Chapter 10 Respiration and Artificial Ventilation Flashcards
Alveolar Ventilation
the amount of air that reaches the alveoli
Tidal Volume
the amount of air moved in one breath
- Normal tidal volume is typically 5-7mL per Kg of body weight
Minute Volume
The amount of air moved into and out of the lungs “Per Minute”
Dead Air Space
roughly a little less then a 1/3 of our tidal volume doesn’t reach alveoli. that remainder is found in the Trachea, Bronchioles, and other parts of airway is known as
Cellular respiration
Gas exchange of O2 and CO2 at the cellular level with circulating blood
Dysfunctions of CardioPulmonary System - pathophysiology
Mechanics Disrupted
- Patient stabbed in chest results in outside air filling pleural space resulting in harder time for lungs to create negative pressure to breath
- Medulla Oblongata damaged by trauma or disease
- some diseases are myasthenia gravis and multiple sclerosis
- Airway problems like Bronchoconstriction caused by COPD or asthma
Gas Exchange interrupted
- low O2 from environment
- Diffusion problems from disease like
- Heart failure and COPD (Chronic Obstructive Pulmonary Disease)
Circulation Issues
- Not enough Blood - Severe Bleeding
- Hemoglobin Problems
- diseases like Anemia cause low amounts of hemoglobins in blood or when body pH becomes to Acidotic may make hemoglobins have a difficult time holding oxygen
Hypoxia
Low levels of Oxygen
Chemoreceptors
Receptors that detect increasing levels of CO2 in body as well as low O2
- stimulate respiratory system to breathe more rapidly
Hypercapnia
High levels of CO2
Respiratory Distress
increased level of breathing, HR and position change may be enough to meet challenge
- a sensation of shortness of breath S.O.B
Respiratory Failure
stage 2
- Hypoxic
- Stages of Hypercapnia
- muscles for respiration start to tire
- inadequate breathing
Respiratory Arrest
Stoppage of breathing
Respiratory Distress Signs and intervention
Adequate Breathing
Increased work of breathing; a sensation of shortness of breath
- O2 by nonrebreather mask (12-15ml of O2) or nasal cannula (2-6ml of O2)
Respiratory Failure Signs and Intervention
Inadequate Breathing
Signs
- patient has some breathing but not enough to live
- rate and/or depth outside of normal limits
- shallow ventilations
- diminished or absent breath sounds
- noises such as stridor, crowing, snoring, gasping, gurgling
- blue (cyanotic) or gray skin color
- decreased minute volume
- O2 saturation less then 95%
Intervention
- assisted ventilation with BVM maybe with O2 hooked up to it
Patient is not Breathing Signs and Intervention
Respiratory Arrest
When breathing completely stops
- Oxygen saturation extremely low or not obtainable
Intervention - Artificial Ventilation
- BVM - 10-12/min for adult, 20/min for child,
20+/min for infant
*Note: Don’t use O2 powered devices on infants or children
Cyanosis
A blue or gray color resulting from lack of oxygen in the body
Several major causes of Hypoxia
- O2 deprived environment
- Patient with emphysema
- patient ODs on Drugs resulting in low RR
- Heart attack disturbing circulatory to lungs
Negative sides effects of positive pressure ventilation
- Decreasing cardiac output/ dropping BP, positive pressure not letting heart fill back up
- gastric Distention - filling stomach with air through esophagus
- hyper ventilation - Too much carbon dioxide to be blown off. Causes vasoconstriction narrowing of the blood vessels, can limit blood flow to the brain.
Hyperventilation
Causes “Vasoconstriction” (narrowing of blood vessels) limiting blood flow to the brain
Techniques of artificial ventilation
- chest rise and fall
- rate of ventilation 10-12/ min for adults
- 20/min for children
- 20+ / min for infant
CPAP
Continuous positive airway pressure
NPPV
- can only be used by what kind of patient?
Noninvasive positive pressure ventilation
- only by awake patients that are breathing on their own! Goes for CPAP and BiPAP
BiPAP
Biphasic continuous positive airway pressure
BVM
Bag Valve Mask
- at least 15L/min for O2
- bag will hold 1000-1600mL of air
- hooked to O2 without reservoir is 50%
- with reservoir provides 100%O2
Stoma
A permanent surgical opening in the neck through which the patient breathes in
FROPVD
Flow restricted oxygen powered ventilation device
Peak flow 100%O2 up to 40 L/min
Has trigger
Inspiration pressure relief valve opens at 60cm of water pressure
*only used on adults
Oxygen cylinders
Green cylinders
Never allowed to be emptied all the way
D cylinder contains 350 L of O2
E cylinder contains 625 L of O2
M cylinder contains 3000 L of O2
Fixed systems on ambulances
G cylinder contains 5300 L of O2
H cylinder contains 6900 L of O2
All filled with 2000-2200 psi
Nonrebreather mask
A face mask and reservoir bag device that delivers high concentrations of oxygen. Patients exhaled air escapes through a valve and is not rebreathed
12-15 L/min
Must fill reservoir before mask is placed on patients face
Provides 80 to 100% concentrations of O2
Nasal Cannula
Provides low concentrations of O2
24-44%O2
Set anywhere from 2-6L/min
Venturi mask
A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air
- used on patients with COPD
- up to 15 L/min
- 24-60% O2
Tracheostomy mask
A device designed to be placed over a stoma or tracheostomy tube to provide supplemental oxygen
Set at 8-10 L/min
Special Considerations in airway management
- Facial injuries - frequent suctioning or endotracheal tube may be necessary
- obstructions - manual techniques like abdominal thrust, chest thrust or finger sweeps.
- Dental appliances - Dentures leave in place if possible but be prepared to remove if endangering airway
Alveolar respiration
Gas exchange of O2 and CO2 in the alveoli and pulmonary capillaries or
What happens when Body PH become acidotic
may make hemoglobins have a difficult time holding oxygen
How much is 1 kg in lbs?
Equals 2.2 lbs
Inspirations (inhalation’s) that are prolonged?
Indicate a possible upper airway obstruction
Expirations (exhalations) that are prolonged?
Indicate possible lower airway obstruction
Emphysema
Lung disease that decreases the efficiency of the transfer of O2 between the atmosphere and the body leading to hypoxia
Artificial ventilation
Forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing
Pocket mask O2 delivery
Approx 50% O2 from mask when 100% O2 connected
Oxygen cylinders are made up of?
Made up of either seamless steel or lightweight alloy
D cylinder contains
350L of O2
E cylinder contains
625 L of O2
M cylinder contains
3000 L of O2
G cylinder contains
5300 L of O2
H cylinder contains
6900 L of O2
(Nonferrous) oxygen wrenches
Wrenches that are made of plastic or of metals that do not contain iron
Pressure regulators make a safe pressure of?
Uses a pressure of 30-70 psi
Humidifier
A device connected to the flow meter to add moisture to the dry oxygen coming from an oxygen cylinder
Hazards of O2 medical and non medical
Non medical
- if punctured can become a middle
- oxygen supports combustion
- oxygen and oil do not mix severe reaction cause an explosion
Medical
- oxygen toxicity or air sac collapse by too much O2 in lungs
- infant eye damage - over a long period (days) can develop scar tissue on retina of infants eye
- respiratory depression or arrest - common in COPD patients
Partial rebreather
9-10 L/min
40-60% O2
B.U.R.P maneuver
Method using index and thumb pushing on thyroid cartilage upward and to the right for paramedic to see larynx
- Bringing Up and to the Right Position-
Most systems have a standard fitting ?
Standard fitting is 15/22 to ensure a proper fit with other respiratory equipment, face masks, and endotracheal tubes
