Airway/Ventilation Flashcards
LEMONS Stands for what?
Look Externally Evaluate 3-3-2 Mallampati Score Obstruction Neck Mobility Saturations
What does SOAPPP Stand for? What is it for?
Prepare for Intubation
Suction Oxygen All Adjuncts Positioning Plan A,B, and C Pharmaceuticals
What is the proper position for intubation? What is it called for obese patients?
The Sniffing or Ear to Sternal Notch Position. In the obese we bring the ear to sternal notch with the ramped position.
How much mmHG should you use when suctioning the ET Tube?
80mmHG
What are the subjective techniques for confirming the placement of an ET tube?
Direct Visualization
Tube Misting
Auscultation
What are the objective techniques for confirming the placement of an ET tube?
Capnography
Esophageal Detector Device
ET Tube Introducer (Bougie) Depth
Pulse Oximetry
What is retrograde intubation?
Where a needle is placed into the airway through the cricoid membrane from the outside and directed superiorly. A guide wire is then passed through the needle and hopefully retrieved in the oral cavity.
What is the total atmospheric pressure? What is the partial pressure of O2? How do you determine it?
Total atomospheric pressure is 760mmHG.
The partial pressure of O2 is 159.6mmHG.
To get the partial pressure you take the % of O2 (21%) and multiply it by the total Atmospheric pressure of 760mmHG.
What is Dalton’s law?
The law that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of the gases of the mixture.
Changes in what stimulates Medullary Response centers to change breathing rate/depth?
Changes in CSF pH.
What drives ventilation?
CO2
What is the Herring Breuer Reflex?
Stretch receptors in lungs that limits the respiration when stimulated by over inflation.
What are J-Receptors?
They are O2 sensing receptors that stimulate brain centers for breathing.
Inspiration is Active or Passive? What kind of pressure does it create in the Thoracic cavity?
It is Active and creates a negative pressure.
What is Boyle’s law?
The principle that at a constant temperature the volume of a gas varies inversely with the pressure exerted upon it.
What is Henry’s Law?
The amount of gas dissolved in a given volume of liquid is directly proportional to the partial pressure of that gas in the gas phase.
What is a Shunt?
An area of the lung that is being perfused but no ventilation is taking place. Can be caused by a number of disease processes. Shunting causes increased Deadspace.
In a normal 70kg male how much tidal volume is there?
How much is the Inspiratory Reserve Volume?
How much is the expiratory reserve volume?
What is the Residual volume?
500ml: Tidal Volume
Inspiratory Reserve: 3000ml
Expiratory Reserve: 1000ml
Residual Volume: 1200ml
How is Inspiratory Capacity calculated?
Vt+IRV= 3500ml
How is Vital Capacity calculated?
Vt+IRV+ERV=4500ml
How is Functional Residual Volume calculated?
ERV+RV=2200ml
How is Total Lung Capacity calculated?
Vt+ERV+IRV+RV=5700ml
What can increase Functional Residual Capacity?
CPAP
CO2 does what to the Vasculature?
An Increase in CO2 causes Vasodialation
A Decrease in CO2 causes Vasoconstriction
What is ARDS?
Acute Respiratory Distress Syndrome
Describe Kussmaul Breathing and What are some potential causes?
Deep rapid respirations.
Causes: Metabolic Acidosis (Diabetes Mellitus), Hyperpnoea Keytones Uremia Sepsis Salicylates Methanol Aldehydes U Lactic Acid/Lactic Acidosis
Describe Cheyne-Stokes Respirations and what are some potential causes? Who is this commonly seen in and when?
Respirations that gradually increase from shallow to deep then back to shallow with periods of apnoea between them.
Causes: Sleep/Hypoxemia/Drugs, Hypoperfusion of the Brain
Seen in the elderly before death.
Describe Biot’s Respirations and what are some potential causes?
Ataxic respirations. Deep rapid respirations with periods of apnoea.
Causes: Neuron Damage/Head Trauma/Brainstem Injury
What can help us estimate the PaO2 from SPO2?
The Oxyhemoglobin Curve
What does a Right Shift mean?
It means the patient is shifting right on the Oxyhemoglobin curve causing an Increased Temp, Increased DPG, and Increased H+ (Acidity)
What does a Left Shift mean?
It means the patient is shifting left on the Oxyhemoglobin curve causing a decreased temp, decreased DPG and a decreased H+ (Alkalosis)
What does SpMET measure? What does it mean?
It measures Methemoglobin and it shows how much of the Iron in hemoglobin is in a Ferric (Fe3+) state and is unable to carry O2.
What is Capnometry?
The measurement of expired CO2
What is Capnography?
A Graphic recording or display of the capnometry over time.
What is Capnograph?
A device that measures CO2
What is a Capnogram?
A Visual representation of expired CO2 (The Waveform)
What is PaCO2?
The partial pressure of CO2 in the arterial blood.
Describe a normal Capnogram
AB: Phase 1: Late Inspiration/Early Expiration (No CO2)
BC: Phase 2: Appearance of CO2 in exhaled gas.
CD: Phase 3: Plateau, Constant CO2
D: Highest Point (ETCO2)
DE: Phase 4: The rapid descent during inspiration.
EA/AB: Respiratory Pause/Late Inspiration/Early Expiration
Draw a “shark fin” Capnogram, What does it indicate?
It indicates possible Obstructive Pulmonary Disease such as Asthma/COPD
What does an elevation in the baseline on a Capnogram indicate?
The rebreathing of CO2 and it is generally seen with Hyperventilation.
What does DOPE stand for? When do you need to remember it.
Displacement
Obstruction
Pneumothorax
Equipment Failure
You need to remember it when you see a capnogram shows NO waveform your ET Tube should be removed immediately.
What does a progressive reduction in ETCO2 levels indicate?
Blowing off more CO2, consistent with hyperventilation.
What does a progressive increase in ETCO2 levels indicate?
Trapping or retaining CO2 consistent with hypoventilation or improving perfusion (Cardiac arrest)
What is the approx. normal ET Tube depth for a male?
21-24cm at the teeth.
What is the approx. normal ET Tube depth for a female?
20-23cm at the teeth.
An increase in CO2 causes what changes in Consciousness? ICP?
Causes a decrease in consciousness.
Causes an increase in ICP.
What are the two causes of unresponsiveness?
Hypoxia and Hypercapnea
A GCS of ? or less might require airway management?
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