Module 5 Flashcards
Most common airway obstruction
Tongue
How long can the brain survive without oxygen?
6 minutes
Upper airway cuts off at
The vocal cords
Upper airway includes
Nasopharynx( nasal cavity, turbinates, nasal septum, sinuses)
Oropharynx ( tongue, palate) ( soft and hard)
Lower airway includes
Trachea aveoli, bronchi bronchioles
Total lung capacity
6L
Right versus left lung lobes
Right lung has three lobes
Left long has two lobes
Turbinates
Three. Boney shelves.
Produce from the lateral walls of the nasal cavity, and extend into the nasal passage
Upper airway
Nasal cavity
Lines with ciliated mucous membrane
Nasal septum
Divides the nasopharynx into two passages, composed of bone and cartilage
Sinus
Cavities formed by cranial bones, prevent contaminants from entering the respiratory track
Hyoid bone
Small horse shoe shaped bone to join epiglottis and thyroid cartilage are attached
Hard vs soft plate
Hard equals anterior portion form by the maxilla and palatine bones
Soft equals posterior to the hard palate
Trachea is the
Windpipe
Conduct for air entry into the lungs
Consist of a series of C-shaped cartilage rings
Which side of the stem bronchus is shorter and straighter
The right side tracheal tubes can end up here
Bronchioles
Dilate constrict in response to stimuli divide into smaller —> bronchi
Aveoli
Are ballon like clusters
Single layer
Site of oxygen and carbon exchange
Atelectatasis
Collapse of the aveoli
Surfactant
Decrease the friction surface tension and keeps the aveoli expanded
3 parts to the pleura sac
Most outer part is the parietal pearl
Middle part is the plural cavity
Inside lining part the visceral pleura
Parts of the lungs (labelled diagram)
You’re doing great keep going :)
Tidal volume equals
Volume of air that is inhaled/exhaled in a single respiration (6-8ml/kg)
Inspiratory reserve volume equals
Amount of air that can be inhaled, in addition to tidal volume
300oml
How much of title volume remains in the upper airway?
1/3
1200ml is expelled to two places and where
1200 ml expelled in each breath
1200 ML is kept in the lung ( revisional volume )
2/3 of air is left where
Alveolar
Ventilation equals
Ability of the body to move air in and out of the lungs
Respirations equal
The exchange of oxygen and carbon dioxide physical exchange of gases
Dead space equals
Any portion of the airway that lingers (but no air flow) therefore cannot participate in gas exchange
Anatomic dead space
Includes the trachea
And large bronchi
Physicallogical dead space
Created by inter-pulmonary obstructions, or atelecatosis
BBM nasal canula we do this
Alveolar volume
Remaining volume of inhaled hair, reaches the aveoli for gas exchange
Aveoli dead space volume is around
350ml
As respirations increases what happens to aveoli volume
Leads to a decrease in aveoli volume which leads to only dead space
Minute volume
Amount of air received in and out in one minute
Minutes alveolar volume
Amount of air that actually participates in gas change in one minute
AMV = DSV x RR
Fio2
Percent of oxygen in inhaled air
Example
Room air 21%
BVM 100%
Inspiration equals how many thirds
Expiration equals how many thirds
Inspiration equals 1/3
Expiration equals 2/3
What part of the brain is responsible for breathing?
Medulla/pons
What nerves are responsible in ventilation
Phrenic nerve
Intercostal nerve
What triggers the impulse to breathe
Carbon
Is the pressure inside of the diaphragm, higher or lower with exhales?
Lower
Anoxia
No breathing
Dyspena
Difficulties in respiration
Hypoxia
Low respiration
Hyperoxia
High respirations
Gas moves from an area of what concentration to an area of what concentration
High concentration to low concentration
What percent of the body’s total oxygen is bound to haemoglobin
97%
Carbon, it’s transported in the blood by what kind of ions
Bicarbon ions
What causes a decrease in oxygen in the blood
Atmo pressure
Severe bleeding
Anemia, low red blood cells
Hyperventilation causes of what in carbon
Causes a decrease in carbon, illuminates more carbon then we can produce
Hypoventation cause carbon to do want
Increase is carbon makes more than you could eliminate
BVM and unconscious patient must always have
An airway adjunct
Head lift/chin lift
No trauma or C-spine
Push back the forehead
Push up on the chin
Jaw thrust
Keep the cervical in line
Two hands on the mandible push up on the jaw
Very painful for alert patients
Suctioning
Max 15 seconds
On the way out
Make sure to close your thumb over the whole
Only suction as far as you can see
Hard suctioning equals vs soft suctioning equals
Yonker
French
NPA
Goes into the posterior pharynx behind the time
Measure in the nose to ear tip
Bevel towards septum
Can be Conscious
Can have a gag reflex
Can’t use and head trauma or base of skull fracture
No suctioning
No nasal trauma
What side should you start with a NPA
Right side first go straight in
If you’ve left, must do 180° turn
Use lube
OPA
Ear tip to jaw to measure
Unconscious
No gag reflex
Smile side towards you
Tip of the hard palate and then turn 180° on soft palate
Green air tanks equal
Oxygen tanks
Room air is
21% oxygen
Hydrostatic test every
10 years
Full tanks equal
2000 psi
Replace tanks at
At 200 psi
D tanks equal
M tanks equal
350 L (0.16)
3450 L (1.56)
Oxygen tank formula
Flow metres
Allows oxygen being delivered to the patient to be adjusted (1 to 25 ml )
Regulators
Reduces/controls the flow of oxygen to a patient
Like 2000 psi reduces to 50 psi
Pressure compensated Flowmeter
Wall mount air regulators that use the ball what is inside the ambulance
Nonrebreathing mask
15 L per minute (10 to 15)
90% oxygen (90-100)
Valves
Fill bag no apena
Simple facemask
10 L/min (6 to 10)
40% to 60% oxygen
No values
Outside air gets in
Nasal canula
1 to 6 L/min
24 to 44% oxygen
Dry out the nose
15 L per minute for igels
Nebs
8 to 6 L in a minute
3 to 5 mL of fluid
For aerosolized meds
Bvm
15 L/min.
Hundred percent on oxygen
Squeeze 1/3 of the bag
Venturi mask
24 %
28%
35%
40%
50%
Depends on the adaptor for highly Pacific oxygen
How many litres does a BVM hold?
17,000 L
How much do you squeeze the Bvm bag
1/3
How much do we pre-oxygen date with a nasal cannula?
Two minutes with 15 L per minute
King LT
Measured in height
Better fit for adults
Two balloons
Ones sits on the trachea one sits on the epiglottis
Vomit risk
LMA
Size equals actual weight
Peds fit better
Less risk for soft tissue trauma
Least effective on obese patients
Igel
Estimated weight
May take up to 10 minutes to warm up
Best option
Dope
Displacement ———moving patient
Obstruction ——— blood or vomit
Pneumothorax ———— hole in your lung
Equipment
How to tell if an in adjunk airway is in place
ET CO2 waveforms
Positive lung sounds
Negativeepi-static sounds
Chest rise
Increased SPO2
Easy compliance
CO2 is made in the cells in what two ways
Aerobic ( with oxygen )
anaerobic( with no oxygen ) and by products which create faster CO2 build up
Once carbon is in the vessels how can It move
20% bound to haemoglobin
75% turn it to bicarbonate
( finds water in the red blood cells, then converts into carbonic acid)
Then splits into bicarbonate and hydrogen before leaving the lungs
If red blood cells lack what happens to the ability up for us to load off CO2
It decreases
ETCO2
Is the partial pressure measured of CO2 at the end of expiration
What part of the brain read CO2 levels in blood
Medulla
Decrease minute volume means too much or too little CO2 ( comp ) (not decomp)
Two little
Increased ET CO2 means you do want to ventilations
Decrease them
Normal wave form
What do these two waveforms represent?
Pink equals hypo ( not enough carbon) leads to much
Orange equals hyper ( to much carbon ) leads to not enough
What do these two waveforms represent?
Yellow equals bronchial spasm
Green equals rebreathing or staircase
Meaning, not having a full exhale
What do these two waveforms represent?
Blue equals tube displacement
Purple equals Rosc
What do these two waveforms represent?
Pink equals patient was breathing tonight to using mechanical intervention
Teal equals apnea or equipment
A sudden increase or rise of ET CO2 by what is what percentage indication of Rossi
10 MM Hg
Is 97% indicated
And for what MMHG for CPR
10 but ideally 25
What does a a bumpy wave pattern represent?
An obstruction
Like a pulmonary embolism
Pulsating of the heart to the lungs resulting in volume changes
PVCO2
Is partial pressure of carbon dioxide in venous blood
PaCo2
Is the partial pressure of carbon dioxide in arterial blood
Hypercapnia
Decrease minute volume/ slow breathing
Overdose, strokes, obesity, pulmonary disease tiredness
HypoCapnia
Increase minute volume/fast breathing
Anxiety (think paper bag)
Shock state decomp
Poor pulmonary perfusion ( RBC)
