Chap 10 Flashcards
Negative effects of Artificial ventilation
- Decrease cardiac output/ dropping blood pressure
- The heart uses the negative pressure the assist in the filling of the chambers with blood. With positive pressure it goes away and the heart can compensate but at risk of blood pressure drop. You can minimize this by using just enough volume to raise the chest
- Gastric distention
- Hyperventilation
Mechanical failures of the Cardiopulmonary system
Mechanics of breathing disrupted
- Stabbed in chest- Tension pneumothorax - Loss of nervous control of respiration- Myasthenia gravis and multiple sclerosis - Painful chest wall injuries- Pain or damage that limits chest wall movement - Airway problems such as bronchoconstriction- Asthma or COPD
Gas exchange interrupted
- Low oxygen levels in the outside air - Diffusion problems- COPD
Circulation issues
- Not enough blood- Blood loss - Hemoglobin problems- Anemia
How is intubation checked if tube is correctly placed?
- Auscultation of both lungs and epigastrium expanding
- Using a capnometry or an end-tidal CO2 detector device
Noninvasive positive pressure ventilation (NPPV)
Assists the ventilations of a breathing patient by assuring that each breath the patient takes maintains adequate pressure within the respiratory tract, improving alveolar ventilation and gas exchange
- CPAP (continuous positive airway pressure)
- BiPAP (biphasic continuous positive pressure)
Nonrebreather mask stats
12-15 liters per minute
80-90%
Two types of advanced airway devices
- Devices that require direct visualization of the glottic opening (endotracheal intubation)
- Laryngoscope is used to visualize the airway
- Blind insertions need head in neutral position
- Devices that are inserted blindly
- King LT airway, Combitube, and laryngeal mask airway (LMA)
- Head in sniffing position
Artificial ventilation(positive pressure ventilation)
Forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing
Major causes of hypoxia
- Trapped in a fire
- Air contains smoke and reduced amounts of oxygen
- Has emphysema
- Decreases efficiency of the transfer of oxygen
- Overdose and depressing effect on respiratory system
- Not breathing enough to support oxygen needs
- Heart attack
- Oxygenated blood can’t be delivered to body due to damaged heart cannot pump the blood
if expirations are prolonged
indicating possible lower airway obstruction
Multiple sclerosis
Demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate
Pressure regulators bring the cylinder pressure down to what PSI range?
30-70 PSI
Alveolar ventilation
how much air actually make it to the alveoli
E cylinder contains
625 liters
Signs of inadequate breathing
- Chest movements are absent, minimal, or uneven
- Abdominal breathing
- No air felt or heard at the nose or mouth
- Breath sounds are diminished or absent
- Noises
- Rate of breathing is too rapid or slow
- Breathing is very shallow, deep or appears labored
- Cyanosis
- Inspirations/ expirations are prolonged
- Unable to speak or cannot speak full sentences
- retractions
- Nasal flaring especially in infants and children
- Low oxygen saturation (<95%)
Average ventilation a sec
- Adults
- Children
Adults- 5 secs
Children- 3 secs
If patient is breathing to slow and requires ventilation?
if rate is very slow?
- Bag patient on every inhale
2. Add ventilations in between the patients own to obtain a rate of 10-12 adult (20 for children and infants)
Automatic transport ventilator
device that provides positive pressure ventilation
- adjusts for ventilation rate and volume
humidifier
a device connected to the flow meter to add moisture to the dry oxygen. Can dry out mucous membrane
Inhalation is a _____process
Active
Gastric distention
- Filling of the stomach with air through the esophagus during positive pressure ventilation
- Side effects-vomiting, restriction of the movement of the diaphragm
What do you do with artificial ventilation if respirations are slow or fast?
Bag on patients inhales and then slowly adjust to normal breathing rates
Two diseases of bronchoconstriction?
Chronic obstructive pulmonary disease (COPD)
Asthma
Color of oxygen cylinders
Green or White
M cylinder contains
3000 liters
Decrease Cardiac output/ dropping blood pressure from positive pressure ventilation
- Normally the heart uses the negative pressure of ventilation to assist the filling of its chambers with blood. When positive pressure is used to ventilate, we eliminate that negative pressure and filling assistance
- Most times the heart can compensate but at risk of drop in blood pressure
Hyperoxygenation
Ventilating the patient normal to slightly more not exceeding 20 breaths per minute for no more than 2-3 minutes. this makes sure patient is oxygenated for intubation
Emphysema
Lung disease that decreases the efficiency of the transfer of oxygen between the atmosphere and the body
G cylinder contains
5300 liters
diffusion of oxygen and carbon dioxide between the alveoli and circulating blood
Pulmonary respiration
What’s oxygen cylinders made of and filled to?
a seamless steel, aluminum, stainless steel, lightweight alloy and is filled to equal 2000-2200 psi
Adequate breathing
- Adult - Child - Infant
- Adult-12-20
- Child-15-30
- Infant-25-50
Cyanosis
blue or grey color resulting from lack of oxygen in the body
Low pressure flow meters
- Pressure compensated flowmeter
- Gravity dependent ball float
- Constant flow selector valve
- Pressure selector switch
Myasthenia gravis
long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness
How long should intubation take no longer than?
30 secs
Partial rebreather mask
9-12 liters per minute
40-60%
Usually not used by EMTs but for home use
Types of artificial ventilation
- Mouth to mask
- Two-rescuer bag valve mask (BVM)
- Flow-restricted, oxygen-powered ventilation device (FROPVD)
- One-rescuer bag valve mask
D cylinder contains
350 liters
Nasal canula
1-6 liters per minute
24-44%
Ventilation rates
Adult
Child
Infant
Adult -10-12
Child - 20
Infant- 20 minimum
If inspirations are prolonged
indicating possible upper airway obstruction
Don’t let O2 cylinders get blow what PSI
200 PSI
What’s the system call when circulatory and the respiratory systems work together?
Cardiopulmonary system
What happens to hemoglobin’s in high pH blood?
difficulty holding oxygen
H cylinder contains
6900 liters
FROPVD
Flow-restricted, oxygen-powered ventilation device
- Manually triggered ventilation device - Peak flow rate of 100% up to 40 liters per minute - pressure relief valve opens at 60cm pressure - audible alarm when relief valve is activated
Bag Valve Mask (BVM) stats
- 15L per minute
- BVM without reservoir delivers 50%
- BVM with reservoir delivers 100%
- Bag holds 1,000-1,600 mL
Respiratory failure (inadequate breathing)
the reduction of breathing to the point where oxygen intake is not sufficient to support life
Venturi mask
up to 15 liters per minute
24-60%
What 2 lubrications to use on a NPA
Water based and non petroleum
Respiratory arrest
when breathing completely stops
diffusion of oxygen and carbon dioxide between the cells and circulating blood
cellular respiration
Tracheostomy mask
- 8-10 liters per minute
- adjustable %
- Used to ventilate through a stoma or tracheostomy
- Clear mucus or secretions
- Use pediatric mask to ventilate stoma
- If unable to ventilate through stoma, seal off stoma and ventilate through mouth and nose
- Leave head and neck in neutral position if ventilating through stoma
Pocket face mask stats
- 16% oxygen without O2 supplementation
- 50% with high concentration oxygen
Hyperventilation
- Caused by ventilating to fast
- To much carbon dioxide blow off
- causes vasoconstriction in the body and can limit blood flow to the brain
Other dangers of oxygen administration
- Oxygen toxicity or air sac collapse
- Body reacts to “overload” of oxygen and reduces lung activity and collapses air sac
- Infant eye damage
- Premature babies can develop scar tissue on the retina of the eye with to much oxygen
- Respiratory depression or respiratory arrest
- People with COPD can have their “drive to breath” wiped out from to much oxygen
BURP
Bringing Up and to the Right Position
Exhalation is a _______process
Passive
Respiratory distress
increased work of breathing; a sensation of shortness of breath
Three major issues to consider when administering oxygen.
- Oxygen is a drug
- Oxygen can cause harm
- Oxygen should be administered based on your overall evaluation of the patients presentation and possible underlying conditions
