endotracheal intubation?
Provides a secure airway
Protects against aspiration
Provides a route for certain medications
What are two disadvantages of endotracheal intubation?
Special equipment needed
Bypasses physiologic function of upper airway (warming/filtering/humidifying)
What are seven complications of endotracheal intubation?
Bleeding Hypoxia Laryngeal swelling Laryngospasm Vocal cord damage Mucosal necrosis Barotrauma
What are three complications of Combitubes?
Pharyngeal or the esophageal trauma can result from poor technique
Unrecognized displacement of tracheal tube into the esophagus
Displacement of the pharyngeal balloon
What will happen if you use a larger oral pharyngeal airway than the pt needs?
It could push the tongue back into the pharynx, blocking the airway
How much air do you inject into nasogastric and orogastric tubes to check stomach placement?
50 cc
At what size do et tubes begin to have cuffs on them?
5.5
Generally what age do kids start having a cuffed et tube?
8 years
What tool do you use measure et tubes for children?
Length based resuscitation tape
Broslow tape
