Resp Test Flashcards
What are the 3 criteria for the unprotected airway?
how to tell if it’s unprotected
Whats the difference between conscious and unconscious airway in the supraglottis?
Gag
Secretions in the mouth
Loss of proximal airway muscle tone – stertor/ increased WOB)
Use elevation of the glottis, retroflexion, and protraction of the airway to open it and allow for better airflow. Using poiseuille’s law when you elgongate the tongue and stretch the supraglottic soft tissue, you enhance the airways’s radius effectively reducing the resistance
Below the glottis there is no change (in consciousness or unconsciousness)
Above the glottis (supraglottically) - in unconious (loss of proximal airway tone) constriction occurs
Conscious Pharynx
Supraglottic: Airway naturally opens (Mouth & Trachea & Nostrils) when a breath is taken
Subglottic: Intercostals and diaphragm pull down
Unconscious Pharynx
Supraglottic: Loss of proximal airway tone = mouth / trachea / nostrils collapse in when a breath is taken (Can’t stay open)
Subglottic: Intercostals and diaphgram much weaker and can’t pull as hard
What is the Philtrums purpose?
a supply of additional skin to be recruited for oral movements requiring stretching of the upper lip.
When jaw thrusting, how does the airway open (medical terminology)
What are the 2 directions of the mentum?
LL (lingual ligament) - attached to the tounge – attached to the glossal part of the toung which has a glosso-epiglottic ligament
At the same time ^ is occuring the follwoing is as well
Mentum – attaches to the anterior belly of digastric muscle – attaches to the hyoid – attaches to the hyo-epigloitic ligament
These processess all pull on the base which in turn further opens the airway also allowing for greater airflow
Explain how maneuvers can improve airway and airflow?
The jaw thrust and chin lift creates a ‘line of sight’ or straighter line for less airflow resistance
The elevation with retroflexiton (along with the previously mentioned) aligns the axis of the pharynx and larynx into straight line without the tongue in the way of course
By using poiseuille’s law we know that by using these manuevers we’ve decreased “length” or bends and therefore resistance that air meets when trying to reach your lungs
- 1 bend = 10x resistance
- Double length = 4x resistance
- Half circumference = 16x resistance
Explain the 5 elements of the unconscious airway assessment
1 finger at the temporalmandibular joint
2 fingers in the mouth
6.5cm for the thyromental distance
Hyperflexion of the neck chin-chest+ retroflextion 135 degrees
Obesity check - check skin thinkness at the neck
All of these are to assist in the most opitmal airway and airflow management possible for the patient
Explain the purpose of using RSI (as opposed to just intubation)
Rapid Sequence Intubation
What does RSI teach us?
It’s easier for ET Tubes to enter in conscious patients because they can protect their own airway
The need for RSI is to protect the airway before it becomes unprotected i.e. unconscious
* a precaution is set for patients that may have a ‘full stomach’ or other risks of pulmonary aspiration
- The unconscious airway is more difficult to protect
- It’s faster and shorter acting than propofol
Explain all of Boiden in detail
Differentiate PE from DVT vs from a foreign body
Chest presentation is the same
* Benzodiazepine overdose - injection can also lead to blood clots
* IV drug user
* birth control
* chemotherapy
Why don’t you want to fill all the holes (apply poiseuille’s law)
Wrong to fill all the wholes – the more stuff in airway – the more airflow is restricted – doubling the length and dropping the radius increases at least 4 and 16 times repectively using poiseuille’s law.
What are the 4 types of hypoxia? Give examples of each
What is asthma (3 main components) How do you treat it?
Increased irritability of the airways leading to recurrent episodes of reversible airway obstruction following exposure to various antigenic or non-antigenic stimuli.
What Occurs:
1. Bronchial smooth muscle contraction
2. mucosal and submucosal inflammation and edema
3. increased mucous production
How to treat: - relieving bronchospasm and improving ventilation
* aiway control
* oxygen - humidified
* beta stimulants (like salbutamol)
* normal saline
* monitor the patient
Explain flail chest?
Why is the BVM a useful tool in treating it?
3 or more ribs are broken in at least 2 places.
MVC are 75% of the cause and 15% in elderly (stiffening of chest wall and oseoprosis)
Flail chest occurs when segments of the chest wall move independently of the rest of the chest wall - usually unilateral but can be bilateral - often associated with blunt force trauma
Seen “later” because once the intercostal muscles become fatigued it becomes more apparent OR because it’s not viewable once positive pressure ventilation has begun
This movement is paradoxical meaning the flail segment moves inward while the rest of the chest wall moves outward and the severity is determined by:
* pleural pressure
* the extent of the flail
* the activation of intercostals muscles during inspiration
Flail chests negatively effects respiration by:
* ineffective vetilations
* pulmonary contusions - edema, hemorrhage, necrosis
* hypoventilation with atelectasis
There is ineffective ventilation because of increased dead space, decreased intrathoracic pressure, and increased oxygen demand from injured tissue
Use a BVM for flail chest becuase overtime the total inspiratory volume becomes smaller i.e. proper gas exchange cannot take place i.e. agressive upfront management of the airway is required
Explain the pharmacodynamics of
Salbutamol
cromolyn sodium
zafirlukast
beclomethasone
ipratromium bromide
Salbutamol - moderately selective beta(2)-receptor agonist, bronchodilator, A measurable decrease in airway resistance is typically observed within 5 to 15 minutes after inhalation of salbutamol
Cromolyn sodium - inhibiting the release of histamine and leukotrienes (SRS-A) from the mast cell
Zafirlukast (antagonist) - blocks the action of the cysteinyl leukotrienes on the CysLT1 receptors, thus reducing constriction of the airways, build-up of mucus in the lungs and inflammation of the breathing passages.
Beclomethasone - inhaled corticosteroid, anti-inflammatory and vasoconstrictive effects
Ipratromium bromide - an acetylcholine antagonist via blockade of muscarinic cholinergic receptors leads to decreased contraction of the smooth muscles
Why can’t epi work if swallowed but salbutamol can?
Epinephrine is a catecholamine Ventolin is not
Catecholamines are destroyed in the stomach so pei had no effect if swallowed but ventolin is usually inhaled AND swallowed. After 20-30min ventolin will produce an effect from GI absorbtion
What does compliance mean?
the continuous measurement of pulmonary compliance calculated at each point representing changes during rhythmic breathing
The compliance of a system is defined as a measurement of the elastic resistance of a system
If the lung has low compliance, it requires more work from breathing muscles to inflate the lungs.
Compliance determines 65% of the work of breathing.
Factors that effect lung compliance:
Age
Lung volume
Surfactant
Elatic properties of the lungs
Surface tension flastic force
