PAAM Exam 1 Flashcards
Trachea bifurcates @?
Carina
where does the gases exhange in the lungs
Aveoli
Identify the differences between the visceral and parietal pleura
V=has no nerves P= has nerves
How does the airway of an adult differ from that of a pediatric patient?
Pedi airway is flimsy and floppy in shape of funnel
What is the difference between ventilation and respiration?
Vent= mechanical Respi= gas exchange
What is the difference between cellular (internal) and pulmonary (external) respiration?
Internal = cells external= lungs
- What is normal Tidal Volume and Dead Space?
500mL & 150mL
How do you calculate alveolar volume,
minute volume,
alveolar minute volume?
AV= TIDAL-DEAD
MINUTE = RR X TIDAL VOL
AVMV= AV x RR
What signals us to breathe→ Central chemoreceptors
pH receptors
Increase in arterial CO2 = what drive
hypercarbic drive
Be able to explain the hypercarbic and hypoxic drives and how do they differ
carbic=too much CO2 so initiates from high PACO2 Oxic= not enough oxy so initiates from low PAO2
How does CO2 get transported throughout our body?
Mostly bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
what is hypoxic drive
Anaerobic katabolism aka not enough oxy in blood
What is the oxygen dissociation curve?
The “train” hemogoblin of picking up and dropping of oxygen and waste
How does either a left or right shift change a hemoglobin molecules attraction to oxygen?
Left more affinity to pick up for LUNGs & right drops off waste in body
What takes place in order to have either a left or right shift occur?
o What occurs during a right shift (Bohr Effect)?
More CO2 less pH picks up oxy in lungs, decreased oxy/ affinity
- What PIN system does an oxygen tank/therapy regular use?
- What is a DISS fitting on an oxygen therapy regulator?
2:5
Diameter Index Sizing System
What occurs during a left shift (Haldane Effect)?
Less CO2 more pH & more oxy/ affinity
What are the indications and contraindications for the different airway adjuncts?
Battle signs, gag reflex, ect
What reflex stops us from over ventilating ourselves?
o What receptors are involved?
Hering-Breuer
Stretch receptors
- What is a V/Q mismatch?
Ventalation perfusion
How do you measure the different airway adjuncts?
Tip mouth to ear OPA Nose to ear lobe= NPA
How do you correctly place an OPA/NPA in both adults and pediatrics?
Displace tongue w/ OPA Bevel to septum in NPAs
What makes an OPA a better airway adjunct over an NPA?
Aspiration, displaces tongue, & can suction
four different ways that you can ventilate a patient, and which one is the best and which one is the worst?
mouth to pocket mask, 2 person BVM, demand valve/FROPVD, 1 person BVM
- What are the different types of suction devices/catheters?
French flexible & yaunker Hard
Suction times for the different age groups
Suction time limits for suctioning an ET or Trach tube?
5,10,15,
5-10
what is “LEMONS”
Looks, Examine 3-3-2, Mallampati, obstruction, neck mobility, saturation of Oxy/
Identify dif/ Mallampati scores:
Examine 3-3-2:
=1 best & see all structures 4 cant see shit
=3 fingers mouth , 3 chin throat, 2 throat to thyroid
what is POGO
scale of glottic opening
What is CPAP and how does it help a patient with either CHF or asthma/COPD?
Continuous Positive Air Pressure → forces PT’s lungs take in more air
What is the maximum amount of pressure that you can use with CPAP without physician direction?
6 LPM
What are the different types of ET blades?
Mac, Miller, Direct, Indirect
Placement during insertion for the two different types (curved vs. straight)
curved=vallecula
straight=epiglottitis
Parts of the ET tube
Cuff, piolet, balloon
How should a stylet be used?
give ETT strength & stability
What is the distal lateral hole called?
Murphys
When is a good time to use a bougie?
Need to feel cartilage rings, Pedi/ intubation, Stoma complications
What is the distal curved tip of a bougie called?
Coude tip
How do you estimate the size of an ET tube for a pediatric patient?
Pedi uncuffed ETT sizing= (age/4) +4 or (age +16)/4
Pedi cuffed ETT sizing= (age/4) +3.5
How do you estimate the weight of a pediatric patient?
(age+4)x2=Kg <Old>
(age X 3) +7=Kg <New></New></Old>
What equipment is used to help facilitate the successful placement of a nasal ET tube?
BAAM Beck Airway Airflow Monitor→ high pitch on inhale
What are Magill Forceps used for?
FBAO Removal
Extraglottic airways
Sit on top of glottic opening
Different types & how to use extraglottic airways (what’s the difference between a single vs double lumen device?)
lumens= “pigtails” PT vent & provider vent
Indications and contraindications for a needle or surgical cricothyrotomy
When theres no other way cric/ em
When would you use a needle versus a surgical procedure?
Needle for 8 y/os or less than & surgical for above
What is the difference between MAI and RSI?
MAI uses= sedative RSI uses= paralytic
What is the most commonly first-line neuromuscular blocking agent used in EMS?
Succinylcholine
How does a depolarizing versus a non-depolarizing neuromuscular blocking medication work?
Depolarizing = 3-5min
Non-Depolarizing = 60-90mins
What is PEEP and how much do we usually use?
Positive expiratory end pressure 5cmH2o
What is the difference between SpO2 and ETCO2?
SpO2= oxy in blood ETCO2= exhaled CO2
What are the two different types of ETCO2 sampling?
Color & waveform
the different ETCO2 waveform types:
hyper/hypoventalation, ROSC, Curare’s cleft,
What is considered normal pH?
7.40pH
Be able to identify a patient with respiratory or metabolic acidosis/alkalosis?
Respiratory =breathing & Metabolic =body complications
Acidosis= less than 7.40pH & Alkalosis= more than 7.40pH
What is the purpose of a chest drainage system?
to get and maintain negative pressure
How much water is required to maintain a patent one-way valve?
Distal tube in 2cm of water
What are the most common complications of a chest tube?
tubes disconnecting & kinking or air leaking
What does Boyle’s Law state?
When/how does it apply in EMS?
= The volume of gas is inversely proportional to the pressure of it (more pressure less volume
=BVM Ventilations
What does Henry’s Law state?
When/how does it apply in EMS?
=amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
=oxygen therapy
What does Charles’s Law state?
When/how does it apply in EMS?
= At a constant temp/, the volume of a gas is directly proportional to the absolute temperature of the Gas
= Ensuring oxy/ cylinders & other gas containers are stored at appropriate temp/s to maintain consistent gas delivery.
What is Gay-Lussac’s Law?
When/how does it apply in EMS?
=As you heat a volume of gas, the pressure is going to go up.
=Gas Storage: gas containers should be kept at stable temp/s to avoid pressure changes that could affect safety/gas delivery.
& PT Care: Recognizing that PTs in hyper/hypothermic conditions might have altered respiratory/circulatory due to changes in gas pressures within the body.
What is Dalton’s Law?
When/how does it apply in EMS?
=Total pressure of a mixture of gases = the sum of the partial pressure of the individual gases.
=Resp/ Gas Exchange: how the partial pressures of oxygen & carbon dioxide affect diffusion across the alveolar-capillary membrane.
& Hyperbaric Oxygen Therapy: Utilizing increased partial pressure of oxy/ to treat conditions like carbon monoxide poisoning by displacing CO from hemoglobin.
most and least common ways CO2 gets transported in the body w/ %s
primarily = As a bicarbonate ion 70%
second most common = attached to a hemoglobin 23%
least common= dissolved in blood plasma 7%
The most common indication for a surgical cricothyrotomy is:
severe facial trauma
As the thoracic cavity begins to expand during inhalation, the intrathoracic pressure:
Less than atmospheric pressure
Kids are mouth breathers b/c ?
nares are smaller and more prone to upper respiratory infection & airway obstruction
different pneumothorax’s:
Hemo, Open, Simple, & Tension
Name the letters
A= Arytenoids B= Corniculates C= Cuneiforms/s D= Ventricular fold
E= Vocal Cords F= Epiglottis G= Epiglottis
Carbonic Acid-Bicarbonate Buffer system formula:
CO2 + H20 <> H2CO3 <> H + HCO3
Narrowest trachea point in adult:
Narrowest trachea point in pedis:
=Vocal cords
=Cricoid cartilage
one of the functions of the upper airway:
=Drying incoming air
The lung tissue receives most of its blood supply from:
=Brachial arteries
Electrical stimulus from the brain is delivered to the diaphragm via the:
=Phrenic nerve
Of the following paranasal sinus cavities, which one is the largest:
=Maxillary
Fever, muscle exertion, shivering, & metabolic processes may cause increased of what
CO2
The trachea is maintained in an open position by:
Cartilaginous C-rings
PTs w/ long history of chronic lung disease, primary stim/ to breathe is:
Increase Lvls of CO2 in the body
The human body contains how many alveoli:
300 million
The main respiratory center lies in the
Medulla Oblengata
During norm/ vent/ size of the thoracic cavity can be increased by contracting the diaphragm and the:
Intercostal muscles
Internal respiration:
External respiration:
=exchange of gases (O2 and CO2) at the cellular level
=exchange of gases (CO2 and O2) in the pulmonary capillaries
Oxy supplemental device draws in room air & mixes it w/ the oxy flow:
Venturi Mask
following would cause a right-shift of the oxygen dissociation curve:
decrease in blood pH
increase of present CO2
increase of temp
following would cause a left-shift of the oxygen dissociation curve:
Increase in blood pH
Decrease of present CO2
Decrease in temp
min/ acceptable vacuum Lvl suctioning units for prehospital setting is:
300mm
Pre-botzinger:
SA node of respiratory system
Increase/decrease of CO2 in blood will make pH:
Do the opposite (CO2 up pH down vice versa)
Central chemoreceptors could be stim/ & activate a vent when there is:
increase in PCO2 level
Demand Valve is:
Manually triggered, oxygen-powered breathing device
As neuromuscular blocking agents start to wear off, what will you see on a patient’s waveform capnography?
Curares cleft
Phase 1 cap/ waveform:
Phase 2 cap/ waveform:
Phase 3 cap/ waveform:
Phase 4 cap/ waveform:
=Respiratory baseline
=Respiratory Upstroke
=Respiratory Plateau
=inspiratory downstroke
order for the placement of an oral ET tube into an adult patient using a Mac laryngoscope blade:
- Insert blade into right-side of the PT’s mouth & sweep tongue to left
2.Visualize the posterior cartilages and the glottic opening - Pass the distal end of the ET tube through the vocal cords
- Inflate distal cuff
- Vent/ through the ETT & auscultate for presence of gastric sounds
- Auscultate for bilateral breath sounds
- Secure ETT
- Attach ETCO2 detector
- Apply C-Collar to PT
What is considered the most common reason a patient with a trach tube summons the help of 911?
Clogged ETT
If hyperventilate, what would you anticipate ETCO2 level to be at?
Less than 35mmHg
What is a good “rule of thumb” for estimating proper depth of an ETT:
Depth should be approximately 3x ETT size
transporting intubated PT attached to vent/ when suddenly the patient starts to decompensate. What would be your first action?
Take of Vent
Capography wave forms
VRG ventral respiratory group
transmits signals via the phrenic nerve & intercostal nerves
DRG dorsal respiratory group
Keeps VRG in check
Pontine respiratory
Smooths out transition of inhalation & exhalation
Pontine respiratory
Smooths out transition of inhalation & exhalation
