ch11 (airway management) Flashcards
brain tissue will begin to die ______ without oxygen
4 to 6 minutes
diffusion
molecules move into an area of high concentration to lower concentration
airway
the upper airway tract or the passage above the larynx (nose, mouth, throat)
the diaphragm and intercostal muscles are responsible for….
rise and fall of the chest that accompany normal breathing
the upper airway includes the:
nose
mouth
jaw
oral cavity
pharynx
larynx
what is the function of the upper airway?
to warm, filter, and humidify air as it enters the body through the nose and mouth
nasopharynx
keeps dust and other small particles out of the respiratory tract
-warms and humidifies air as it enters the body
oropharynx
allows air, food and fluid to pass through
epiglottis
separates the digestive system from the respiratory system
-prevents food and liquid from entering the larynx during swallowing
aspiration
the introduction of vomit or other foreign material in the lungs
larynx
marks where the upper airway ends and lower airway begins; voice box
glottis
space between the vocal chords and the narrowest portion of the adult’s airway
vocal chords
primary center for speech production; contain defense reflexes that protect the lower airway
-lateral borders of the glottis
the function of the lower airway is to…
deliver oxygen to the alveoli
trachea
windpipe
-conduit for air entry into the lungs
carina
where the trachea divides into the left and right main stem bronchi
the lungs consist of…
smaller bronchi, bronchioles, and alveoli
visceral pleura
covers the outer surface of the lung tissue
parietal pleura
lines the inside of the thoracic cavity
bronchioles
thin, hollow tubes made of smooth muscle
-branch into alveolar ducts
alveoli
functional site for the exchange of oxygen and carbon dioxide
-surrounded by pulmonary capillaries
describe how oxygen diffuses throughout the body
- oxygen diffuses through the lining of the alveoli into the pulmonary capillaries
- from the pulmonary capillaries it is carried back to the heart for distribution throughout the body
- at the same time, carbon dioxide diffuses from the pulmonary capillaries into the alveoli, where it’s exhaled and removed from the body
mediastinum
-between the lungs; separates the right lung from left lung
what is in the mediastinum
- heart
- great vessels
- esophagus
- trachea
- major bronchi
- nerves
phrenic nerves
found in the thorax
-innervate the diaphragm muscle, allowing it to contract
-necessary for adequate breathing
ventilation
act of moving air into and out of the lungs
oxygenation
the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream
respiration
the actual exchange of oxygen and carbon dioxide in the alveoli and tissues of the body
inhalation
the active muscular part of breathing
-diaphragm and intercostal muscles retract (allowing air to enter the body and travel to the lungs)
accessory muscles
secondary muscles of respiration
partial pressure
the amount of gas in air or dissolved in fluid (blood)
tidal volume
amount of air that is moved into or out of the lungs during one breath
residual volume
the air that remains in the lungs after maximal expiration
alveolar ventilation
volume of air that reaches the alveoli
(dead space air - tidal volume)
minute volume
volume of air moved through the lungs in 1 minute
(tidal volume x respiratory rate)
alveolar minute volume
volume of air moved through the lungs in 1 minute
(multiply tidal volume - dead space and respiratory rate)
vital capacity
the amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible
dead space
portion of tidal volume that does not reach alveoli and does not participate in gas exchange
exhalation
does not require muscular effort; a passive process
-diaphragm and intercostal muscles relax
air will reach the lungs only if…
it travels through the trachea
patent
maintaining the airway so air can enter and leave the lungs freely
hypoxia
tissues+cells in the body do not get enough oxygen
hypoxic drive
secondary control of breathing
-detects drops in the oxygen level in the blood
dyspnea
shortness of breath
the best time to give a patient oxygen is…
before signs and symptoms of hypoxia appear
metabolism
cellular respiration
-cells combines nutrients (sugar) and oxygen and produces energy (ATP) and waste products (water+CO2)
external respiration
pulmonary respiration
-gas exchange between lungs and in pulmonary capillaries
surfactant
reduces surface tension within the alveoli and keeps them expanded
-makes it easier for gas exchange to occur
how much of hemoglobin receptor sites contain oxygen?
96-100%
internal respiration
exchange of oxygen and carbon dioxide between the systemic circulatory system and the cells of the body
aerobic metabolism
-with oxygen
cells convert glucose into energy
anaerobic metabolism
-without oxygen
-cells do not completely convert glucose into energy and lactic acid
-cannot meet the metabolic demands of the cell and they will eventually die
chemoreceptors
monitor the levels of oxygen, CO2, hydrogen ions, and pH of CSF provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time
hypercarbia
oxygen levels in the blood DECREASE, carbon dioxide levels INCREASE
intrapulmonary shunting
blood enters the lungs from the right side of the heart, bypasses the alveoli, and goes to the left side of the heart in an unoxygenated state
hemothorax
a collection of blood in the pleural cavity
pneumothorax
accumulation of air/gas in the pleural cavity
tension pneumothorax
accumulation of air/gas in the pleural cavity that gradually increases the pressure in the chest and interferes with cardiac function
aerosol-generating procedure (AGP)
any airway manipulation that induces the production of aerosols that may present a risk for airborne transmission of pathogens (ex: CPR)
bilateral
a body part or condition that appears on both sides of the midline
bag-mask device
device with a one-way valve and a face mask attached to a ventilation bag (delivers 90% more supplemental oxygen)
labored breathing
working hard to breath, using accessory muscles (chest, back, abdomen)
what is the normal respiratory rate in adults?
12-20 breaths/min
what is the normal respiratory rate in children?
12-40 breaths/min
what is the normal respiratory rate in infants?
30 to 60 breaths/min
retractions
movements in which the skin pulls in around the ribs during inspirations
agonal gasps
occasional gasping breaths
Cheyne-Stokes respirations
irregular respiratory pattern of abnormal breathing that increases and then decreases in rate and depth followed by a period of apnea
where are Cheyne-Stokes respirations seen?
in patients with stroke or head injuries
apnea
lack of spontaneous breathing
ataxic breathing
irregular, ineffective respirations that may or may not have an identifiable pattern
Kussmaul respirations
deep rapid respirations (seen in patients with metabolic acidosis)
pallor
pale skin (associated with poor perfusion caused by illness or shock)
pulse oximetry
measures patient’s oxygenation status
SpO2
the percentage of hemoglobin molecules that are bound in arterial blood
end-tidal CO2
the amount of CO2 present at the end of an exhaled breath
capnometry
digital numeric reading of the end-tidal CO2 level
capnography
numeric reading+graph of the end tidal CO2 levels from breath to breath
what is the normal range of end-tidal CO2?
35-45mmHg
head-tilt chin lift maneuver
tilting the patient’s head back and lifting the chin
jaw thrust maneuver
opens the airway by placing the fingers behind the angle of the jaw and lifting the jaw upward; used for patients with spinal injuries
tonsil tips
plastic, rigid pharyngeal suction tip; best for children and infants
suction catheter
used to remove fluids from the patient’s airway
stoma
opening through the skin that goes into an organ or other structure
oropharyngeal (oral) airway
- keeps the tongue from blocking the upper airway
- make it easier to suction to oropharynx if necessary
gag reflex
protective reflex mechanism that prevents food and other particles from entering the airway
nasopharyngeal (nasal) airway
used with an unresponsive or patient with an altered LOC, who has an intact gag reflex and is not able to maintain his or her airway spontaneously
recovery position
maintain a clear airway in an unconscious patient who is not injured and breathing on their own; lay patient on their side
pin-indexing system
system for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas
American Standard Safety System
safety system for large cylinders to prevent accidental attachment of a regulatory to a cylinder containing the wrong type of gas
oxygen toxicity
damage to cellular tissue due to excessive oxygen levels in the blood
nonrebreathing masks
administer high concentrations of oxygen to significantly hypoxemic patients who are otherwise breathing adequately
(provides up to 90% inspired oxygen)
nasal cannula
delivers oxygen through two small, tubelike prongs that fit into the patients nostrils
(provides 24-44% inspired oxygen)
cardiac output=
stroke volume x heart rate
stroke volume
the amount of blood ejected by the ventricle in one cardiac cycle
cardiac output
amount of blood ejected by the left ventricle in 1 minute
adult ventilation rate
1 breath every 6 seconds
child ventilation rate
1 breath every 2-3 seconds
infant ventilation rate
1 breath every 2-3 seconds
the volume of air delivered to the patient is based on…
chest rise and fall
gastric distention
inflation of the stomach with air
when does gastric distention occur?
when you ventilate a patient too forcefully or rapidly
passive ventilation
air movement into and out of the chest occurs passively from chest compressions
automatic transport ventilator (ATV)
ventilation device attached to a control box that allows the variables of ventilation to be set; frees the EMT to perform other tasks while PT is being ventilated
compliance
ability of alveoli to expand when air is drawn in during inhalation
poor lung compliance
inability of alveoli to fully expand during inhalation
positive pressure ventilation
forcing air into the lungs under pressure during inspiration
negative pressure ventilation
creates a sub-atmospheric pressure around the chest, drawing air into the lungs
continuous positive airway pressure (CPAP)
noninvasive means of providing ventilatory support for patients experiencing respiratory distress; prevents the need for endotracheal intubation
tracheostomy
an opening in the neck that connects the trachea directly to the skin
mild airway obstruction
able to exchange air but will have varying degrees of respiratory distress; noisy breathing + coughing
severe airway obstruction
cannot breathe, talk or cough
good air exchange
patient can cough forcefully; may hear wheezing
wheezing
whistling sounds during respiration between coughs
wheezing is indicative of…
mild lower airway obstruction
stridor
high pitched noise heard on inspiration
stridor is an indication of…
mild upper airway obstruction
endotracheal intubation
inserting a tube into the trachea to maintain and protect the airway
preoxygenation
providing oxygen prior to intubation to raise oxygen levels of body tissues
apneic oxygenation
oxygen in a high-flow nasal cannula is left in local during an incubation attempt; allowing for continuous oxygen delivery into airways during all phases of the procedure
direct laryngoscopy
visualization of the vocal chords with a laryngoscope
video laryngoscopy
visualization of the vocal cords using a video camera and monitor
gum elastic bougie
flexible device inserted between the glottis under direct laryngoscopy
BE MAGIC
B: perform Bag-mask preoxygenation
E: Evaluate for airway difficulties
M: Manipulate the patient
A: Attempt first-pass intubation
GI: use a supraGlottic airway if unable to intubate
C: Confirm successful intubation/Correct any issues
esophageal intubation
airway device has been placed into the esophagus rather than into the trachea; causes air being pumped into the stomach and gastric distention
barrier device
protective device that limits exposure to patient’s body fluids
denitrogenation
replacing nitrogen in the lungs with oxygen
