Chapter 11: Airway management

Question 1

What is the difference between ventilation, oxygenation, and respiration?

Answer 1

Ventilation is in and out air movement controlled by the CSF’s detection of CO2,
-hypoxia is low oxygen, hypoxic drive is triggered by high CO2
Oxygenation is the loading of oxygen
Respiration is the exchange of CO2 and O2

Question 2

What is respiration affected by?

Answer 2

altitude, partial pressure of oxygen, pneumonia, COPD, FBAO, pulmonary edema

Question 3

What is circulation affected by?

Answer 3

pulmonary embolism (common after any surgery), pneumothorax (collapsed lung), blood loss, anemia (less oxygen transferred), shock: hypovolemic or vasodilatory.

Question 4

What are common concerning respiratory patterns?

Answer 4

Agonal, Cheyne-Stokes: deep/rapid then apnea cycles because of stroke/head injury, Ataxic: irregular/ineffective breathing, caused by a head injury, Kussmall: Rapid deep/labored/gasping sign of metabolic acidosis (too much sugar in blood: diabetes)

Question 5

What are the suction limits for partially obstructed airways?

Answer 5

Adult: 15sec Children: 10sec, Infant: 5 sec

Question 6

What are examples of pulmonary ventilation problems?

Answer 6

Infection, allergy, unresponsiveness, FBAO, trauma

Question 7

What are the main ventilation devices and when are they used?

Answer 7

BVM: Administers positive pressure, used for unresponsive, gasping, poor color -rescue breathing for slow ventilations, attach to oxygen to improve oxygenation status
NRBM: High flow oxygen (10-15 LPM) Oxygen delivery: 90% for respiratory distress, pale, cool, moist, AMS (suggests hypoxia), significant trauma.
Nasal canula: Low flow (1-6LPM) Oxygen delivery: 24-44% to boost slightly low SpO2, chest pain, slightly low SpO2

Question 8

What is a PEEP valve?

Answer 8

Positive, End-Expiratory Pressure. used for ventilation over a long time to keep lungs from collapsing

Question 9

What is CPAP?

Answer 9

Continuous Positive Airway Pressure. It needs a seal, avoids intubation can force fluid out of the lungs, patient must be able to think and obey and is not used on trauma or bleeding patients, this will lower blood pressure

Question 10

What is the oxygen administration flowchart?

Answer 10

Pt SpO2 indicate hypoxia: Nasal cannula (if will work), otherwise NRBM. Then monitor SpO2 and clinical signs (AMS)
Pt SpO2 not indicate hypoxia: Other evidence of hypoxia (anxiety/agitation, cyanosis, accessory muscle use, abnormal breath sounds) or other instability or Compensated/decompensated shock, yes: administer lowest lev. O2 that will improve patient. No: Pt does not need oxygen

Question 11

What are the indications and contraindications of CPAP?

Answer 11

Indications:
Pt able to obey, signs of moderate-severe respiratory distress from pulmonary edema, COPD, or bronchospasm, submersion incident, rapid breathing affecting minute volume, SpO2 <90%
Contraindications:
Respiratory arrest/agonal respirations, hypoventilating (slow rate or reduced tidal volume), cannot speak, X able to obey, X self-maintained airway, hypotension, pneumothorax or chest/face trauma, tracheostomy, GI bleeding, nausea, vomiting, cardiogenic shock, CPAP mask cannot fit properly, pt cannot tolerate mask.