Respiratory System Flashcards
What form does Salbutamol come in and what is the dose?
2.5mg/2.5ml nebule or 5mg/2.5ml nebule. 5mg initial dose, no max limit.
The indications of _________ is acute asthma attack where normal inhaler has failed, expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause, exacerbation of COPD.
Salbutamol
There are no contraindications of __________ in an emergency.
Salbutamol
The cautions of __________ include hypertension, angina, overactive thyroid, late pregnancy, severe hypertension with people on beta blockers.
Salbutamol
What form does Ipratropium Bromide come in and what is the dose?
250mcg/1ml nebuliser liquid. 500mcg dose (2ml) - max dose.
What are the 3 indications of Ipratropium Bromide?
- Acute severe or life-threatening asthma
- Acute asthma unresponsive to Salbutamol
- Exacerbation of COPD - unresponsive to Salbutamol.
What are the 3 cautions of Ipratropium Bromide?
Use with care in patients with Glaucoma (protect eyes from mist), Pregnancy/breast feeding, Prostatic Hyperplasia.
What form does Adrenaline 1:1000 come in and what is the dose?
1mg/1ml pre-filled syringe or ampoule.
0.5ml dose (500mcg) - no limit.
The indications of _________ ____ are anaphylaxis, life-threatening Asthma with failing ventilation and continued deterioration - despite nebuliser therapy.
Adrenaline 1:1000
What are the 2 cautions of Adrenaline 1:1000?
Severe hypertension may occur in patients on non-cardioselective beta-blockers (like Propranolol).
Do not administer IV adrenaline in anaphylaxis.
What are the three tiny bones called in the Nasal Cavity?
Inferior, Middle and Superior Nasal Conchae
(1) What is the nasal cavity lined with? (2) What do they contain?
(1) Respiratory Mucosa Cells (2) These contain cilia, that moves dirt laden mucous
Respiratory mucosa cells that line the nasal cavity are what type of cells? And what do they contain?
Ciliated Columnar Epithelial Cells that contain mucous-secreting goblet cells.
What is the main function of mucous?
To warm and moisten inhaled air before it goes down to the lungs
What are the 5 openings of the Nasopharynx?
2 Pharyngeal tonsils, 2 auditory tubes, and a nostril
What are the two sets of tonsils?
Palatine tonsils and lingual tonsils
What is the Adam’s apple called and where is it located?
Thyroid cartilage located in the laryngopharynx
What does the epiglottis do and where is it located?
The epiglottis closes when swallowing food to stop food going down the larynx and into the lungs, and it is situated in the laryngopharynx.
What is the larynx also known as and why?
The voice box, because it houses the vocal chords.
What are vocal chords and what do they do?
Gathered mucous membranes that cover up the ligaments, which vibrate when air passes over them, producing sound waves (speech).
Why is the anterior view of the larynx important for paramedic practice?
A needle may be used for emergency airway puncture in the Cricothyroid ligament, which is in between the Thyroid cartilage and the Cricoid cartilage.
What is the trachea also known as?
The windpipe
What does the trachea divide in to?
Two large branches - the primary bronchi.
What is the trachea and bronchi made up of?
Epithelial tissue, smooth muscle, and rings of cartilage to ensure it doesn’t collapse under the change of pressure between the lungs and the airway.
What are the 3 layers of the lungs?
Parietal layer, Visceral Pleura and Pleural Cavity
How many lobes does the right lung have and what are they called?
3 lobes; Superior, middle and inferior
How many lobes does the left lung have?
2 lobes; Superior and inferior
What is the diaphragm?
A dome-shaped thin skeletal muscle used in respiration.
What does the diaphragm do during inhalation?
Contracts and flattens, creating a vacuum effect.
What happens to the diaphragm during exhalation?
It relaxes
What controls the diaphragm?
The phrenic nerve, which runs down from the neck to the diaphragm.
What is Boyle’s law and how does it relate to respiration?
If the pressure decreases - the volume increases.
During breathing this means that the contraction and relaxation of muscles acts to change the volume in the thoracic cavity, and as the thoracic cavity and lungs move together, this changes the volume of the lungs.
What is Charles’ Law and how does it relate to respiration?
If the temperature increases - so does the volume.
This means that when cold air is inhaled, the volume will change as it warms in passing through the nose.
The pressure of a mixture of gas is the sum of the pressures - of those individual components is recognised as _________ ____. This relates to the lungs as gases go from an area of high pressure to low pressure, so the partial pressures of inhaled and alveolar air determine why oxygen goes into the alveoli, and why carbon dioxide leaves the alveoli.
Dalton’s Law (of partial pressures)
What is Henry’s Law and how does it relate to respiration?
The amount of a gas that dissolves in a liquid is directly proportional to the partial pressure of that gas.
This explains how gases dissolve across the alveoli, as the higher the gas, the more gas will be dissolved into the blood.
What is passive inspiration?
The phase of ventilation which air enters the lungs
What is passive expiration?
The phase of respiration in which air is expelled from the lungs.
What respiratory muscles initiate passive inspiration?
The diaphragm (flattens) and external intercostal muscles (expands thoracic cavity).
What respiratory muscles initiate passive expiration?
The diaphragm (relaxes) and internal intercostal muscles (relaxes)
What is active inspiration?
Contraction of the accessory muscles to increase the volume of thoracic cavity - usually during exercise or an asthma attack.
What is active expiration?
Contraction of several thoracic and abdominal muscles to decrease the volume of the thoracic cavity.
What is external respiration?
The exchange of gases with the external environment at an alveolar level.
What are the 3 main modes of transport of Carbon Dioxide?
Through bicarbonate ions (HCO3-), by blood plasma, and by erythrocytes.
What is internal respiration?
The exchange of gases between the capillaries and the cells / metabolising tissues of the body.
What is cellular respiration?
The process by which living cells break down glucose molecules and release energy.
What are the 3 stages of cellular respiration?
Glycolysis, Krebs Cycle and Electron Transport
What is the regulation of normal breathing controlled by?
Autonomic Nervous System
What is the medullary respiratory centre responsible for and where is it located?
Generates rhythmic nerve impulses that stimulate contraction of the inspiratory muscles - diaphragm and the external intercostal muscles.
This is located in the medulla oblongata.
What is the pneumotaxic area responsible for and where is it located?
Inhibits the respiratory centre, so it limits the contraction of the inspiratory muscles and prevents the lungs from over-inflating. It also controls the rate and pattern of breathing.
It is located in the upper pons.
What is the apneustic area responsible for and where is it located?
Stimulates the inspiratory centre, prolonging the contraction of the inspiratory muscles.
This is located in the lower pons.
What 3 groups of sensory neurons control respiration?
Peripheral chemoreceptors, Sensory chemoreceptors and Stretch receptors.
What are breath sounds categorised by?
Duration, sound, location, frequency and pitch.
What does FLAPS stand for? (chest inspection)
Feel Look Auscultate Percuss Search back/armpits
What does TWELVE stand for? (neck inspection)
Trachea Wounds Emphysema (subcutaneous) Larynx Veins (jugular) Evaluate
When performing an auscultation, what should the patient do?
Breathe with their mouth open (not through their nose).
Cross their arms in front of their chest when listening posteriorly.
The main functions of the ________ palate are to aid speech, swallowing, and breathing.
Soft
______ ___states pressure is inversely proportional to volume (at a constant temperature)
Boyle’s Law
_________ _____________ is the only contra-indication of Oxygen administration detailed in the JRCALC.
Explosive Environments
_____________ respond to changes in the partial pressures of PO2 and PCO2 in the blood and cerebrospinal fluid.
Chemoreceptors
When the volume of the thoracic cavity decreases – the volume of the lungs (1) ________ and the pressure within the lungs (2) ________
(1) decreases
(2) increases
Expiration is the phase of ventilation in which air is expelled from the lungs. It is initiated by ________ of the inspiratory muscles
Relaxation
Henry’s law states that the amount of a gas that dissolves in a liquid is directly proportional to the_______ ________of that gas
Partial pressure
The pharmacokinetics of nebulised Ipratropium Bromide, mean around________% is lost into the GI tract.
90%
Oxygen increases the risk of________at the scene of an incident
Fire hazard
__________ _____ is indicated in life threatening Asthma with failing ventilation, continued deterioration despite nebulised therapy.
Adrenaline 1:1000
The 3 indications for the administration of salbutamol in our practice are (1)________ ,(2)________and (3)________
(1) Acute asthma attack
(2) Expiratory wheezing
(3) Exacerbation of COPD
Oxyhaemoglobin is an unstable compound that readily dissociates releasing________
Oxygen
The following 5 conditions do not require the administration of supplemental oxygen, unless the patient is hypoxaemic:
(1) Myocardial infarction
(2) Paraquat poisoning
(3) Heat exhaustion
(4) Post convulsions
(5) Shortness of Breath
Charles’ Law states that (1) ________ is directly proportional to (2) ________ at a constant pressure
(1) temperature
(2) volume
External respiration is the exchange of gases with the ________environment, and occurs in the________of the lungs.
(1) external
(2) alveoli
The oral cavity has dual functions as part of the (1) ________and (2) ________systems
(1) digestive
(2) respiratory
_________ _____________ are located in the arch of the aorta and carotid bodies
Peripheral chemoreceptors
When the volume of the thoracic cavity increases – the volume of the lungs (1) ________and the pressure within the lungs (2) ________
(1) increases
(2) decreases
_______ ____states that the total pressure of a mixture of gases is the sum of the partial pressures of each gas in the mixture (it is only true for ideal gases).
Dalton’s Law of Partial Pressures
Non-humidified O2 can have a drying and irritating effect on the ______ __________ after prolonged use.
Mucous membrane
The______has c-shaped horizontal rings of hyaline cartilage along it’s length to protect it from closing due to pressure changes.
Trachea
Name the 2 sets of tonsils found in the Oropharynx:
(1) ______ and (2) ______
(1) Lingual tonsils
(2) Palatine tonsils
Active inspiration involves the contraction of the _________ _________of breathing (in addition to those of quiet inspiration, the diaphragm and external intercostals)
Accessory muscles
__________ is the phase of ventilation in which air enters the lungs.
Inspiration
_________ _____________refers to gas exchange across the respiratory membrane in the metabolizing tissues.
Internal respiration
The majority of oxygen molecules (98.5%) are carried from the lungs to the body’s tissues by a specialized transport system, which relies on the______/______
(1) Erythrocytes
(2) Red Blood Cells
The sensitivity of the central chemoreceptors to raised arterial______is the most important factor in maintaining homeostasis of blood gases.
PCO2
Aside from an allergic reaction, what 5 presentations are all possible side effects of Ipratropium bromide administration?
(1) Nausea
(2) Dry mouth (common)
(3) Tachycardia
(4) Arrhythmia
(5) Paroxysmal tightness of the chest
The administration of Ipratropium bromide is contra-indicated by ________
Nothing (in an emergency)
Epinephrine is a sympathomimetric that stimulates both α and β _________ ________
Adrenergic receptors
The _______ ______of the lung is the outer membrane which is attached to the inner surface of the thoracic cavity and this layer is innervated by the intercostal nerves and the phrenic nerve.
Parietal pleura
As per Boyle’s law, an increase in lung volume results in a (1) ______ in (2) ______ within the lungs
(1) decrease
(2) pressure
Oxygen is required for cellular respiration; therefore, it is an ______ problem
Aerobic
Oxygenation is essential for normal physiological function alongside Cell ______
Metabolism
The pharmacodynamics of __________ is that its a selective beta2 adrenoreceptor stimulant. It is a relaxant on the smooth muscle in the medium and smaller airways - which are in spasm in acute asthma attacks.
Salbutamol
The side effects of __________ include: tremor, tachycardia, palpitations, headache, feelings of tension, peripheral vasodilation, muscle cramps and a rash.
Salbutamol
The pharmacodynamics of ___________ ________ are that it is an antimuscarinic bronchodilater - not a beta2 agonist so won’t work as quickly as Salbutamol.
It works better in children with acute asthma and adults suffering with COPD.
Ipratropium bromide
The pharmacodynamics of Adrenaline 1:1000 show that it is a ____________ that stimulates alpha and beta adrenergic receptors. As a result, myocardial and cerebral blood flow is enhanced during CPR - causing it to be more effective due to increased peripheral resistance which improves perfusion pressures. It also reverses allergic manifestations of acute anaphylaxis, and relieves bronchospasms.
Sympathomimetic
What is the common presentation of hydrocortisone?
100mg/1ml solution for injection
What are the 3 indications of hydrocortisone?
Severe or life-threatening asthma
Anaphylaxis
Adrenal crisis
What is the IV dose for hydrocortisone for asthma or adrenal crisis?
100mg – max dose (slow injection over 2 mins min)
What is the IV dose for hydrocortisone for anaphylaxis?
200mg - max dose (slow injection over 2 mins min)
_____________ is a glucocorticoid drug that restores BP, blood sugar, cardiac synchronicity and volume. High levels are important to survive shock. Therapeutic actions include suppression of inflammation and immune response.
Hydrocortisone
____________ may cause stinging or burning sensations.
Hydrocortisone
_________ ___________ is the process by which living cells break down glucose molecules and release energy
Cellular respiration
_______ ___________ refers to gas exchange across the respiratory membrane in the metabolizing tissues.
Internal respiration
__________ ____________ are located in the arch of the aorta and carotid bodies
Peripheral chemoreceptors
Aside from an allergic reaction, what 5 presentations are all possible side effects of Ipratropium bromide administration?
- Nausea
- Dry mouth (common)
- Tachycardia
- Paroxysmal tightness of the chest
- Arrythmia
What part of the upper respiratory system has these 3 functions: Protect the airway from choking/foreign bodies, regulate the flow of air into the lungs and production of sounds used in speech?
Larynx
What 5 conditions do not require the administration of supplemental oxygen, unless the patient is hypoxaemic?
- Myocardial infarction
- Paraquat poisoning
- Heat exhaustion
- Post convulsions
- Shortness of breath
Expiration is the phase of ventilation in which air is expelled from the lungs. It is initiated by ___________ of the inspiratory muscles
Relaxation
________ ____ states pressure is inversely proportional to volume (at a constant temperature)
Boyle’s Law
Henry’s law states that the amount of a gas that dissolves in a liquid is directly proportional to the _______ ________ of that gas
Partial pressure
The 3 indications for the administration of salbutamol in our practice are: (1) ______ _______ ______, (2) ___________ __________ and (3) _____________ ___ _____
- Acute asthma attack
- Expiratory wheezing
- Exacerbation of COPD
