Paramedic Resource Manual Section 1 Flashcards
What are the 3 things that the upper respiratory tract does to the air a person breathes?
- filter
- warmed
- humidified
What organs compose your upper airway?
- nasal cavity
- pharynx
- larynx
- trachea
Where are the superior, middle, and inferior turbinates located?
they can be visualized as 3 scroll like elevations of bone covered with mucous membrane
Why might you hear an unpleasant “crunching” noise when placing an NPA?
The NPA displaces the turbinates
Why no NPA with suspected head trauma?
The cribiform plate may fracture, allowing leakage of cerebrospinal fluid into the nose. Attempting to pass any tube through the nose in such a pt may result in the tube passing through the fracture into the cranium.
What causes sinusitis?
Obstruction of drainage from a sinus
What is the pharynx?
The pharynx is the space extending from the base of the skull to the larynx,
What are the 3 parts pharynx?
- nasopharynx
- oropharynx
- laryngopharynx
Trauma to the larynx is often associated with
cervical spine injury
The larynx extends from
- hyoid bone to the lower border of the cricoid cartilage
The larynx lies anterior to the
3rd to 6th cervical vertebrae
What are the 4 major laryngeal cartilages
- epiglottis
- thyroid
- arytenoids
- cricoid
What is often referred to as the Adams Apple
The thyroid cartillage
What bone resembles a horseshoe shape?
hyoid bone
What cartilage acts as protection for and an anchor point for the vocal cords?
thyroid cartilage
What is the name of the ligament that connects the hyoid bone and thyroid cartilage
thyrohyoid ligament
Below the thyroid cartilage what is the gap you can palpate?
cricoid cartilage
Name of the ligament between thyorid and cricoid cartilages
cricothyroid ligament and membrane
What anatomical object is directly behind the hyoid bone?
epiglottis
What is the role of the epiglottis
the epiglottis slides superiorly and posteriorly to cover the top of the larynx
What structures do the vocal cords attach to?
the thyroid cartilage and the arytenoid cartilage
The trachea extends from the….
cricoid cartilage, opposite the sixth cervical vertebra to the 5th thoracic vertebra
What is the area where the bifurcation of the trachea is?
carnia
What is the approximate length of the trachea
10cm
Why are the tracheal rings horseshoe shaped?
So that when you swallow, the esophagus can expand to allow food to be transported to the stomach safely
What are structures of the lower respiratory tract?
- right and left mainstream brnchi
- secondary bronchi
- tertiary bronchi
- bronchioles
- terminal bronchioles
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
- alveoli
What are the associated structures of the lower respiratory tract?
- pleura
- pleural cavity
- bony thorax
- muscles of respiration
What area does the bronchi enter the lungs?
Hilum
The main stem bronchi have what structure that is similar to trachea
rings of cartilage
If a pt has an object lodged in the brochus, which bronchus would it be?
The right bronchus is approximately in direct line with the trachea. So this is where objects likely get lodged
What are characterstics of the right bronchus?
- approx 5 cm long
- shorter than the left
- more vertical
- larger caliber
- at a 25 degree angle
What are characteristics of the left bronchus
- a little longer than 5cm
- greater angle 45 degree angle
How many lobes in each lung?
Left - 2
Right - 3
How many bronchopulmonary segments in each lung?
Right - 10
Left - 9
What is the structure called that seperates the air from the blood in the alveoli
respiratory membrane
What is the total alveolar surface area?
70m squared
What are 2 causes that can impair O2 exchange
- excess alveolar fluid as in a pulmonary edema
- alveolar collapse as in atelectasis or a pneumothorax resulting in shunting
What separates the lungs and contains the heart and major vessels ?
mediastinum
What do the base of each lung lie in contact with?
The upper surface of the diaphragm
What is the lingula?
A small tongue of lung tissue between the oblique fissure and the cardiac notch
What is the pleurae?
2 serous sacs enclosing the lungs
What are the parts of the pleurae?
visceral - inner
parietal - outer
seperated by thin layer of serous fluid
What are 2 things that can destroy the pleural bond?
- air (pneumothorax)
- fluid
What is the costodiaphragmatic recess?
Area in the pleural cavity where the lungs do not fill. Small pleural effusions will accumulate in the recesses when the patient is erect.
What are the 3 parts of thoracic cavity?
- right pleural cavity
- left pleural cavity
- mediastinum
What organs are in the mediastinum?
- heart
- trachea
- esophagus
Contraction of the respiratory muscles results in an enlargement of the thoracic cage and expansion of the lungs. This expansion reduces the pressure within the lungs. What is this process describing?
Inspiration
What is the average pressure gradient created upon inspiration?
3mm
Does the diaphragm move upward or downward upon inspiration
During inspiration, the diaphragm moves downward (contracts and flattens).
What is the main action of the diaphragm?
Enlarge the thoracic cavity downward
Do external intercostals help with inhalation or in exhalation?
External intercostal muscles help with inspiration
- They pull the ribs up and out, expanding the chest cavity so air can flow into the lungs
Do internal intercostals help with inhalation or exhalation
Internal intercostal muscles help with exhalation
- They pull the ribs down and in, decreasing the chest cavity volume to push air out (especially during active or forceful breathing, like exercise or blowing out a candle).
If the spinal cord is transected above C-3, how does this affect respiration?
all muscles of ventilation are paralyzed
maximal contraction of the inspiratory muscles of respiration can lower the intra pleural pressure to as much as?
60-100mmHg atmospheric
Is expiration a passive or active process?
Passive
What are the conditions in which the muscles of expiration actively contracting?
- High rates of ventilation (above 40 lpm)
- moderately severe airway obstruction
What induces the cough reflex?
Cough refelx is induced by irritation of sensory nerve endings in the larynx, trachea or the larger bronchi
Define Elastance
the property of matter which allows it to return to its original shape after having been deformed by some external force
Define Compliance in terms of pulmonary physiology
refers to the amount of pressure that must be generated to expand the lungs with a given volume
In the normal individual the respiratory muscles require between
3-14 ml of O2 (<5% of the total bodies oxygen consumption)
In a pt with severe cardiac or pulomonary pathological states the oxygen cost of breathing can
increase
Define tidal Volume
the measure of the volume of air inspired and exhaled with each breath at rest
What is the average tidal volume of a healthy adult
400 - 500 mL
Define Residual Volume
air remaining after expiration
Define Functional Residual Capacity
The volume of gas remaining in the lung at the end of normal tidal exhalation.
Defijne total lung capacity
maximum amount of air the lungs can contain
Define forced vital capacity
max amount of air that can be exhaled after a maximal inspiration
An increase in the measured lung volumes indicates that the lungs are…..
- hyperinflated because of obstruction of the airways (as in asthma)
- loss of lung elasticity (emphysema)
What does the control centre of ventilation in the body use to increase or decrease resp rate?
The control centre of the brain responds to increased blood CO2 levels
If a pt has lower CO2 levels what happens to the ventialtion rate?
ventilation decreases
How is breathing different for pts with elevated CO2 levels?
- breathe based on there hypoxic drive
- drive is hypoxia vs ph
Where is hypoxia primarily sensed
carotid and aortic chemoreceptors
What does metabolic acidosis do to the respiratory centre?
stimulates the resp centre resulting in hyperventilatiion
- lowers blood CO2 content and will elevatethe serum ph towards normal
Define Asthma
- chronic inflammatory disease of the airways eith hyperreactivity of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways that changes in severity either sponanteously or as a result of therapy
Define Emphysema
A condition of the lung characterized by abnormal, permanent enlargement of the air spaces distal to the terminal bronchiole, accompanied by destruction of their walls
Define Bronchitis
Chronic or recurrent excess mucous secretion in the bronchial tree, in most instantces accompanied by cough
Do most pts with COPD only have 1 of the folowing?
- Asthma
- Emphysema
- Bronchitis
Most pts that have COPD have some combination of the 3
What is a pink puffer?
A pt with COPD that is caused only by emphysema who presents as thin, anxious, alert,, oriented, dyspneic, tachypneic and hyperventilating
Dyspnea is the hallmark
Why do people who are SOB purse there lips?
It increases airway pressure, thereby internally splinting the airway
Why are pts referred to as blue bloaters?
Pts who have COPD due to chronic bronchitis. This refers to chronic central cyanosis due to the shunting (V/Q mismatch) that occurs in the lung, resulting decreased O2 saturation. Pts will be realtively stocky or obese, often with productive of sputum
Which type of pts with COPD deteriorates more quickly?
Blue bloaters may deteriorate more quickly and the 3 main causes are usually
- pneumothorax
- Pulmonary Embolism
- atelectasis
Why is severe migrating chest pain considered a big red flag?
It is considered a major sign for a thoracic aneurysm
What does the difference of systolic bps need to be suggests an aortic dissection
greater than 15mmHg
