week 2 Flashcards

Question

Trachea anatomy of the airway

Answer 1

Serves as a conduit for air entry into the lungs Tubular structure, approximately 10 to 12 cm in length and consists of a series of C-shaped cartilaginous rings Begins immediately below the cricoid cartilage Descends anteriorly down the midline of the neck and chest to the level of the fifth or sixth thoracic vertebra Divides into the right and left main stem bronchi at the level of the carina

Answer 2

Point of entry for blood vessels and the bronchi on each lung Lungs consist of the entire mass of tissue that includes the smaller bronchi, bronchioles, and alveoli.

Answer 3

Right lung has three lobes. Left lung has two lobes.

Answer 4

Divides into increasingly smaller bronchi once it enters the lungs Further divide into smaller bronchioles Smaller bronchioles branch into alveolar ducts that end at the alveolar sacs.

Answer 5

Balloon-like clusters of single-layer air sacs Functional site for the exchange of oxygen and carbon dioxide with the pulmonary capillaries Surfactant is present on the alveoli to decrease surface tension to keep alveoli open Atelectasis-when alveoli collapse

Answer 6

Thorough assessment and appropriate management are of utmost importance in the prehospital setting Can “see” or hear a patient breathing Usually indicative of a problem. breathing at rest should appear effortless not labored. Normal adult respiratory rate between 12 and 20 breaths/min

Answer 7

Patients experiencing compromise to their a/w status will try to compensate with preferential positioning Upright tripod position (elbows out) Semi-Fowler (semi-sitting) position Avoid a supine position.

Answer 8

Is the airway open and patent? Is it likely to remain so? Sonorous sounds Gurgling or bubbling sounds

Answer 9

Simple to complex Easiest problem to solve is position. Possibility of spine injury drives the decision of which technique to use to open the airway. Obstruction requires BLS procedures to clear the obstruction.

Answer 10

Is the pt Conscious, alert, and able to speak without difficulty? Most likely indicates no immediate airway or breathing problems However, You must still closely monitor a patient’s airway and breathing status and be prepared to intervene.

Answer 11

dyspnea Any difficulty in respiratory rate, regularity, or effort Hypoxemia- a decrease in arterial O2 levels, left untreated may lead to….. Hypoxia- a lack of O2 to the body’s cells and tissues, left untreated may lead to….. Anoxia- an absence of O2, results in cellular and tissue death

Answer 12

Proper airway management involves Opening the airway Clearing the airway Sequence of treatment should follow these steps 1. Assessing 2. intervening 3. reassess breathing 4. And repeat 1-3

Answer 13

How is the patient positioned? Is rise and fall of the chest adequate? Is the patient gasping for air? What is the skin colour? Is there flaring of the nostrils? Are they drooling? Can you visualize blood, vomit or other foreign bodies? Is the patient breathing through pursed lips? Do you note any retractions? Is the patient using accessory muscles to breathe? Is the patient’s chest wall moving symmetrically?

Answer 14

Air movement at the patient’s nose and mouth Auscultate breath sounds with a stethoscope.

Answer 15

Chin lift and/or modified jaw thrust maneuver. Visualize the oro-pharynx Suction and/or remove foreign bodies. Insert an oral airway if the patient has a decreased LOC and NO gag reflex. Insert a nasal airway if the patient has a decreased LOC and a gag reflex.

Answer 16

Note any resistance or change in ventilatory compliance Increased compliance or decreased compliance For any changes in tidal volume (amount of air going in and out) Change in pulse quality, or even the disappearance of a pulse during inhalation may also be detected.

Answer 17

Supine position or semi-fowlers position In a perfect world, all patients would present in this position for ease of evaluation. If patient found prone, log roll the patient as a unit Quickly open the airway, assess breathing, and intervene as needed In nontraumatic patient with decreased LOC the recovery position may be utilized

Answer 18

Left lateral recumbent position Should be used in all nontrauma patients with a decreased LOC who are able to maintain their own airway spontaneously and are breathing adequately

Answer 19

Most common cause of airway obstruction In the pt with a decreased LOC is the Tongue Manually maneuver thepatient’s head to lift the tongue forward.

Answer 20

Tilting the patient’s head back and lifting the chin technique used for opening the airway of a patient who has not sustained trauma Indications- unresponsive pt with no C-spine injury, or pt is unable to protect own A/W Contraindications- possible C-spine injury Advantages- no equip, simple, safe, noninvasive Disadvantages- does not protect from aspiration

Answer 21

If you suspect a cervical spine injury Open the airway by placing your fingers behind the angle of the jaw and lifting the jaw forward. Indications- pt unable to protect own A/W, ?? C-spine injury Contraindications- not tolerated Advantages- can be used with C-collar, no equip required Disadvantages- does not protect against aspiration, fatigue, require 2 medics for BVM

Answer 22

Similar to the head tilt–chin lift maneuver Employ both maneuvers simultaneously

Answer 23

Tongue- most common cause of obstruction in an unconscious pt or one with a decreased LOC. - the jaw relaxes, and the tongue falls back on the posterior pharyngeal wall You will note Snoring respirations in partial obstruction, Complete obstruction- no respirations (apnea) Simple to correct with manual maneuvers

Answer 24

Foreign body Typical victim is middle-aged or older and wears dentures. Patients with conditions that decrease their airway reflexes are at an increased risk, ie. CVA, ETOH (alcohol)use Mild or severe airway obstruction depending on size and location S&S- Choking, gagging, stridor, dyspnea, aphonia, dysphonia,

Answer 25

Results in spasmodic closure of the vocal cords, completely occluding the A/W Many different causes- examples…..asthma, anaphylaxis, epiglottitis, stress, inhalation injury, GERD May be caused by trauma during an overly aggressive intubation attempt or immediately upon extubation May be relieved by PPV

Answer 26

Patency depends on good muscle tone to keep the trachea open Increases airway resistance by decreasing airway size secondary to decreased muscle tone, laryngeal edema, and ventilatory effort

Answer 27

Blood or other fluid significantly increases mortality. In addition being a foreign body in the A/W, aspirated substances can destroy delicate bronchiolar and lung tissue as well as introduces pathogens into the lungs, and decreases the patient’s ability to ventilate Suction should be readily available for any patient with an unprotected A/W

Answer 28

Can cause a partial to completely obstructed A/W Important- Rapid but careful assessment is required to determine the severity of the obstruction as treatment differs

Answer 29

Relaxation of tongue in unresponsive pt Foreign body- food, dentures, small toys Blood clots, broken teeth or other damaged tissue following trauma Airway tissue swelling- infection, allergic reaction Aspirated vomit

Answer 30

Typically experiences a sudden inability to breathe, talk, or cough Pt typically grasps at his or her throat, Will turn cyanotic and make attempts to move air; they will appear frantic and in a state of panic May exhibit a Weak, ineffective,or absent cough.

Answer 31

Unresponsive patient Manage as if he or she has a compromised airway. Open and maintain the airway with the appropriate manual maneuver. Assess for breathing. Provide artificial ventilation if necessary.

Answer 32

If you are unable to ventilate or if you feel resistance when ventilating, reopen the airway and again attempt to ventilate the patient. Lung compliance is the ability of the alveoli to expand during ventilation. Poor lung compliance is characterized by increased resistance during ventilation

Answer 33

If Large pieces of vomitus, mucus, loose dentures, or blood clots are found in the airway, sweep them forward and out of the mouth with your gloved index finger. Blind finger sweeps of the mouth are not recommended Take care not to force the foreign body deeper into the airway. Do not blindly insert any object into the patient’s mouth. Suction to clear the airway of secretions.

Answer 34

Abdominal thrusts Most effective method of dislodging and forcing an object out of the airway Aims to create an artificial cough by forcing residual air out of the victim’s lungs If the patient is in the advanced stages of pregnancy or is morbidly obese, perform chest thrusts instead.

Answer 35

Patient’s mouth filled Vomitus, blood, or secretions? Suction apparatus enables you to remove the liquid quickly and efficiently. Ventilating a patient with secretions in his or her mouth will force material into the lungs, resulting in an upper airway obstruction or aspiration. If you hear gurgling, the patient needs suctioning!

Answer 36

Ambulances should carry: Fixed suction unit Portable suction unit Regardless of your location, must have quick access to suction unit

Answer 37

Mechanical or vacuum-powered suction units Should be capable of generating sufficient vacuum Amount of suction should be adjustable for use in children and intubated patients. Check the vacuum at the beginning of every shift.

Answer 38

Wide-bore, thick-walled, nonkinking tubing Soft and rigid suction catheters A nonbreakable, disposable collection bottle A supply of water for rinsing the catheters

Answer 39

Suction catheter Hollow, cylindrical device Used to remove fluids and secretions from the patient’s airway Yankauer catheter(tonsil-tip catheter) Rigid catheter

Answer 40

Suction catheter (continued) Whistle-tip catheters Soft catheters

Answer 41

Suction only as far as you can see… Measure from Middle of mouth to tragus Adult setting=380mmHg No more than 10 sec intervals Adequate oxygenation between intervals

Answer 42

Mortality increases significantly if a patient aspirates. Suctioning the upper airway is critical to prevent aspiration. Removes not only liquids from the airway, but also oxygen- limit suction intervals to 10 seconds Any patient who is to be suctioned should be adequately preoxygenated first.

Answer 43

Using soft-tip catheters Must be lubricated when suctioning the nasopharynx Used through an ET tube Catheter is inserted and suction is applied during extraction of the catheter to clear the airway

Answer 44

Before inserting any suction catheter Make sure you measure for the proper size. Never insert a catheter past the base of the tongue.

Answer 45

First step Open the airway, initially by manual methods, then cross finger/scissor to open mouth If the patient has an altered LOC, an artificial airway may then be needed to help maintain an open air passage. An artificial airway is not a substitute for proper head positioning.

Answer 46

Curved, hard plastic device Fits over the back of the tongue Designed to hold the tongue away from the posterior pharyngeal wall

Answer 47

Considerations Indications- unresponsive pt, absent gag reflex Contraindications- conscious pt, intact gag reflex Advantages- noninvasive, easily placed, prevents tongue from blocking the glottis Disadvantages- does not prevent aspiration (not definitive A/W) Complications- may induce gag and unexpected vomiting, soft tissue or dental trauma from poor technique

Answer 48

Improperly sized or inserted incorrectly- (measure from earlobe to corner of the mouth) Could actually push the tongue back into the pharynx, creating an airway obstruction Rough insertion can injure the hard palate, resulting in oral bleeding and creating a risk of vomiting or aspiration. Prior to inserting, suction the oropharynx as needed to ensure that the mouth is clear of blood and fluids. If the patient gags while being suctioned, consider using a nasopharyngeal airway instead

Answer 49

Open And Clear The Airway: An oropharyngeal airway holds back the tongue. Insert an oral airway if the patient has a decreased LOC and NO gag reflex. Open the mouth and insert the airway inverted. Rotate the airway 180◦ and slide down the curvature of the tongue. Fully insert the airway so the flange rests on the teeth.

Answer 50

Nasal 15-cm long, soft, rubber tube Inserted through the nose into the posterior pharynx behind the tongue Allows passage of air from the nose to the lower airway Much better tolerated than an oral airway in patients who have an intact gag reflex yet an altered LOC

Answer 51

Indications- unresponsive patient or with Altered Mental Status(AMS), with intact gag reflex Contraindications- intolerance, facial or skull Fx (basal) Advantages- use as suction portal, tolerated by awake pts, used in pt with trismus Disadvantages- severe bleeding from poor technique, does not protect from aspiration

Answer 52

Tip of the nostril to the earlobe If it is too long it may obstruct the patient’s airway. If the patient becomes intolerant of the nasal airway, gently remove it from the nasal passage

Answer 53

There are 3 adult sizes for the i-gel airway adjunct Size 5 “Orange” Large adult 90 kg+ Size 4 “Green” Medium adult 50-90kg Size 3 “Yellow” Small adult 30-60kg

Answer 54

Ease and speed of insertion* Reduced trauma* Superior seal pressure* Gastric access* Integral bite block* Non-inflatable cuff

Answer 55

Lined with ciliated mucous membrane which trap dust and small particles Mucous membrane is delicate with a rich blood supply Trauma to the posterior nasal cavity may result in Bleeding that cannot be controlled by direct pressure. Concern for deeper skull and cranial injury (cribiform plate

Answer 56

lines the lungs

Answer 57

lines the thoracic cavity Small amount of fluid is found between the pleurae