Chapter 11: Airway Management Flashcards
Define: aerobic metabolism
metabolism that can proceed only in the presence of oxygen
Define: aerosol-generating procedure
any airway manipulation that induces the prouction of aerosols that may present a risk for airborne transmission of pathogens, such as CPR
Define: agonal gasps
abnormal breathing pattern characterized by slow, gasping breaths, sometimes seen in pts in cardiac arrest
Define: airway
the upper airway tract or the passage above the larynx, which includes the nose, mouth, and throat
Define: alveolar minute volume
the volume of air moved through the lungs in 1 minute minus the dead space; calculated by multiplying tidal volume (minus dead space) and respiratory rate
Define: American Standard Safety System
a safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas
Define: anaerobic metabolism
the metabolism that takes place in the absence of O2, the main by-product is lactic acid
Define: apnea
absence of spontaneous breathing
Define: apneic oxygenation
a technique in which oxygen administered via a high flow nasal cannula is left in place during an intubation attempt, allowing for continuous oxygen delivery into the airways during all phases of the procedure
Define: aspiration
in the context of the aiway, the introduction of vomitus or other foreign material into the lungs
Define: ataxic respirations
irregular, ineffective respirations that may or may not have an identifiable pattern
Define: automic transport ventilatro (ATV)
a ventilation device attached to a control box that allows the variables of ventilation to be set. It frees the EMT to perofrm other tasks while the pt is being ventilated
Define: bag-mask device
a device with a one-way valve and a face mask attached to a ventilation bag; when attached to a reservoir and connected to oxygen, it delivers more than 90% supplemental oxygen
Define: barrier device
a protective item, such as a pocket mask, with a valve, that limits exposure to a pt’s bodily fluids
Define: bilateral
a body part or condition that appears on both sides of the midline
Define: bronchioles
subdivision of the smaller bronchi in the lungs; made of smooth muscle and dilate or constrict in response to various stimuli
Define: capnography
a noninvasive method to quickly and efficiently provide info on a pt’s ventilatory status, circulation, and metabolism. It effectively measures the concentration of carbon dioxide in expires air overtime
Define: capnometry
the use of a capnometer, a device that measures the amount of expired CO2
Define: carina
point at which the trachea bifurcates into the left and right main stem bronchi
Define: chemoreceptors
monitor the levels of O2, CO2, and the pH of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time
Define: Cheyne-stokes respirations
a cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea
Define: compliance
the ability of alveoli to expand when air is drawn in during inhalation
Define: continuous positive airway pressure (CPAP)
a method of ventilation used primarily in the treatment of critically ill pts w respiratory distress; can prevent the need for endotracheal intubation
Define: dead space
any portion of the airway that does contain air and cannot participate in gas exchange, such as the trachea and bronchi
Define: denitrogenation
the process of replacing nitrogen in the lungs with oxygen to maintain a normal oxygen saturation level during advanced airway management
Define: diffusion
movement of gas from an area of higher concentration to an area of lower concentration
Define: direct laryngoscopy
visualization of the airway with a laryngoscope
Define: dyspnea
shortness of breath
Define: endotracheal (ET) intubation
insertion of an endotracheal tune directly through the larynx between the vocal cords and into the trachea to maintain and protect an airway
Define: end-tidal CO2
the amount of carbon dioxide present at the end of an exhaled breath
Define: esophageal intubation
improper placement of an advanced airway device into the esophagus rather than into the trachea
Define: exhalation
the passive part of breathing process in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs
Define: external respiration
the exchange of gases between the lungs and the blood cells in the pulmonary capillaries; also called pulmonary respiration
Define: gag reflex
a normal reflex mechanism that causes retching; activated by touching the soft palate or the back of the throat
Define: gastric distention
a condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation
Define: glottis
the space in between the vocal cords that is the narrowest portion of the adult’s airway; also called the glottic opening
Define: good air exchange
a term used to distinguish the degree of distress in a pt w a mild airway obstruction. With good air exchange, the pt is still conscious and able to cough forcefully, although wheezing may be heard
Define: gum elastic bougie
a flexible device that is inserted between the glottis under direct laryngoscopy; the endotracheal tube is threated over the device, facilitating its entry into the trachea
Define: head tilt-chin lift maneuver
a combination of 2 movements to open the airway by tilting the forehead back and lifting the chin; not used for trauma pts
Define: hemothorax
a collection of blood in the pleural cavity
Define: hypercarbia
increased carbon dioxide level in the bloodstream
Define: hypoxia
deficient oxygen concentration in the tissues
Define: hypoxic drive
a backup system to control respiration; senses drop in the oxygen level in the blood
Define: inhalation
the active, muscular part of breathing that draws air into the airway and lungs
Define: internal respiration
the exchange of gases between the blood cells and the tissues
Define: intrapulmonary shunting
bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart
Define: jaw-thrust maneuver
technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward; used for pts who may have a cervical spine injury
Define: labored breathing
the use of muscles of the chest, back, and abdomen to assist in epxanding the chest; occurs when air movement is impaired
Define: larynx
a complex structure formed by many independent cartilaginous structures that all work together; where the upper airway ends and the lower airway begins; also called the voice box
Define: mediastinum
space between the chest that contains the heart, major blood vessels, vagus nere, trachea, major bronchi, and esophagus; located between the 2 lungs
Define: mild airway obstruction
occurs when a foreign body partially obstructs the pt’s airway. the pt is able to move adequate amounts of air, but also experiences some degree of respiratory distress
Define: minute volume
the volume of air that moves into and out of the lungs per minute; calculated by multiplying the tidal volume and respiratory rate; also called minute ventilation
Define: nasal cannula
an oxygen-delivery device in which oxygen flows through two small, tubelike prongs that fit into the pt’s nostrils; delivers 24% to 44% supplemental oxygen, depending on the flow rate
Define: nasopharyngeal (nasal) airway
airway adjunct inserted into the nostril of an unresponsive pt or a pt with an altered level of consciousness who is unable to maintain airway patency directly
Define: nasopharynx
the part of the pharynx that lies above the level of the roof of the mouth, or palate
Define: nonrebreathing mask
a combination mask and reservoir bag system that is the preferred way to give oxygen in the prehospital setting; delivers up to 90% inspired oxygen and prevents inhaling the exhaled gases (co2)
Define: oropharyngeal (oral) airway
airway adjunct inserted into the mouth of an unresponsive pt to keep the tongue from blocking the upper airway and to facilitate suctioning the airway, if necessary
Define: oropharynx
a tubular structure that forms the posterior portin of the oral cavity, which is bordered superiorly by the hard and soft palates, laterally by the cheecks, and inferiorly by the tongue
Define: oxygenation
the process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs
Define: oxygen toxicity
a condition of excessive oxygen consumption resulting in cellular and tissue damage
Define: parietal pleura
thin membrane that lines the chest cavity
Define: partial pressure
used to describe the amount of gas in air or dissolved in fluid, such as blood
Define: passive ventilation
the act of air moving into and out of the lungs during chest compressions
Define: patent
open, clear of obstruction
Define: phrenic nerves
the two nerves that innervate the diaphragm; necessary for adequate breathing to occur
Define: pin-indexing system
a system established for portable cyliners to ensure that a regulator is not connected to a cyliner containing the wrong type of gas
Define: pneumothorax
an accumulation of air or gas in the pleural cavity
Define: poor air exchange
a term used to describe the degree of distress in a pt with a mild airway obstruction. w poor air exchange, the pt often has a weak, innefective cough, increased difficulty breathing, or possible cyanosis and may produce a high-pitched noise during inhalation (stridor)
Define: preoxygenation
the process of providing oxygen, often in combination w ventilation, prior to intubation in order to raise the oxygen levels of body tissues; a critical step in advanced airway management. This extends the time during which an advanced airway can be placed in an apneic pt, because the more oxygen that is available in the alveoli, the longer the pt can maintain adequate gas exchange in the lungs during the procedure.
Define: pulse oximetry
an assessment tool that measures oxygen saturation of hemoglobin in the capillary beds
Define: recovery position
a side-lying position used to maintain clear airway in unconscious pts without injuries who are breathing adequately
Define: residual volume
the air that remains in the lungs after maximal expiration
Define: respiration
the process of exchanging oxygen and carbon dioxide
Define: retractions
movements in which the skin pulls in around the ribs during inspiration
Define: severe airway obstruction
occurs when a foreign body completely obstructs the pt’s airway. the pt cannot breathe, talk, or cough
Define: stoma
an opening through the skin and into an organ or other structure
Define: stridor
a harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope
Define: suction catheter
a hollow, cylindrical device used to remove fluid from the pt’s airway
Define: surfactant
a liquid protein substance that coats the alveoli in the lungs, decrease alveolar surface tension, and keeps the alveoli expanded; a low level in a premature infant contributes to respiratory distress syndrome
Define: tension pneumothorax
an accumulation of air or gas in the pleural cavity that progressively increases with pressure in the chest and that interferes with cardiac function, with potentially fatal results
Define: tidal volume
the amount of air (in mL) that is moved in or out of the lungs during one breath
Define: tonsil lips
large, semi-rigid suction tips recommended for suctioning the pharynx
Define: tracheostomy
a surgical procedure to create an opening (stoma) into the trachea; a stoma in the neck connects the trachea directly to the skin
Define: ventilation
the exchange of air between the lungs and the environment; occurs spontaneously by the pt or with assistance from another person
Define: video laryngoscopy
visualization of the vocal cords, and thereby placement of the endotracheal tube, that is facilitated by use of a video camera and monitor
Define: visceral pleura
thin membrane that covers the lungs
Define: vital capacity
the amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible
Define: vocal cords
thin white bands of tough muscular tissue that are lateral borders of the glottis and serve as the primary center for speech production
Define: wheezing
a high-pitched whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis
What are the 2 basic techniques for opening the airway?
the head tilt - chin lift maneuver, or if trauma is suspected, the jaw-thrust
What is the next priority after opening the airway?
Suctioning. Rigid tonsil-tip catheters are the best catheters to use when suctioning the pharynx, soft plastic catheters are used to suction the nose and liquid secretionsi n the back of the mouth
When is the recovery position used?
to help maintain airway in pts without traumatic injuries who are unconscious and breathing adequately
Who might be patients that require oxygen?
- pts with signs of dyspnea
- pts with signs of shock
- pts experiencing signs of myocaridal infarction w an oxygen saturation of less than 94%
If there is a pressure reading on a regulator gauge, is it safe to remove the regulator from the valve stem?
No
What are the methods ofproviding artificial ventilation?
mouth-to-mask ventilation, two-person bag-mask ventilation, and one-person bag-mask ventilation.
Combined with your own breath, mouth-to-mask will give a pt up to 55% oxygen; a bag-mask device w an oxygen reservoir and supplemental oxygen can deliver nearly 100% oxygen
