respiratory and airway Flashcards
perfusion
circulation of blood through lungs
diffusion
gas exchange co2 and o2
where is respiratory center housed
brainstem specifically medulla
wheezing
lower airways (bronchioles0
Stridor
upper airway obstruction ( subglottic)
rhonchi
secretions in broncial airways
eupnea
normal respirations
cheyne stokes breahtign
periods of breahting with periods of apnea
biots respirations
regular deep respirations followed by periods of apnea
apneustic respirations
deep gasping inspirations
associated with stroke or trauma
kussmals
rapid and deep
nasal cannula LPM and concentration
1-6 24-44%
nebulizer LPM
4-6 handheld and 6-8 mask
NRB LPM and concentration
12-15 80-100%
BVM LPM, tidal volume, BPM
at least 15
adult 1 sec, 500ml tidal volume
dead space 150 ml
12 adults
20 peds
CPAP indications
F’N CPAP
flail chest
near drowning
copd
pulmonary edema/embolixm
asthma
pneumonia
miller blade goes where
directly to epiglottis
endotrol tube
used in nasotracheal intubation
Ped tube formula
(16+age)/4
PH
7.35-45
Co2 ABG
35-45
bicarb
22-26
ABG in respiratory acidosis
PH down
paco2 up
hco3 normal
abg in respiratory alkaloiss
ph up
paco2 down
hco3 normal
abg in metabolic acidosis
ph down
paco2 normal
hco3 down
abg in metabolic alkalosis
ph up
paco2 normal
hco3 up
ROME acronym
respiratory opposite metabolic equal
respiratory
ph decreases co2 increases
metabolic
ph down, hco3 down
respiratory acidsois cause
hypoventialtion (retaining to much co2)
respiratory alkalosis cause
hyperventilation ( blowing off to much co2)
metabolic acidosis cause
build up of lactic acid ex
lactic acidosis, dka, renal failure, sepsis, toxins
metabolic acidosis treatment
respiratory rate, fluid, bicarb
metabolic alkalosis cause
loss of hydrogen ions (rare)
vomiting, suctioning, large amounts of baking soda or antacids
phases of etco2
phase 1- respiratory baseline, late phase of inspiration
phase 2- respiratory upstroke, exhalation of dead space gasses and gasses from alveoli
phase 3- respiratory plateau
airflow through alveoli with nearly constant co2 level
phase 4 - inspiratory phase, sudden downstroke on waveform
CPR etco2
10-15 mmhg
change cpr if less than 10
sharkfin etco2
prolonged expiratory phase,
asthma, copd, anaphylaxix, fabo, treat this with bronchodilators
rising baseline etco2
pt is rebreathing co2. check equipment for o2 flow, allow more time for exhalation, ensure cuff has good seal
prolonged waveform higher than 45mmhg
hypoventilation
shortened waveform less than 35 mmhg
hyperventilation.
consider dka, sepsis, tca od, methanol ingestion
breathing around ett etco2
angled sloped downstroke means cuff is to small or wrong size
curare cleft
dip on the plataeu, neuromuscular blockade is wearing off. pt is able to take a small breath at the top
what is COPD
umbrella term that covers chronic bronchitis and emphysema
chronic bronchitis
“blue bloater”
overweight
productive cough
coarse rhonchi
chronic cyanosis
resistance on inspiration and expiration
emphysema
pink puffer
thin
barrel chested
nonproductive cough
wheezing and rhonchi
dyspnea on exertion
pursed lip breathing
clubbing on fingers
what is asthma
bronchoconstriction and inflammation.
asthma symptoms
dyspnea
intercostal retractions
decreasing loc
inability to speak sentances
tachycardia
tachypnea
etco2 above 45 mmhg
status asthmaticus
severe prolonged asthma attack that has not been stopped by bronchodilators
asthma treatment
02 and bronchodilators
consider nebulized mag sulfate
steroids
IV fluids
Epi
cpap
what is pneumonia
infection that causes acute inflammatory response
bacterial, viral, fungal
pneumonia symptoms
productive cough
pleuritic chest pain tachypnea
wheezing crackles and rhonchi
fever
what is ARDS
form of hypoxemic respiratory failure
what causes ARDS
significant pulmonary edema leads to severe hypoxemia,, intrapulmonary shunting, reduced lung compliance and irreversible lung damage
Pulmonary embolism risk factors
bedridden
long flights
hx of dvt
femal pt on bc
smoking
PE ss
rapid onset dyspnea
cough
pain
anxiety
hypertension
tachypnea
tachycardia
crackles, wheezes, rhonchi
EKG finding PE
S1q3t3
Right axis deviation
PE obstructive shock
pt can enter obstructive shock. give 20 ml/kg fluid repeated as necessary
simple pneumothorax
presence of air in pleural space
diminshed breath sounds
dyspnea and restlessness
tachypnea
tension pneumothorax
accumulation of air in pleural space that causes. tension(obstruction)
ss
jvd
hyperresonance
subcutaneous emphysema
late sign will be obstructive shock
HAPE:
causes, when it develops, height, symptoms, treatment
increased pulmonary artery pressure
symptoms begin 24-72 hours after exposure above 8000 ft
all lung sounds plus tachycardia and cyanosis
treat with o2 and decend altitude
AMS causes, symptoms
rapidly ascending above 5000 ft
headache, nausea, vomiting, weakness, dizziness, fatigue, tachy or bradycardia, postural hypertension
ataxia marks the change to hace
atelectasis
collapse of lung tissue (alveoli) makes respiration difficult due to inadequate ability of the alveoli to function
carina
bifurcation of trachea into right and left bronchus
compliance
ease of expansion of lungs
diaphragm
muscular portion that divides lungs and thoracic area
expiratory reserve volume
amount of gas that can be expelled after a breath. normal is 1,100 ml
fick principal
oxygen delivered to an organ is equal to the amount of oxygen that is consumed by and carried away from the organ
hering breur reflex
reflex that prevents overinflation of lungs
hypoxic drive
stimulus to breathe is from low o2 levels
intrapulmonic pressure
pressure of gas in alveoli
intrathoracic pressure
pressure in pleural space or throracic cavity
lower airway
structures below glottis
mediastinum
area of body whihc includes trachea, esophagus, heart, great vessles
minute volume
amount of gas exhaled in 1 min
(rr x tidal volume)
normal is around 5L
oxyhemoglobin
oxygenated hemoblobin
carboxyhemoglobin
hemoglobin saturated by co
residual volume
amount of air in lungs after max exhalation
average is 1200
tidal volume normal
5-7L
total lung capacity
5800 ml
upper airway
area above glottic opening
vallecula
decompression between epiglottis and base of tongue
Vital capacity
amount of gas that can move on the deepest inspiration and expiration
what lines trachea
cilia and goblet cells
how many rings on trachea
15-20
pleural layers
visceral- lines the lungs
pleural space
parietal pleura- seperates rib muscle from pleural space
phrenic nerve
location and function
C3-5
initiates contraction at diaphragm
intrapulmonic pressure
pressure of gas in alveoli ( a bit above 760 mmhg)
intrathoracic pressure
pressure in pleural space
(typically below atmospheric pressure around 750
Normal breathing uses how much energy? vs abnormal
5% 30%
Hypoxemia
decreased o2 in arterial blood
Hypoxia
decreased o2 in tissue
Chemoreceptors
detect changes i co2 and hydrogen levels
O2 D cylander PSI/L
4000
350L
O2 E cylinder PSI/L
6000
625L
O2 M cylinder PSI/L
3450 PSI
3000L
H or K O2 cylinder PSI/L
4500 PSI
6900 L
suction requirements machine
LPM
MMHG
timing
intake:30 LPM
300mmhg when clamped
80-100 for adults
adult:15 sec
child:10 Sec
Infant:5 sec
management of upper airway obstruction
if able to speak encourage to cough
unable to speak= abd thrusts
unconscious = open airway, 2 ventilations, chest compressions
only finger sweep when foreign body is able to be seen, use magills
Racemic epi indications
croup, asthma, bronchospasm
