Airway Management - Pathophysiology of Respiration Flashcards
Monitor levels of oxygen, CO2, hydrogen ion concentration, and the pH of the CSF and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time
Chemoreceptors
Central chemoreceptors are located ___
In the medulla
Peripheral chemoreceptors are located ___
In the carotid arteries and the aortic arch
Central chemoreceptors respond quickly to ___
Slight elevations in the CO2 level or a decrease in the pH of the CSF
Peripheral chemoreceptors are sensitive to ___
Decreased levels of oxygen in arterial blood as well as to low pH levels
When serum CO2 or hydrogen ion levels increase because of medical or traumatic conditions involving the respiratory system, chemoreceptors ___
Stimulate the medulla to increase the respiratory rate, thus removing more CO2 or acid from the body
One area in the medulla is responsible for ___. Another area of the medulla is primarily responsible for ___
- Initiating inspiration based on the info received from the chemoreceptors
- Motor control of the inspiratory and expiratory muscles
In addition to the medulla, stimulation from the pons affects the ___ of respirations
Rate and depth
The lung has a functional role of ___
Placing ambient air in proximity to circulating blood to permit gas exchange by simple diffusion
Ventilation and perfusion must be ___
Matched
V̇
Ventilation
Q̇
Perfusion
When ventilation is compromised but perfusion continues ___
Blood passes over some alveolar membranes without gas exchange taking place. This results in a lack of oxygen diffusing across the membrane and into the bloodstream. CO2 is also not able to diffuse across the membrane into the lungs and is recirculated within the blood stream. This leads to hypoxemia
What happens with perfusion across the alveolar membrane is disrupted?
Alveoli are filled with oxygen, but disrupted blood flow does not allow for optimal exchange of gases across the membrane. This results in less oxygen absorption in the bloodstream and less CO2 removal. Can lead to hypoxemia
Thrombus
Blood clot
Two types of factors that cause airway obstructions
Intrinsic and extrinsic
Intrinsic factors to airway obstructions
Infections, allergic reactions, and unresponsiveness (tongue obstruction)
Medications that depress the CNS lower the respiratory ___
Rate and volume
Increased CO2 level in the blood
Hypercarbia
Most common airway obstruction in an unresponsive patient
The tongue
___ are good indicators that the tongue may be obstructing the airway
Snoring respirations and the position of the head or neck
Patients with allergic reactions not only have a potential airway obstruction from swelling, but may also have a ___
Decrease in pulmonary ventilation from bronchoconstriction
As the bronchioles constrict, air is ___
Forced through smaller lumens, resulting in decreased ventilation
Extrinsic factors affecting pulmonary ventilation can include ___
Trauma or foreign body airway obstruction
Unconscious patients with a fractured mandible may require ___ to maintain an open airway
The insertion of an airway adjunct
Blunt or penetrating trauma and burns can disrupt airflow through the ___, resulting in ___
- Trachea and into the lungs
- Oxygenation deficiencies
___ are crucial to the patient’s outcome in situations involving extrinsic factors
Proper airway management and high concentrations of oxygen
Result of nonfunctional alveoli
Inhibit the diffusion of oxygen and CO2
Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart
Intrapulmonary shunting
The greater the degree of intrapulmonary shunting, the greater the degree of ___
Hypoxemia
Drowning victims and patients with pulmonary edema have fluid in the ___
Alveoli
Two kinds of factors affecting respiration
Internal and external
When circulation is inadequate, ___ is inadequate to meet the metabolic needs of the body
Perfusion
An accumulation of gas or air in the pleural cavity
Pneumothorax
A collection of blood in the pleural cavity
Hemothorax
An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and that interferes with cardiac function, with potentially fatal results
Tension (simple) pneumothorax
Open pneumothorax
Sucking chest wound
Deficiency in red blood cells
Anemia
An abnormal decrease in circulating volume that causes inadequate oxygen delivery to the body
Hypovolemic shock
Vasodilatory shock is caused by ___
The size of the blood vessels
Poor tissue perfusion leads to ___
Anaerobic metabolism
Wear ___ whenever airway management involves suctioning or an aerosol-generating procedure (AGP)
A mask and protective eyewear that includes eye shields (not glasses)
Any airway manipulation that induces the production of aerosols constitutes and ___
AGP
Wear ___ if conducting an AGP or if the patient has a highly contagious disease
N95 or powered, air-purifying respirator and gown in addition to the normal PPE
Adult respiratory rate range
12 to 20 breaths/min
Child respiratory rate range
12 to 40 breaths/min
Infant respiratory rate range
30 to 60 breaths/min
The respiratory rate of a patient is so important that it should be noted at the beginning of your radio report, after ___
Mental status
Skin pulling in around the ribs or above the clavicles during inspiration
Retractions
Occasional gasping breaths after the heart stopped
Agonal gasps
When assessing a patient with a potential airway compromise, pay particular attention to the ___ environment
External
Conditions such as high altitude and enclosed spaces alter the ___ of oxygen in the environment
Partial pressure
A cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea
Cheyne-Stokes respirations
Cheyne-Stokes respirations are often seen in patients with ___
Stroke and patients with serious head injuries
Lack of spontaneous breathing
Apnea
Irregular, ineffective respirations that may or may not have an identifiable pattern
Ataxic respirations
Patients experiencing a metabolic or toxic disorder may display ___ respirations
Kussmaul
Characterized as deep, rapid respirations commonly seen in patients with metabolic acidosis
Kussmaul respirations
If a patient can speak using only minimal words while at rest is attempting to ___. This is a sign of ___
- Preserve residual volume in the lungs
- Inadequate ventilation
Patients with inadequate breathing have inadequate ___
Minute volume
Slow or fast respiratory rate may result in a reduction in ___
Tidal volume and decreased ventilation adequacy
Ventilation issue care includes ___
Supplemental oxygen and ventilatory support
If there is more than one patient with respiratory issues, consider ___
The presence of poisonous or toxic gases or an infections cause such as pneumonia affecting the community
___ are excellent indicators of respiration
LOC and skin color
Pale skin and mucous membranes
Pallor
Pallor is typically associated with ___
Poor perfusion caused by illness or shock
Progression of cyanosis from poor perfusion
- Peripherally in the fingertips
- Centrally in the mucous membranes and around the lips
- Anaerobic metabolism occurs
Skin I marked with blotches of different colors
Mottling
Hemoglobin delivers ___ of the oxygen to the tissues, oxygen dissolved in plasma delivers the other ___
- 97%
- 3%
An oxygen saturation of ___ or lower generally requires treatment unless the patient has ___
- 94%
- A chronic condition causing perpetually low oxygen saturation levels
In conditions such as stroke or heart attack, oxygen is applied when the Spo2 drops below ___
94%
Pulse oximeters are inaccurate below ___
85%
How long for pulse oximeter to update
Typically as long as 60 seconds
Patient with ___ may not have enough peripheral perfusion to be detected by the pulse oximeter
Significant vasoconstriction or very low perfusion (including decompensated shock and cardiac arrest)
If there is not enough peripheral perfusion for the pulse oximeter in the finger ___
Move it to a more central location such as the bridge of the nose or earlobe
Causes of inaccurate pulse oximeter readings
- Hypovolemia
- Anemia
- Severe peripheral vasoconstriction
- Time delay in detecting respiratory deficiency
- Dark or metallic nail polish
- Dirty fingers
- CO poisoning
To assess ventilation, you will need to measure ___
Exhaled CO2 levels
Measure of the maximal concentration of CO2 at the end of an exhaled breath
End-tidal CO2
Low end-tidal CO2 could indicate ___
- Hyperventilation
- Decreased CO2 return to the lungs because of reduced CO2 production at the cellular level secondary to conditions such as shock or cardiac arrest
When cardiac output increases, end-tidal CO2 levels generally ___
Increase
High end-tidal CO2 could indicate ___
Retaining CO2 secondary to ventilation inadequacy
An absence of end-tidal CO2 could indicate ___
The patient is not breathing at all
Normal range of end-tidal CO2
35 to 45 mm/Hg
Use of capnography
Determine proper placement of an advanced airway, assess a patient’s ventilatory status, and avoid inadvertent hyperventilation of patient’s with head injuries
Waveform capnography can be used to determine changes in ___
Cardiac output
Waveform capnography provides the first indication of return of ___
Spontaneous circulation after cardiac arrest
ROSC
Return of spontaneous circulation
A normal capnographic waveform has ___ distinct phases
4
Phases of a normal capnographic waveform
Phase I: Respiratory baseline
Phase II: Expiratory upslope
Phase III: Alveolar plateau
Phase IV: Inspiratory downstroke
The duration of each capnographic waveform corresponds to ___
The duration of ventilation
The space between each capnographic waveform corresponds to ___
The respiratory rate
