Ch 10 Airways Flashcards
What r the 4 methods used to artificially ventilate the patient:
Mouth to mask
Bag-mouth (BVM) operated by 2 people
Flow restricted, oxygen-powered ventilation device (manually triggered device)
Bag-valve mask (BVM) operated by 1 person
What r the 3 major considerations when using a device for artificial ventilation?
- Must be able to maintain a good mask seal
- Device must b able to deliver adequate volume of air to inflate the lungs.
- Must b a connection to allow for simultaneous oxygen delivery while artificially ventilating
Infants and children must be ventilated at a rate of:
12-20 times per min
Adults must be ventilated at a rate of:
10-12 times per min
Ventilation performed with chest compressions in (adults and children) & (infants) at a ratio of:
30 compressions to 2 ventilations (Adults & Chlidren)
What is the rate of ventilation for a newborn infant with a pulse?
40-60 per min
Newborn baby with no pulse should receive chest compressions to ventilation rate:
90 compressions to 30ventilations
Ventilating a patient too rapidly does not allow for adequate exhalation and can cause what?
Gastric distention
This was once thought to reduce complications associated with positive pressure ventilation when the unresponsive patient’s airway is not protected by an advanced airway device. This technique was intended to reduce the incidence of gastric inflation, regurgitation, and aspiration of gastric contents. (sellick maneuver)
Cricoid pressure
T/F according to the American Heart Association the cricoids pressure is not recommended for routine use but can be used to facilitate insertion of an endotracheal tube in an adult.
True
In a pediatric patient cricoids pressure can only be considered if:
An extra EMT is available to apply pressure without compromising the airway or effective ventilation and guard against collapse of the trachea from excessive pressure.
When an endotracheal tube is inserted during intubation is also known as:
Laryngoscopy
What is the technique to perform cricoid pressure:
- Locate the thyroid cartilage (adams apple)
- Locate the base of the thyroid cartilage, locate a small, soft midline indention the cricothyroid membrane.
- Place your index finger on one side of the cricoid cartilage, your tumb on the other side and apply backwards pressure. Avoid completely compressing the cartilage.
This is another and more effective method to facilitate insertion of the endotracheal tube (BURB)
Backwards Upright Rightward Pressure
T/F the cricoids cartilage is the only complete cartilaginous ring?
True
What is the best method to prevent gastric inflation?
Slow, sustained ventilation over 1 second with a controlled tidal volume
Of the 21% oxygen only how much is used by the body? And what happens to the remaining amount?
5%, the remaining 16% is exhaled
What makes the greatest contribution to maintaining a high oxygen content in the exhaled air?
Dead space, volume that was not used in gas exchange
T/F there is a low risk of contracting an infectious disease from mouth to mouth
True
T/F During mouth-to-nose ventilation the mouth is closed.
True
MOUTH-TO-MASK and BAG-VALVE VENTILATION: GENERAL CONSIDERATIONS
If a patient has a pulse, the amount of air volume delivered to the patient should be approximately:
10 ml/kg
Ventilation rates and frequency of ventilation for patient with pulse: Adult
10-12 per min/ one every 5-6 seconds
Ventilation rates and frequency of ventilation for patient with pulse: Child (1-adolescent) & Infant (up to 1 yrs old)
12-20 per min/ one every 3-5 seconds
Ventilation rates and frequency of ventilation for patient with pulse: Newborn (up to 30 days old)
40-60 per min/ one every 1-1.5 seconds
Ventilation rates and frequency of ventilation for patient with pulse for ratio of compression to ventilation (ONE PERSON CPR) for adult, child, infant, newborn.
30 compressions at rate of at least 100/minute to 2 ventilations (Adult, Child, Infant)
3 compressions to 1 ventilation (newborn)
Ventilation rates and frequency of ventilation for patient with pulse for ratio of compression to ventilation (2 PERSON CPR) for adult, child, infant, newborn.
Adult: 30 compressions at rate of at least 100/minute to 2 ventilations
Child & Infant: 15 compressions at rate of at least 100/minute to 2 ventilations
Newborn: 3 compressions to 1 ventilation
Compression rates, Ventilation rates and frequency of ventilation for patient without a pulse with an Advanced Airway in place for adult, child, infant, newborn
Adult, Child, Infant: At least 100 per minute with no pause for ventilation/ 8-10 per minute/ one ventilation every 6-8 seconds.
Neonate: 3 compressions to 1 ventilation/ 30 per minute/ one ventilation after every third compression.
Positioning yourself at the top of the patients head for mouth to mask technique is referred to as
Cephalic technique
However if performing one-person cpr its better to position yourself to the side of the patients head, this is known as:
Lateral technique
When administering mouth to mask what technique would you use to hold the mask?
“C-E” Technique
If a patient is in cardiac arrest you would need to use what method to perform ventilation
Switch from a jaw thrust to a head tilt chin lift maneuver
T/F Diaphragm provides 60%-70% of breathing.
True
A manual resuscitator used to provide positive ventilation
Bag valve mask (BVM) device
The Bag Valve Mask consists of the following:
Self inflating bag, one-way nonrebreather valve, face mask, intake/oxygen reservoir valve and an oxygen reservoir.
And adult sized BVM should have a volume of approximately how many ml?
1,600
In an adult you need to deliver approximately how many ml with each ventilation?
600ml
A BVM in newborn, infant, children should have a minimum volume of how many ml?
450-500
A major advantage of using a BVM is that it can deliver close to 100% oxygen by adding:
Adding oxygen and a reservoir
On a BVM a non-jamming valve system should allow a max of oxygen inlet flow of how many lpm?
30
The standard size couplings for masks are
15/22
When conducting a 1 person BVM technique if you r having difficulty maintaining an open airway insert either:
Oropharyngeal or nasopharyngeal airway
Ventilation should not be interrupted for more than how many seconds at a time?
30 sec
Another method for providing positive pressure ventilation also known as a manually triggered ventilation device powered by oxygen that delivers 100% oxygen.
Flow-restricted oxygen powered ventilation device
T/F FROPVD can only b used on adult patients?
True
T/F When using the FROPVD on a patient in cardiac arrest AVOID using the automatic mode, USE the manual mode to avoid an increase in positive-end-expiratory pressure.
True
This device is used for positive pressure ventilation that has been shown to be excellent at providing and maintaining a constant rate and tidal volume during ventilation and oxygenation of arterial blood. Can deliver oxygen at lower inspiratory flow rates and longer inspiratory times.
Automatic transport ventilator (ATV)
T/F use the head tilt chin lift method if the pt does not have spinal injury.
True
A reduced minute volume due either to an inadequate respiratory rate or to an inadequate tidal volume.
Hypoventilation
Adequate breathing rate but an inadequate tidal volume (shallow breathing)
Hypopnea
Adequate tidal volume but has a respiratory rate that is too slow
Bradypnea
Respiratoy rate that is too fast
Tachypnea
Is a form of noninvasive positive pressure ventilation used in the awake and spontaneously breathing patient who needs ventilator support
Continuous positive airway pressure (CPAP)
T/F CPAP is applied to patients that have a respiratory disease or cardiac failure, and are often used to avoid the need to place endotracheal tube to artificially ventilate the patient.
True
This positive pressure device should be used with caution in patients with hypotension and hypovolemia because it creates an increase in inthrathoracic pressure that may result in a decrease in cardiac output.
(CPAP) Continuous positive airway pressure
T/F a decrease in the respiratory rate may indicate a positive response.
True
T/F As the patients oxygenated levels improve with CPAP, the heart rate will typically decrease.
True
Dyspnea
Difficulty breathing
This airway device allows for different airway pressures to be set for inspiration and expiration.
(BiPAP) Bilevel positive airway pressure
T/F overventilating a pt can lead to serious complications?
True
In a cardiac arrest patient, hyperventilation and prolonged positive pressure ventilation can lead to a decrease in cardiac output, blood pressure and perfusion.
True
T/F Overinflated alveoli may cause the capillaries in the lungs to become compressed and obstruct blood flow to the left atrium.
True
A surgical opening in the front of the neck that may be permanent or temporary.
Stoma
Define total laryngectomy
No longer any connection of the trachea to the mouth and nose.
T/F with a laryngectomy the stoma is permanent.
True
Is mouth to stoma ventilation recommended?
NO
When controlling airway and providing artificial ventilation in infants and children use a bag valve mask with a minimum volume of how many ml? with or without a pop-off valve?
450-500ml and WITHOUT a pop-off valve
What is the ventilation rate for infants and children?
12-20 per min
Avoid using the use of the (WHAT) airway with mid face trauma?
Nasopharyngeal
How many liters are in the following cylinders: D, E, M, G, H
D= 350, E= 625, M= 3,000, G= 5,300, H= 6,900
Gas flow from an oxygen cylinder is controlled by a:
Pressure regulator
Name the two types of regulators and how much oxygen they supply
High pressure- 50psi
Therapy regulator- 0.5 lpm up to 25lpm
he delivery of oxygen over a long period of time you should consider using
Humidified oxygen
If either respiratory rate or tidal volume is inadequate , begin positive pressure ventilation with oxygen flowing at how many lpm?
15 lpm
This device has an oxygen reservoir bag attached to the mask with one way valve between them that prevents the patients exhaled air from mixing with the oxygen in that reservoir. This is the preferred method for delivering oxygen in the prehospital setting.
Nonrebreather
Most typically the oxygen cylinder should be set at a rate of
15lpm
An alternative oxygen delivery device that provides a very limited oxygen concentration ranging from 24-44%. Given to a patient who is not tolerate the nonrebreather mask. Consists of 2 soft plastic tips (nasal prongs) in a thin tube which is provided with a “LOW FLOW” system
Nasal cannula
The liter flow for the nasal cannula should be set at no less than (?lpm) and no greater than (?lpm)
1 & 6
This mask does not deliver a high concentration of oxygen and has no reservoir but can deliever up to 60% oxygen. Oxygen flow rate is set at 10 lpm but must not be less than 6 lpm.
Simple Face Mask
This mask is equipped with a two-way valve that allows the patient to rebreath about 1/3 of their exhaled air. Flow rate is between 6lpm and 10 lpm and provides oxygen concentrations of 35-60%
Partial Rebreather Mask
This mask is commonly used for a patient with a history of COPD because of its ability to deliver a PRECISE concentration of oxygen.
Venturi Mask
This mask delivers a aerosolized medication, bland aerosol therapy, or oxygen to a Tracheostomy tube (T-tube).
Tracheostomy mask
