Airway, Respiration, and Artificial Ventilation Flashcards
Define ventilation. Why is ventilation significant?
Ventilation is the moving of air in and out of the lungs. Proper ventilation is required for effective oxygenation and respiration. However, ventilation does not ensure oxygenation. For example, in cases of smoke inhalation and carbon monoxide poisioning, ventilation occured, but not oxyenation.
What is inhalation in the respiratory system?
Inhalation is the active part of ventilation (energy is required).
What happens during inhalation?
During inhalation, the diaphragm and intercostal muscles contract, intrathoracic pressure decreases, and a vacuum is created.
What happens as the thorax enlarges, pertaining to inhalation?
As the thorax enlarges, air passes through the upper airway into the lower airway and finally into the alveoli.
What is exhalation in the respiratory system?
Exhalation is the passive part of ventilation (energy is not required).
What happens during exhalation?
During exhalation, the diaphragm and intercostal muscles relax, the thorax decreases in size, and air is compressed out of the lungs.
What happens to the intrathoracic pressure, pertaining to exhalation?
During exhalation, intrathoracic pressure exceeds atmospheric pressure.
Describe the factors that cause an airway obstruction.
An airway obstruction is the blockage of an airway structure leading to the alveoli, which will prevent effective ventilation. Causes of an airway obstruction include the tongue (the number one cause of an airway obstruction), fluid, swelling, or foreign bodies.
What are the primary methods of controlling oxygen delivery?
The need for oxygen can rise or fall based on activity, illness, injury, etc. The primary methods of controlling oxygen delivery are increasing or decreasing the rate of breathing, and increasing or decreasing the tidal volume of breaths.
Tidal volume is the amount of air inhaled or exhaled in one breath.
What is hypoxia? Why is hypoxia important?
Hypoxia is the inadequate delivery of oxygen to the cells.
What are the early indications of hypoxia?
Early indications of hypoxia include restlessness, anxiety, irritability, dyspnea, and tachycardia.
What are the late indications of hypoxia?
Late indications of hypoxia include altered or decreased level of consciousness, severe dyspnea, cyanosis, and bradycardia (especially in pediatric patients).
How does the body monitor breathing status? Why is this important?
The carbon dioxide drive is the body’s primary system for monitoring breathing status. The body monitors carbon dioxide levels in the blood and cerebrospinal fluid.
What is the hypoxic drive? How does the hypoxic drive correlate to chronic obstructive pulmonary disease (COPD) patients?
The hypoxic drive is a backup system to the carbon dioxide drive. It monitors oxygen levels in plasma. As a result, the hypoxic drive may be used by end-stage chronic obstructive pulmonary disease patients who have chronically high levels of carbon dioxide.
What may occur from prolonged exposure to high concentrations of oxygen in hypoxic-drive patients?
Prolonged exposure to high concentrations of oxygen in hypoxic-drive patients may depress spontaneous ventilations.
What is oxygenation? Why is oxygenation important in the respiratory system?
Oxygenation is the delivery of oxygen to the blood. Oxygenation is required for respiration but does not ensure respiration.
What percentage of oxygen does surrounding air contain?
Surrounding air contains about 21% oxygen.
What percentage of oxygen does expired air contain?
Expired air contains about 16% oxygen.
What is respiration?
Respiration is the exchange of oxygen and carbon dioxide.
The heart and brain become irritable due to lack of oxygen.
What are the different stages of brain damage? How long does it take to develop brain damage from lack of oxygen?
- Brain damage begins within about 4 minutes.
- Permanent brain damage likely occurs within 6 minutes.
- Irrecoverable brain injury likely occurs within 10 minutes.
Assessment of breathing includes looking, listening, and feeling.
What are the components of a respiratory assessment?
- Look for chest rise and fall.
- Listen for breathing, ability to speak, and lung sounds.
- Feel for air movement and chest rise and fall.
- Place your ear near the victim’s mouth and nose, and place your hand on the victim’s chest.
What are the indications of adequate breathing?
Adequate breathing involves normal respiratory rate and rhythm, non-labored breathing, adequate tidal volume, and clear bilateral lung sounds.
What are the indications of inadequate breathing?
Inadequate breathing involves abnormal respiratory rate or breathing pattern, nasal flaring (enlargement of the nostrils while breathing), abnormal, diminished, or absent lung sounds, paradoxical motion (flail chest segment moves in opposite direction of the thorax), unequal rise and fall of the chest, dyspnea, accessory muscle use, retractions, cyanosis, and agonal respiration (dying gasps), or apnea (no breathing).
What is auscultation? What is the correct way to auscultate the lungs?
Auscultation is the use of a stethoscope to listen for lung sounds. The top left lung field is compared to the top right lung field. Same for mid- and lower lung fields. Lung sounds are compared side to side, not top to bottom. Auscultation of the lungs should be systematic, including all lobes of the anterior, lateral, and posterior chest. Normal lung sounds are clear and equal bilaterally.
What is the proper way to auscultate the lobes of the anterior chest?
Place the stethoscope at the midclavicular line (about the second intercostal space). This is about 2 inches below the clavicle but above the nipple line. Auscultate bilaterally (on both sides of the chest). Next, place the stethoscope at the midaxillary line (about the fourth intercostal space). This is below the armpit at about the nipple line. Auscultate bilaterally.
Lung sounds are often easier to access or hear on the posterior chest.
What is the proper way to auscultate the lobes of the posterior chest?
Place the stethoscope at about the midclavicular line (above and below the scapula bilaterally). Auscultate for lung sounds and equality.
What do absent or diminished lung sounds indicate?
Absent or diminished lung sounds indicate little or no air exchange. Wheezing
What is wheezing? Where is wheezing auscultated?
Wheezing is a high-pitched sound usually heard during exhalation, auscultated in the lower airway. However, inspiratory wheezing is heard over the neck, this indicates a narrowing in the large, upper airways in the neck.
What is rales? Where is rales auscultated?
Rales is a “wet” or “crackling” sound usually heard during inhalation.
What is stridor? Where is stridor auscultated?
Stridor is a high-pitched sound indicating partial upper airway obstruction. Stridor is auscultated in the upper airway (neck), not the lower lung fields.
Describe pulse oximetry. What is a normal pulse oximetry reading?
Pulse oximetry is onsidered the “sixth vital sign.” Oxygen saturation is a measure of the amount of oxygen-carrying hemoglobin (red blood cells) in the blood relative to the amount of hemoglobin not carrying oxygen. It does not identify definitively how much oxygen is in the blood, however, it is an indication of respiratory efficiency. Normal oxygen saturation is 98% or above. Below 94% indicates the need for supplemental oxygen.
List the limitations of pulse oximetry.
- It is an indication of respiratory efficiency, not confirmation.
- Pulse oximetry cannot measure the amount of heomglobin only the oxygen saturation of the hemoglobin that is present.
- A measurement may be difficult to obtain on some patients due to hypovolemia, hypothermia, anemia, nail polish, or carbon monoxide poisoning.
- Pulse oximetry cannot distinguish between oxygen saturation and carbon monoxide saturation.
- There can be a time delay between the patient’s pulse oximeter readingand the patient’s current respiratory status.
What are the indications for head tilt-chin lift airway technique?
Indications for head tilt-chin lift airway technique includes patients with altered or decreased level of consciousness, patients with suspected airway obstruction, and patients requiring suction.
What is a contraindication for head tilt-chin lift airway technique?
The head tilt-chin lift airway technique is contraindicated if there is suspected cervical-spine (c-spine) injury.
What are the indications for jaw-thrust airway technique?
Indications for jaw-thrust airway technique includes patients with altered or decreased level of consciousness and suspected c-spine injury.
What are the contraindications for jaw-thrust airway technique?
The jaw-thrust airway technique is contraindicated if the patient is conscious.
What is an oropharyngeal airway (OPA) adjunct used for?
An oropharyngeal airway adjunct is used to prevent the tongue from obstructing the airway. Failure to size or insert the oropharyngeal airwway correctly can cause the tongue to block the airway.
What is an indication to the use of an oropharyngeal airway (OPA) adjunt?
An oropharyngeal airway adjunct can only be used on an unresponsive patient without a gag reflex.
What is a contraindication to the use of an oropharyngeal airway (OPA) adjunct?
An oropharyngeal airway adjunct cannot be used on a conscious patient or any patient with an intact gag reflex.
Explain how to properly size an oropharyngeal airway (OPA) adjunct.
Measure from the corner of the mouth to the earlobe. The oropharyngeal airway adjunct should be positioned during measuremet as it will reside upon insertion.
Remove oropharyngeal airway immediately if the patient gags.
Explain how to properly insert an oropharyngeal airway (OPA) adjunct in an adult patient.
- Manually open the airway and suction as needed.
- Insert the oropharyngeal airway adjunct upside down with the distal end pointing toward the roof of the mouth.
- Rotate 180 degrees while advancing the oropharyngeal airway adjunct until flange (flat proximal portion) rests on the patient’s lips.
Always have suction available.
Remove oropharyngeal airway adjunct immediately if the patient gags.
Explain how to properly insert an oropharyngeal airway (OPA) adjunct in a pediatric patient.
- Manually open the airway and suction as needed.
- Depress tongue with a tongue depressor and insert directly (without rotating), or insert oropharyngeal airway sideways adjunct and rotate 90 degrees until flange (flat proximal portion) rests on the lips.
Always have suction available.
What is a nasopharyngeal airway (NPA) adjunct used for?
A nasopharyngeal airway adjunct is used to prevent the tongue from obstructing the airway in patients who may not be able to protect their own airway.
What are the indications to the use of a nasopharyngeal airway (NPA) adjunct?
A nasopharyngeal airway adjunct can only be used on a patient without a gag reflex, a patient with a deacreased level of consciousness, but with an intact gag reflex preventing the use of the oropharyngral airway adjunt.
