Respiratory & Airway

Question 1

Ventilation (Key Terms)

Answer 1

The process of air movement into and out of the lungs

Question 2

Perfusion (Key Terms)

Answer 2

The circulation of blood through the lung tissue

Question 3

Diffusion (Key Terms)

Answer 3

The process of gas exchange (carbon dioxide and oxygen)

Question 4

Respiratory Center

Answer 4

Medulla oblongata

Question 5

Crackles/Rales

Answer 5

Fine, bubbling sound heard on auscultation of the lung. Produced by air entering the distal airways and alveoli that contain serious secretions

Question 6

Rhonchi

Answer 6

abnormal, coarse, rattling respiratory sounds, usually caused by secretions in the bronchial airways

Question 7

Stridor

Answer 7

abnormal, high-pitched, usical sound caused by an upper airway obstruction (subglottic)

Question 8

Wheezing (Lung Sounds)

Answer 8

form of rhonchi, characterized by a high pitched, musical quality. Produced in the lower airways (bronchioles)

Question 9

Eupnea (Respiratory Patterns)

Answer 9

Normal respirations

Question 10

Tachypnea (Respiratory Pattern)

Answer 10

increased (fast) respirations

Question 11

Bradypnea (Respiratory Patterns)

Answer 11

decreased (slow) respirations

Question 12

Apnea (Respiratory Patterns)

Answer 12

no respirations (not breathing)

Question 13

Cheyne Stokes (Respiratory Patterns)

Answer 13

abnormal
respirations with regular, periodic breathing with intervals of apnea and a crescendo-decrescendo pattern of respirations

Question 14

Biot’s (Respiratory Patterns)

Answer 14

abnormal respirations characterized by regular deep inspirations followed by regular or irregular periods of apnea

Question 15

Apneustic (Respiratory Patterns)

Answer 15

abnormal rapid respirations associated with deep, grasping inspirations - most often associated with stroke or trauma

Question 16

Kussmaul’s (Respiratory Patterns)

Answer 16

rapid and deep respirations - most often associated with diabetic keto acidosis (DKA) as a compensatory mechanism in an attempt to correct the body’s metabolic acidosis

Question 17

Oropharyngeal airway (Airway Adjuncts & Devices)

Answer 17

Used on patients without a gag reflex, moves tongue forward as it curves back to pharynx

Measured from center of mouth to angle of jaw

Insert device along roof of mouth, rotate 180 degrees to sit anatomically (can insert in “normal” position in pediatrics)

Question 18

Nasopharyngeal airway (Airway Adjuncts & Devices)

Answer 18

Used in patients with intact gag reflex, moves tongue and soft tissue forward to provide channel for air

Measured from patient’s nostril to the tip of the earlobe or to the angle of the jaw

Bevel always goes towards the nasal septum

Question 19

Nasal Cannula (Airway Adjuncts & Devices)

Answer 19

Liters/Minute:1-6

Oxygen Concentration: 24-44%

Question 20

Nebulizer (Airway Adjuncts & Devices)

Answer 20

Nebulized albuterol, ipratropium, and epinephrine

Liters/Minute: 4-6 (hand-held); 6-8 (mask)

Question 21

Non-rebreather mask (Airway Adjuncts & Devices)

Answer 21

Liters/Minutes: 12-15

Oxygen Concentration: 80-100%

Question 22

Bag Valve Mask (Airway Adjuncts & Devices)

Answer 22

Liters/Minute: at least 15

Use two rescuers when possible to deliver ventilations

Deliver breath over 1 second of time, allow for adequate exhalation

Squeeze bag until you see chest rise, release bag
- Average tidal volume in adult 500mL
-Average dead space in adult 150mL

12 breaths per minute in adults

20 breaths per minute in pediatrics

Question 23

CPAP (Airway Adjuncts & Devices)

Answer 23

Tight fitting mask, not a leak tolerant system

Centimeters of water pressure (cmH20): 4-20
- Most protocols do not exceed 10cmH20

Indications for CPAP:
F: Flail Chest
N:Near Drowning
C:COPD
P:Pulmonary Edema,
Pulmonary Embolism
A: Asthma,ARDS
P: Pneumonia

Typically not used in pediatrics (<12 years of age), however, pediatric CPAP is gaining traction in prehospital setting.

In pediatric CPAP, all settings are the same, it’s simply a smaller mask

Question 24

Laryngeal mask airway

Answer 24

Supraglottic Airways

SIzes 1-5

Inserted through mouth into pharynx

Advanced until resistance is felt as end of tube “seats” in the hypopharynx

Confirm placement through traditional methods

Question 25

i-gel

Answer 25

Supraglottic Airways Non-inflatable cuff Designed to rest over the larynx Insertion is same as LMA, but without inflation Takes less than 5 seconds to insert, faster than LMA

Question 26

King LT-D Airway (Supraglottic Airways)

Answer 26

Supraglottic Airways Similar to i-gel and LMA Single tube with two cuffs, that is placed into the esophagus Holes between the two cuffs allow for ventilations to be delivered near the glottis

Question 27

Miller Blade

Answer 27

Straight blade, size 1 -4 Tip of blade is applied directly to the epiglottis to expose vocal cords Typically recommends for infant intubation -> provides greater displacement of the tongue May be better for anterior airways

Question 28

Macintosh Blade

Answer 28

Curved blade, sizes 1-4 Tip of blade is inserted into the vallecula -> displaces tongue to the left the epiglottis without touching it May reduce chance of dental trauma

Question 29

Stylet

Answer 29

May be inserted through ET tube before intubation, adds rigidity and shape to tube Must be recessed 1-2" into the tube, should not pass the "Murphy's Eye"

Question 30

Bougie

Answer 30

60-70cm in length Can be used in place of stylet, performs very well in difficult and anterior airways Patient can be "intubated" with the bougie, then ET tube is slid over bougie into the airway (remove bougie after tube is in place)

Question 31

Endotracheal Tube

Answer 31

Size: 0.5-10 Average Adult Male: 7.5 Average Adult Female: 7 Direct placement through glottis opening into trachea Confirm placement with traditional methods - capnography is the gold standard!

Question 32

Endotrol

Answer 32

Same size as endotracheal tubes, performs, same way as endotracheal tube Often used for nasotracheal intubation due to ring at top of tube that allows for distal manipulation/movement of the tube

Question 33

BAAM Device

Answer 33

Placed on end of endotracheal tube (or Endotrol) to help identify proximity of glottis opening and when patient is inhaling/exhaling during nasotracheal intubation. Device Will Produce loud whistling noise. Glottis is largest during inspiration, which is when tube should be advanced into glottic opening

Question 34

Things to remember - Nasotracheal intubation occurs only in patient with?

Answer 34

Respirations

Question 35

Things to remember - Pediatric Tube size formula

Answer 35

(16 + age) / 4

Question 36

Things to Remember -DOPE (Diagnosing tube problems)

Answer 36

Displacement Obstruction Penumothorax Equipment Failure