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PCP > Chapter 13 Airway Management and Ventilation > Flashcards

Chapter 13 Airway Management and Ventilation Flashcards

1
Q

facial injuries increase index of suspicion for c spine injuries. what manoeuvre should you use to manage the airway

A

use the jaw-thrust manoeuvre and keep the patients head in a vertical position

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2
Q

when ventilating patients with facial trauma what should you cognisant of

A

stay alert of ventilation compliance, sounds that may indicate laryngeal edema

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3
Q

what considerations apply when dealing with dental appliances

A

if they fit tight leave them in place, if they are loose or have potential to dislodge you will want to remove them.

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4
Q

what do you need for a perform bag-mask device-to-stoma

A

two paramedics are needed, one to seal the nose and mouth, the other the operate the device

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5
Q

what is the required manoeuvre to ventilate a patient with a stome

A

there are no required manoeuvres to ventilate a PT with a stoma, just make sure you use an infant- or child sized mask to get a proper seal

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6
Q

how long should you suction a patient with a stoma

A

limit suction to a maximum of 10 seconds

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7
Q

how many minutes can the brain survive for without oxygen, before permanent brain damage occurs?

A

6 minutes

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8
Q

function of upper airway

A

warm, filter and humidify air as it enters the body through the nose and mouth

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9
Q

pharynx is composed of what 3 parts

A
  • nasopharynx
  • oropharynx
  • laryngopharynx
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10
Q

turbinates function

A

increase the surface area of the nasal mucosa, improving the processes of warming, filtering, and humidification of inhaled air

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11
Q

what complications exist for a needle cricothyrotomy

A

improper placement can result in severe bleeding secondary to damage of adjacent structures, excessive air leakage can cause subcutaneous emphysema, subsequent obstruction may occur

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12
Q

what is a total laryngectomy

A

surgical removal of the entire larynx, people who have had this are called a neck breather

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13
Q

how is a laryngectomy performed

A

performed by making a tracheostomy, thus creating a stoma, orifice that connects the trachea to the outside air

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14
Q

what complications are there with an open cricothyrotomy

A

minor bleeding, severe bleeding result of inadvertent laceration of external jugular vein. must be done quickly or it will cause hypoxia in the patient, could result in cardiac arrhythmias, permanent brain damage, cardiac arrest, create a false passage

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15
Q

what complications exist for a cricothyrotomy

A

improper placement can result in severe bleeding secondary to damage of adjacent structures, excessive air leakage can cause subcutaneous emphysema, subsequent obstruction may occur

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16
Q

when is a failure to intubate called

A

defined when failure to maintain an acceptable oxygen saturation level during or after one or more failed intubation attempts, or a total of three failed intubation attempts by an experienced intubator

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17
Q

cavities formed by the cranial bones are?

A

sinuses

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18
Q

what is RSI

A

rapid sequence intubation, represents a culmination and integration of all your airway skills. includes safe smooth induction of sedation and paralysis followed immediately by intubation

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19
Q

most common cause of anatomic upper airway obstruction?

A

tongue

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20
Q

adenoids are

A

lymphatic tissue that filters bacteria

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21
Q

tonsils function

A

help trap bacteria

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22
Q

two pockets of tissue on the lateral borders of the larynx?

A

piriform fossae

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23
Q

function of the lower airway

A

exchange oxygen and carbon dioxide

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24
Q

at what does the trachea divide into the right and left mainstream bronchi?

A

carina

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25
Q

bronchus that is shorter and straighter?

A

right bronchus

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26
Q

what are the indications and contraindications for a needle cricothyrotomy

A

indic; inability to vent, unable to secure airway through a more conventional method.
Cont; severe airway obstruction above site of catheter

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27
Q

what size of needle do you use for a cricothyrotomy

A

14 to 16 gauge needle

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28
Q

what complications are there with an open cricothyrotomy

A

minor bleeding, severe bleeding result of inadvertent laceration of external jugular vein. must be done quickly or it will cause hypoxia in the patient, could result in cardiac arrhythmias, permanent brain damage, cardiac arrest, create a false passage

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29
Q

blood vessels and bronchi enter each lung at the?

A

hilum

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30
Q

approximately how much L of air can adult lungs hold?

A

6

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31
Q

number of lobes per lung

A

right- three lobes

left- two lobes

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32
Q

minute volume definition, and how to determine

A

amount of air that moves in and out of the respiratory tract per minute, determined by tidal volume X respiratory rate

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33
Q

parietal pleura function

A

lines the inside of the thoracic cavity

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34
Q

surfactant function

A

proteinaceous substance that lines alveoli, which decrease surface tension on the alveolar walls and keeps them expanded

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35
Q

are advanced airways necessary?

A

in most situations you can secure an a patent airway using basic methods, in rare situations however factors preclude the use of conventional methods and you must use an advanced method

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36
Q

when is a failure to intubate called

A

defined when failure to maintain an acceptable oxygen saturation level during or after one or more failed intubation attempts, or a total of three failed intubation attempts by an experienced intubator

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37
Q

atelectasis definition

A

condition where the amount of pulmonary surfactant is decreased or the alveoli are not inflated, and they collapse

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38
Q

tidal volume definition

A

volume of air that is inhaled or exhaled during a single respiratory cycle

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39
Q

normal tidal volume in adults and infants/children

A

adult- 5-7 mL/kg

infant/child- 6-8mL/kg

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40
Q

inspiratory reserve volume definition

A

amount of air that can be inhaled in addition to the normal tidal volume

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41
Q

dead space definition

A

any portion of the airway where air lingers but does not participate in gas exchange

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42
Q

anatomic dead space definition

A

includes the trachea and larger bronchi, where residual gas may remain at the end of inhalation

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43
Q

alveolar volume definition

A

remaining volume of inhaled air, that does not reach the alveoli and does not participate in gas exchange

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44
Q

alveolar volume is equal to?

A

tidal volume-dead space volume

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45
Q

minute volume definition

A

amount of air that moves in and out of the respiratory tract per minute

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46
Q

how much time do you have to intubate before you have to stop and ventilate

A

if you cannot intubate within 30 seconds stop and ventilate the patient with a bag-mask device and 100% oxygen before trying again

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47
Q

what is RSI

A

rapid sequence intubation, represents a culmination and integration of all your airway skills. includes safe smooth induction of sedation and paralysis followed immediately by intubation

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48
Q

what are the general steps for RSI

A

prep of patient and equip, preoxygenation and passive oxygenation, premedication, sedation and paralysis, intubation, maintenance of paralysis and sedation

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49
Q

minute alveolar volume definition, and how to determine

A

amount of air that actually reaches the alveoli per minute and participates in gas exchange, determined by (tidal volume-dead space volume) X respiratory rate

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50
Q

functional residual capacity definition

A

amount of air that can be forced from the lungs in a single exhalation

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51
Q

expiratory reserve volume definition

A

amount of air that you can exhale following normal exhalation

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52
Q

residual volume definition

A

air that remains in the lungs after maximal expiration

53
Q

fraction of inspired oxygen (FIO2) definition

A

percentage of oxygen in inhaled air

54
Q

ventilation definition

A

physical act of moving air in and out of the lungs

55
Q

breakdown of ventilation cycle

A

inspiration 1/3

expiration 2/3

56
Q

two types of nerves that affect breathing

A

phrenic nerves- supply the diaphragm

intercostal nerves- supply the intercostal muscles

57
Q

3 regions of respiratory centre in the medulla

A
  • respiratory rhythmicity centre
  • apneustic centre
  • pneumotaxic centre
58
Q

second control of breathing

A

hypoxic drive

59
Q

external respiration definition

A

exchange of gasses between the lungs and the blood cells in the pulmonary capillaries

60
Q

internal respiration definition

A

exchange of gases between the blood cells and tissues

61
Q

pulse oximeter function

A

reads percentage of hemoglobin that is saturated with oxygen, normally greater than 95%

62
Q

conditions that reduce the surface area for gas exchange

A

flail chest, diaphragmatic injury, simple or tension pneumothorax, open pneumothorax, hemothorax, and hemopneumothorax

63
Q

injury caused by severe compression of the chest

A

traumatic asphyxia

64
Q

condition where blood entering the lungs from the right side of the heart will bypass the alveoli and will return to the left side of the heart in an unoxygenated state

A

intrapulmonary shunting

65
Q

two ways hypoventilation can occur

A
  • carbon dioxide production can exceed the body’s ability to eliminate it
  • carbon dioxide elimination can be depressed to the extent that it no longer keeps up with normal metabolism
66
Q

hyperventilation definition

A

carbon dioxide elimination exceeds carbon dioxide production

67
Q

hypercapnia definition

A

carbon dioxide builds up in the blood

68
Q

hypocapnia definition

A

carbon dioxide level in the blood falls

69
Q

major components of air

A
  • nitrogen 78.62%
  • oxygen 20.84%
  • carbon dioxide 0.04%
  • water vapour 0.50%
70
Q

normal adult respiratory rate (at rest)

A

between 12-20 breaths/min

71
Q

preferential positioning, two types

A

-tripod position (elbows out)
-semi-fowler (semi-sitting)
patients with respiratory distress will avoid a supine position

72
Q

hypoxemia definition

A

decrease in arterial oxygen levels

73
Q

hypoxia definition

A

lack of oxygen to the body’s cells and tissues

74
Q

anoxia definition

A

absence of oxygen that results in cellular and tissue death

75
Q

pulsus paradoxus definition

A

systolic blood pressure drops more than 10 mmHg during inhalation

76
Q

Analysis of arterial blood gases (ABGs) function

A

provide the most comprehensive quantitative information about the respiratory system

77
Q

end-tidal carbon dioxide detectors function

A

detect the presence of carbon dioxide in exhaled air

78
Q

colourimetric carbon dioxide detector function

A

probides qualitative information regarding the presence of carbon dioxide in the patient’s exhaled breath

79
Q

capnometer function

A

provides quantitative information, in real time, by both detecting and measuring exhaled carbon dioxide levels

80
Q

capnographer function

A

provides a quantitative graphic representation of exhaled carbon dioxide levels

81
Q

waveform capnography function

A

provides quantitative, real-time information regarding the patients exhaled carbon dioxide level

82
Q

4 phases of waveform

A

phase 1: (A-B) respiratory baseline, initial stage of exhalation
phase 2: (B-C) expiratory upslope
phase 3: (C-D) expiratory or alveolar plateau
phase 4: (D-E) inspiratory downstroke

83
Q

if patient is in a prone position, and you need to get them into a supine position how would you do so`

A

log roll the patient as a unit

84
Q

manual airway maneuvers (3)

A
  • head tilt-chin lift manoeuvre
  • jaw-thrust manoeuvre (with or without head tilt)
  • tongue jaw lift manoeuvre
85
Q

special type of curved forceps

A

magill forceps

86
Q

suctioning time limits for adult,child,infant

A

adult 15 seconds
child 10 seconds
infant 5 seconds

87
Q

plastic-tip catheter with large diameter and that is rigid, good option for suctioning pharynx

A

yankauer catheter (tonsil-tip catheter)

88
Q

soft plastic, nonrigid catheters that can be placed in the oropharynx or nasopharynx or down tracheal tube

A

french or whistle-tip catheter

89
Q

how to measure suction catheter

A

from corner of the mouth to the earlobe

90
Q

oropharyngeal airway device

A

curved, hard plastic device that fits over the back of the tongue, designed to hold the tongue away from the posterior pharyngeal wall

should only be used in unresponsive patients without a gag reflex

91
Q

nasopharyngeal airway device

A

soft rubber tube that is inserted through the nose into the posterior pharynx behind the tongue, allowing passage of airway from nose to the lower airway

measured from tip of nostril to angle of the jaw

used on unresponsive patients

92
Q

colors and sizes of oxygen tanks

A

silver, chrome, green, or some combination of the 3
D tank- 350 L, typically carried from ambulance to patient
M tank- 3450 L, remains on unit as main supply
E tank- 625 L

93
Q

what pressure you need to change oxygen cylinders at

A

200 psi or below, 200 psi is the safe residual pressure

94
Q

2 types of flowmeters

A
  • pressure-compensated flowmeter, incorporates a float ball within a tapered calibrated tube
  • bourdon-gauge flowmeter, not affected by gravity and can be placed in any position
95
Q

nonrebreathing mask device

A

preferred device for delivering oxygen to spontaneously breathing patients in the prehospital setting
good mask-to-face seal and a flow rate of 15 L/min, capable of delivering approximately 90% inspired oxygen
includes one-way valve preventing patient from exhaling into it

96
Q

nasal canula device

A

flow rate of 1 to 6 L/min

deliver an oxygen concentration of 24% to 44%

97
Q

simple face mask device

A

full mask enclosure with open side ports, room air drawn through side ports on inhalation, exhaled vented through holes on each side of mask
can deliver between 40-60% oxygen at 10 L/min

98
Q

venturi mask device

A

draws room air into the mask along with the oxygen flow, allowing for administration of highly specific oxygen concentrations
can deliver 24-50% oxygen flow rate of 6-12 L/min

99
Q

hi-ox mask device

A

modification of the nonrebreathing mask, like the nonrebreather the patient inhales oxygen from the reservoir bag via one-way valve, unlike the nonrebreather the exhaled breath passes through another one-way valve and then through a high-efficiency filter before exiting the mask

100
Q

small-volume nebulizer device

A

used primarily to deliver aerosolized medications

101
Q

oxygen humidifier device

A

small bottle of water through which the oxygen leaving the cylinder becomes moisturized before it reaches the patient

102
Q

methods of positive pressure ventilation (3)

A
  • mouth to mask
  • two person bag mask device
  • one person bag mask device
103
Q

mouth to mask ventilation, inlet valve vs. no inlet valve

A
  • with no inlet valve you will deliver 16% oxygen to the patient
  • with inlet valve connected to a source at a flow rate of 15 L/min can deliver up to 55% oxygen
104
Q

one-person bag-mask ventilation device

A
  • most common device to ventilate in prehospital setting

- at a flow rate of 15 L/min and reservoir attached can almost deliver 100% oxygen

105
Q

two-person bag-mask ventilation device

A
  • much more efficient than one-person technique

- disadvantage is that it requires extra personnel

106
Q

what is the major advantage of a multimumen airway

A

it cannot be improperly placed, effective ventilation is possible if the tube enters the esophagus or trachea

107
Q

during the expiratory phase, the patient exhales against a resistance called?

A

positive end-expiratory pressure (PEEP)

108
Q

what is the major risk of extubation

A

over estimation of the patients ability to protect his or her own airway

109
Q

what is the major complication associated with the combitube

A

unrecognised displacement of the tube into esophagus

110
Q

what are important things to remember when performing tracheobroncial suctioning

A

first rule is DO NOT DO IT IF YOU DONT HAVE TO, avoid suctioning unless secretions are so massive they interfere with ventilation, preoxygenation before suctioning is vital, try not to exceed 10 to 15 seconds

111
Q

most CPAP devices are set to deliver a fixed FIO2 level of?

A

30-35% however some can deliver as high as 80%

112
Q

insertion of NG tube

A

through the nose, into the nasopharynx, through the esophagus, and into the stomach

113
Q

what are the contraindications of nasotracheal intubation

A

contraindicated in apneic patients, head trauma and mid face fractures, deviated septum, nasal polyps, frequent cocaine users

114
Q

how does an esophageal detector device work

A

if tube is in trachea air is easily drawn into the syringe and plunger does not move when released. however the esophagus is flaccid, if tube is in the esophagus a vacuum is created as the plunger is withdrawn, and plunger moves back toward zero when released

115
Q

primary requirements for advanced airway management (2)

A
  • failure to maintain a patient airway

- failure to adequately oxygenate and ventilate

116
Q

what is the proper tube insertion technique

A

after visualizing the glottic opening, insert the tube from the right corner of the PTs mouth. As you pass through the vocal cords, rotate the tube to the right and direct the tip downward

117
Q

what must you do before you extubatne in the pre hospital setting

A

you must always preoxygenate the the patient before you extubate

118
Q

how do you perform proper laryngoscope blade insertion

A

position yourself at the top of the PTs head. hold it in your left hand as far down as possible, insert blade into right side of mouth, use flange of blade to sweep tongue gently to the left side of mouth. slowly advance blade into vallecula (curved) beneath the epiglottis(straight). exert gentle traction at a 45’ angle to the floor.

119
Q

what is digital intubation

A

aka blind or tactile intubation, involves directly palpsting the glottic structures and elevating the epiglottis with your middle finger

120
Q

what are the indications of nasotracheal intubation

A

indicated for patients breathing spontaneously but require definitive airway management, responsive patients or PTs with altered mental status and intact gag reflex

121
Q

how do you confirm proper tube placement

A

visualizing the tube being placed is the first and most reliable method., a second method is auscultation of even and proper breath sounds

122
Q

what is the proper tube insertion technique

A

after visualizing the glottic opening, insert the tube from the right corner of the PTs mouth. As you pass through the vocal cords, rotate the tube to the right and direct the tip downward

123
Q

what is a bougie

A

bougie is a small flexible device approx 1cm in diameter and 60cm long. the angle of the distal tip facilitates entry into the glottic opening and feel the ridges of the tracheal wall

124
Q

how do you perform proper laryngoscope blade insertion

A

position yourself at the top of the PTs head. hold it in your left hand as far down as possible, insert blade into right side of mouth, use flange of blade to sweep tongue gently to the left side of mouth. slowly advance blade into vallecula (curved) beneath the epiglottis(straight). exert gentle traction at a 45’ angle to the floor.

125
Q

what is a bundle of care

A

includes preoxygenation, passive high- flow oxygenation, and the sniffling position.

126
Q

indications for orotracheal intubation by direct laryngoscopy

A

airway control needed as result of coma, respiratory arrest, cardiac arrest, ventilation support before impending respiratory failure, absent gag reflex

127
Q

how many different sizes of laryngoscope blades are there

A

0-4. 0,1,2 are appropriate for infants, children. 3 &4 are for adults

128
Q

what is the advantage of a curved laryngoscope

A

less likely to be levered against the teeth

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