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Emergency Medical Technician > Airway Management - Pathophysiology of Respiration > Flashcards

Airway Management - Pathophysiology of Respiration Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

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

A

Chemoreceptors

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2
Q

Central chemoreceptors are located ___

A

In the medulla

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3
Q

Peripheral chemoreceptors are located ___

A

In the carotid arteries and the aortic arch

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4
Q

Central chemoreceptors respond quickly to ___

A

Slight elevations in the CO2 level or a decrease in the pH of the CSF

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5
Q

Peripheral chemoreceptors are sensitive to ___

A

Decreased levels of oxygen in arterial blood as well as to low pH levels

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6
Q

When serum CO2 or hydrogen ion levels increase because of medical or traumatic conditions involving the respiratory system, chemoreceptors ___

A

Stimulate the medulla to increase the respiratory rate, thus removing more CO2 or acid from the body

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7
Q

One area in the medulla is responsible for ___. Another area of the medulla is primarily responsible for ___

A
  1. Initiating inspiration based on the info received from the chemoreceptors
  2. Motor control of the inspiratory and expiratory muscles
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8
Q

In addition to the medulla, stimulation from the pons affects the ___ of respirations

A

Rate and depth

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9
Q

The lung has a functional role of ___

A

Placing ambient air in proximity to circulating blood to permit gas exchange by simple diffusion

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10
Q

Ventilation and perfusion must be ___

A

Matched

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11
Q

V̇

A

Ventilation

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12
Q

Q̇

A

Perfusion

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13
Q

When ventilation is compromised but perfusion continues ___

A

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

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14
Q

What happens with perfusion across the alveolar membrane is disrupted?

A

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

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15
Q

Thrombus

A

Blood clot

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16
Q

Two types of factors that cause airway obstructions

A

Intrinsic and extrinsic

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17
Q

Intrinsic factors to airway obstructions

A

Infections, allergic reactions, and unresponsiveness (tongue obstruction)

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18
Q

Medications that depress the CNS lower the respiratory ___

A

Rate and volume

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19
Q

Increased CO2 level in the blood

A

Hypercarbia

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20
Q

Most common airway obstruction in an unresponsive patient

A

The tongue

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21
Q

___ are good indicators that the tongue may be obstructing the airway

A

Snoring respirations and the position of the head or neck

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22
Q

Patients with allergic reactions not only have a potential airway obstruction from swelling, but may also have a ___

A

Decrease in pulmonary ventilation from bronchoconstriction

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23
Q

As the bronchioles constrict, air is ___

A

Forced through smaller lumens, resulting in decreased ventilation

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24
Q

Extrinsic factors affecting pulmonary ventilation can include ___

A

Trauma or foreign body airway obstruction

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25
Q

Unconscious patients with a fractured mandible may require ___ to maintain an open airway

A

The insertion of an airway adjunct

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26
Q

Blunt or penetrating trauma and burns can disrupt airflow through the ___, resulting in ___

A
  1. Trachea and into the lungs
  2. Oxygenation deficiencies
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27
Q

___ are crucial to the patient’s outcome in situations involving extrinsic factors

A

Proper airway management and high concentrations of oxygen

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28
Q

Result of nonfunctional alveoli

A

Inhibit the diffusion of oxygen and CO2

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29
Q

Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart

A

Intrapulmonary shunting

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30
Q

The greater the degree of intrapulmonary shunting, the greater the degree of ___

A

Hypoxemia

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31
Q

Drowning victims and patients with pulmonary edema have fluid in the ___

A

Alveoli

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32
Q

Two kinds of factors affecting respiration

A

Internal and external

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33
Q

When circulation is inadequate, ___ is inadequate to meet the metabolic needs of the body

A

Perfusion

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34
Q

An accumulation of gas or air in the pleural cavity

A

Pneumothorax

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35
Q

A collection of blood in the pleural cavity

A

Hemothorax

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36
Q

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

A

Tension (simple) pneumothorax

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37
Q

Open pneumothorax

A

Sucking chest wound

38
Q

Deficiency in red blood cells

A

Anemia

39
Q

An abnormal decrease in circulating volume that causes inadequate oxygen delivery to the body

A

Hypovolemic shock

40
Q

Vasodilatory shock is caused by ___

A

The size of the blood vessels

41
Q

Poor tissue perfusion leads to ___

A

Anaerobic metabolism

42
Q

Wear ___ whenever airway management involves suctioning or an aerosol-generating procedure (AGP)

A

A mask and protective eyewear that includes eye shields (not glasses)

43
Q

Any airway manipulation that induces the production of aerosols constitutes and ___

A

AGP

44
Q

Wear ___ if conducting an AGP or if the patient has a highly contagious disease

A

N95 or powered, air-purifying respirator and gown in addition to the normal PPE

45
Q

Adult respiratory rate range

A

12 to 20 breaths/min

46
Q

Child respiratory rate range

A

12 to 40 breaths/min

47
Q

Infant respiratory rate range

A

30 to 60 breaths/min

48
Q

The respiratory rate of a patient is so important that it should be noted at the beginning of your radio report, after ___

A

Mental status

49
Q

Skin pulling in around the ribs or above the clavicles during inspiration

A

Retractions

50
Q

Occasional gasping breaths after the heart stopped

A

Agonal gasps

51
Q

When assessing a patient with a potential airway compromise, pay particular attention to the ___ environment

A

External

52
Q

Conditions such as high altitude and enclosed spaces alter the ___ of oxygen in the environment

A

Partial pressure

53
Q

A cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea

A

Cheyne-Stokes respirations

54
Q

Cheyne-Stokes respirations are often seen in patients with ___

A

Stroke and patients with serious head injuries

55
Q

Lack of spontaneous breathing

A

Apnea

56
Q

Irregular, ineffective respirations that may or may not have an identifiable pattern

A

Ataxic respirations

57
Q

Patients experiencing a metabolic or toxic disorder may display ___ respirations

A

Kussmaul

58
Q

Characterized as deep, rapid respirations commonly seen in patients with metabolic acidosis

A

Kussmaul respirations

59
Q

If a patient can speak using only minimal words while at rest is attempting to ___. This is a sign of ___

A
  1. Preserve residual volume in the lungs
  2. Inadequate ventilation
60
Q

Patients with inadequate breathing have inadequate ___

A

Minute volume

61
Q

Slow or fast respiratory rate may result in a reduction in ___

A

Tidal volume and decreased ventilation adequacy

62
Q

Ventilation issue care includes ___

A

Supplemental oxygen and ventilatory support

63
Q

If there is more than one patient with respiratory issues, consider ___

A

The presence of poisonous or toxic gases or an infections cause such as pneumonia affecting the community

64
Q

___ are excellent indicators of respiration

A

LOC and skin color

65
Q

Pale skin and mucous membranes

A

Pallor

66
Q

Pallor is typically associated with ___

A

Poor perfusion caused by illness or shock

67
Q

Progression of cyanosis from poor perfusion

A
  1. Peripherally in the fingertips
  2. Centrally in the mucous membranes and around the lips
  3. Anaerobic metabolism occurs
68
Q

Skin I marked with blotches of different colors

A

Mottling

69
Q

Hemoglobin delivers ___ of the oxygen to the tissues, oxygen dissolved in plasma delivers the other ___

A
  1. 97%
  2. 3%
70
Q

An oxygen saturation of ___ or lower generally requires treatment unless the patient has ___

A
  1. 94%
  2. A chronic condition causing perpetually low oxygen saturation levels
71
Q

In conditions such as stroke or heart attack, oxygen is applied when the Spo2 drops below ___

A

94%

72
Q

Pulse oximeters are inaccurate below ___

A

85%

73
Q

How long for pulse oximeter to update

A

Typically as long as 60 seconds

74
Q

Patient with ___ may not have enough peripheral perfusion to be detected by the pulse oximeter

A

Significant vasoconstriction or very low perfusion (including decompensated shock and cardiac arrest)

75
Q

If there is not enough peripheral perfusion for the pulse oximeter in the finger ___

A

Move it to a more central location such as the bridge of the nose or earlobe

76
Q

Causes of inaccurate pulse oximeter readings

A
  1. Hypovolemia
  2. Anemia
  3. Severe peripheral vasoconstriction
  4. Time delay in detecting respiratory deficiency
  5. Dark or metallic nail polish
  6. Dirty fingers
  7. CO poisoning
77
Q

To assess ventilation, you will need to measure ___

A

Exhaled CO2 levels

78
Q

Measure of the maximal concentration of CO2 at the end of an exhaled breath

A

End-tidal CO2

79
Q

Low end-tidal CO2 could indicate ___

A
  1. Hyperventilation
  2. Decreased CO2 return to the lungs because of reduced CO2 production at the cellular level secondary to conditions such as shock or cardiac arrest
80
Q

When cardiac output increases, end-tidal CO2 levels generally ___

A

Increase

81
Q

High end-tidal CO2 could indicate ___

A

Retaining CO2 secondary to ventilation inadequacy

82
Q

An absence of end-tidal CO2 could indicate ___

A

The patient is not breathing at all

83
Q

Normal range of end-tidal CO2

A

35 to 45 mm/Hg

84
Q

Use of capnography

A

Determine proper placement of an advanced airway, assess a patient’s ventilatory status, and avoid inadvertent hyperventilation of patient’s with head injuries

85
Q

Waveform capnography can be used to determine changes in ___

A

Cardiac output

86
Q

Waveform capnography provides the first indication of return of ___

A

Spontaneous circulation after cardiac arrest

87
Q

ROSC

A

Return of spontaneous circulation

88
Q

A normal capnographic waveform has ___ distinct phases

A

4

89
Q

Phases of a normal capnographic waveform

A

Phase I: Respiratory baseline
Phase II: Expiratory upslope
Phase III: Alveolar plateau
Phase IV: Inspiratory downstroke

90
Q

The duration of each capnographic waveform corresponds to ___

A

The duration of ventilation

91
Q

The space between each capnographic waveform corresponds to ___

A

The respiratory rate

Emergency Medical Technician (100 decks)

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