Written Flash Cards
Amount of air that moves in and out of respiratory tract per minute
Minute Volume
Nerves that innervate the external intercostal muscles (the muscle between ribs)
Intercostal Nerves
A small, horseshoe bone to which the jaw, tongue, epiglottis, and thyroid attach
Hyoid Bone
Increased CO2 in arterial blood
Hypercapnia
A device that attaches between the trachea tube and BVM. Contains paper which should turn yellow during proper exhalation
Capnography
A device that attaches between the tracheal tube and ventilation device; Uses special paper that turns purple during exhalation, indicating the presence of exhaled CO2
Colourmetric CO2 detector
Abnormality that is formed by the attachment of CO to the hemoglobin molecule
Carboxyhemoglobin (COHb)
A compound formed by oxidation of the iron on hemoglobin
Methemoglobin
Hemoglobin that is occupied by O2
Oxyhemoglobin (HbO2)
Hemoglobin after O2 has been released to the cells
Reduced Hemoglobin
Drawing in the intercostal muscle and muscles above the clavicles during respiratory distress
Retractions
Severe dyspnea when lying down
Orthopnea
Absence of O2
Anoxia
A decrease in arterial O2
Hypoxemia
Decreased CO2 in arterial blood
Hypocapnia
The point at which the trachea bifurcates (divides) into the left and right mainstem bronchi
Carina
Context of kidney, a cleft where ureters, renal blood vessels, lymphatic vessels, and nerves enter and leave the kidney
Hilum
Cerebrospinal fluid drainage from the nose
Cerebrospinal Rhinorrhea
Cerebrospinal fluid drainage from the ears
Cerebrospinal Otorrhea
The alveolar collapse that prevents the use of that portion of the lung for ventilation and oxygenation
Atelectasis
The volume of inhaled air that reaches the alveoli and participates in gas exchange is equal to tidal volume minus dead space volume. The average is ~350 mL in an adult
Alveolar Volume
Lymphatic tissues located on the posterior nasopharyngeal wall that filter bacteria
Adenoids
A portion of the brainstem that influences the respiratory rate by increasing the number of inspirations per minute
Apneustic Centre
Monitor the levels of O2, CO2, and PH of CSF and provide feedback to respiratory centers to modify the rate and depth of breathing based on the body’s need at any given time
Chemoreceptors
Lymphatic tissue that is located in the posterior pharynx; Helps trap bacteria
Tonsils
Area of the brainstem that has an inhibitory influence on inspiration
Pneumotaxic Centre
Additional dead space created by intrapulmonary obstructions oractelasis
Physiologic Dead Space
Nerves that innervate the diaphragm
Phrenic Nerves
Forms roof of mouth and separates oropharynx and nasopharynx
Palate
Amount of air remaining in the lungs after normal passive exhalation; Sum of residual and expiratory volume
Functional Residual Capacity (FRC)
Any difficulty in respiratory rate, regularity, or effort
Dyspnea
Percentage of O2 in exhaled air
Fraction of Inspired O2
Conditions that Impair Lung Function
Breathing, but gas exchange is impaired CO2 levels rise
- Severe cases of atelectasis
- Pneumonia
- Pulmonary edema
- Asthma
- COPD
A device that attaches in the same way as a capnography, but provides a light-emitting diode (LED) readout of the patient’s exhaled CO2
Capnometer
A waveform display of exhaled CO2 shown on a portable cardiac monitor/defibrillator
Waveform Capnography
The ability of alveoli to expand when air is drawn into the lungs, either during negative pressure ventilation/positive pressure ventilation
Lung Compliance
Indication for CPAP
- Alert and able to follow commands
- Moderate/severe signs of respiratory distress
- Respiratory distress after submersion
- Breathing rapid, effecting minute volume
- SPO2 < 90%
Mechanical maintenance of pressure in the airway at the end of expiration to increase the volume of gas in the lungs
Positive End-Expiratory Pressure (PEEP)
Application of posterior pressure to the cricoid cartilage to reduce the risk of gastric distension and regurgitation during positive pressure ventilation; Sellick Maneuver
Cricoid Pressure
Inflation of the stomach with air
Gastric Distension
Difficulty speaking
Dysphonia
Inability to speak
Aphonia
O2 flowmeter commonly used because it is not affected by gravity and can be placed in any position
Bourdon-Gauge Flowmeter
Contraindications for CPAP
- Tracheostomy
- Active GI bleed, nausea/vomiting
- HX of recent GI surgical procedure
- Unresponsive
- Respiratory arrest/agonal respirations
- Unable to speak
- Unable to protect own airway
- Hypoventilation
- Hypotension
- Signs and symptoms of pneumothorax
- Closed head injury
- Facial trauma
- Cardiogenic shock
- Unable to sit up
- Can’t fit CPAP strap
- Cannot tolerate mask
Non-invasive means of raising breathing baseline above ambient pressure via tight-fitting mask:
1. Steins airway
2. Increases residual volume capacity
CPAP
Attaches to the end of the O2 cylinder and reduces the high pressure of gas to a safe range
Therapy Regulator
Automotive space/pocket located between space of tongue and epiglottis
Vallecula
Recurrent large areas of SC edema of sudden onset, seen mainly in young women, frequently result from allergy to drug or food
Angioedema
3 bony shells protrude from the lateral wall of the nasal cavity and extend to the nasal passageway, parallel to the nasal floor; Severe to increase the surface area of the nasal mucosa, improving the process of warming, filtering, humidifying inhaled air
Turbinates
Structures Involved in the Conduction of Air
- Nose
- Pharynx
- Larynx
- Trachea
- Bronchi
- Terminal Bronchioles
Major Functions of the Respiratory System
- Provide passageway for O2 and CO2 to enter and exit body
- Facilitates gas exchange of O2 and CO2 in the body
Mechanical process of moving air in and out of the lungs
Ventilation
Movement of molecules through a membrane from an area of greater concentration to an area of less concentration
Diffusion
Circulation of blood through the capillaries
Perfusion
Exchange of gases between a living organism and its environment
Respiration
Responsible for warming and humidifying air
Upper Airway
Responsible for gas exchange of CO2 and O2
Lower Airway
The volume of air remaining in the lungs after a normal tidal volume expiration
= ERV + RV
Functional Residual Capacity (FRC)
Minimum amount of air that can be inspired after a normal expiration
= TV + IRV
Inspiratory Capacity (IC)
Maximum amount of air that can expire after a maximum inspiratory effort
= TV + ERV
Vital Capacity (VC)
Maximum amount of air contained in lungs after a maximum inspiratory effort
= TV + IRV + ERV + RV
Total Lung Capacity
Amount of air remaining in lungs after a forced expiration
Residual Volume (RV)
Amount of air that can be forcefully exhaled after a normal TV exhalation
Expiratory Reserve Volume (ERV)
Amount of air inhaled or exhaled with each breath under resting conditions
Tidal Volume (TV)
- Covers thoracic wall and superior face of the diaphragm
- Forms lateral walls of mediastinal
Parietal Pleura
Amount of air that can be forcefully inhaled after a normal TV inhalation
Inspiratory Reserve Volume
Covers external lung surface including fissures
Visceral Pleura
Severe constriction of larynx in response to allergy
Laryngospasm
Main supporting cartilage of larynx; A shield-shaped structure formed by 2 plates that join in a “V” shape anteriorly to form laryngeal prominence known as atoms apple
Thyroid Cartilage
Explain Pulmonary Circulation
Blood leaves the right ventricle via the pulmonary artery, pulmonary capillary bed brings RBCs close to terminal bronchioles, and more perfusion at the lung base than apex. After picking up O2, blood returns to the left atrium via pulmonary veins
Explain Normal Ventilation
Inspiration:
- Negative pressure forcing air into the lungs
- Pulls down on diaphragm, causing lungs to fill
- Rib cage moves up
Expiration:
- Positive pressure forcing air out of lungs
- Diaphragm relaxes (moves up), lungs empty
- Rib cage moves down
Reduces ventilation by allowing air to enter the thorax during the inspiratory phase
Sucking Chest Wound
Signs and Symptoms of Increased WOB
- Chest wall retractions
- Soft-tissue retractions
- Nasal flaring
- Trachea tugging
- Paradoxal respiratory movement
- Pulsus Pardoxus
Signs and Symptoms of Obstructive Airway Disease
- Pursed lip breathing
- Increased inspiratory-expiratory (I:E) ratio
- Abdominal muscle use
- JVD
Why could a patient be Hyperventilating?
- Conditions that impair lung function
- Conditions that impair mechanisms of breathing
- Conditions that impair neuromuscular apparatus
- Conditions that reduce respiratory drive
Conditions that Impair Mechanisms of Breathing
- A high cervical fracture
- Flail chest
- Diaphragmatic rupture
- Severe retractions
- Obesity
- Pregnancy
- Abdomen full of air/blood
- Abdominal/chest binding
- Anything that impairs pressure changes that allow breathing
Conditions that Reduce Respiratory Drive
- Opiate overdose
- ETOH intoxication
- Head injury
- Hypoxic drive
- Asphyxia
- Cardiac arrest
Conditions that Impair Neuromuscular Apparatus
- Patients with head trauma
- Intracranial infections
- Brain tumors
- Serious injury to the spinal cord (above C5)
- Guillain-Barré syndrome
Pharmacological agent that stimulates the beta-2 receptor sites (lungs) found in smooth muscle; Includes common bronchodilators like salbutamol
Beta-2 Agonist
Excessive accumulation of fluid in the pleural space
Pleural Effusion
The coughing up of blood
Hemoptysis
A situation in which a portion of the output of the right side of the heart reaches the left side without being oxygenated in the lungs. May be caused by; Atelectis, pulmonary edema
Shunt
A situation where a person’s stimulus to breathe comes from a decrease in PaO2 levels rather than the normal stimulus, a rise in PaO2
Hypoxic Drive
A chronic inflammatory condition affecting the bronchi that is associated with excess mucus production that results from overgrowth of mucous glands in airways
Chronic Bronchitis
Infiltration of any tissue by air or gas; A chronic obstructive pulmonary disease characterized by distension of the alveoli and destructive changes in lung parenchyma
Emphysema
A term used to describe any condition that causes hyperactive bronchioles and bronchospasms
Reactive Airway Disease
1/3 sets of lymphatic organs that comprise the tonsils; Located at the back of the throat, on each side of the posterior opening of the oral cavity; Help protect the body from bacteria introduced into the mouth and nose
Palatine Tonsils
Deep, gasping respirations characterize the person with diabetes who is in ketoacidosis (diabetic coma), with marked hyperpnea and tachypnea
Kussmaul Respirations
A false membrane is formed by a dead tissue layer. Seen in the posterior pharynx of patients with diphtheria
Pseudomembrane
A collection of pus in a sac, formed by necrotic tissue and an accumulation of WBCs
Abscess
A common disease of childhood characterized by a barking cough and wheezing due to inflammation of the larynx and upper airway
Croup
Full of pus
Purulent
A chronic bacteria disease caused by mycobacterium tuberculosis that usually affects the lungs but can also affect other organs (brain or kidneys) characterized by a cough lasting 2-3 weeks, night sweats, headache, weight loss, hemoptysis, chest pain
Tuberculosis (TB)
A coarse, loud-pitched breath sound is heard in patients who have chronic mucous in their membranes
Rhonchus
An outdated term for abnormal breath sounds that have fine, crackling quality, now called crackles
Rales
A type of abnormal breath sound that occurs in addition to normal breath sounds; crackles and wheezes
Adventitious
The numeric percentage of CO2 contained in the last few millimeters of exhaled air
End Tidal Carbono Dioxide (ETCO2)
Vibrations in the chest as the patient breathes
Tactile Fremitus
Visible bulging of jugular veins when the patient is in semi-fowlers or full-fowlers. Indicative of inadequate blood movement through the heart and lungs
Jugular Vein Distension
Severe Constriction of bronchial tree
Bronchospasm
A weakening or loss of palpable pulse during inhalation, characterized by cardiac tamponade and severe asthma
Pulsus paradoxus
Severe SOB occurs at night after several hours of recumbency, during which fluid pools in the lungs; forced to sit up to breathe. Caused by left heart failure or decompensation of COPD
Paroxysmal Nocturnal Dyspnea
Increased urine production by kidney
Diuresis
A protective mechanism that terminates inhalation, preventing over-expansion of lungs
Hering-Bruer Reflex
A disease of unknown aetiology that causes paralysis that progresses from feet to head
Guillain-Barré Syndrome
Heart disease that develops secondary to lungs disease, usually affecting primarily right side of heart
Cor Pulmonale
An overabundance/overproduction of RBCs, resulting in increased viscosity and volume; characteristic of chronic lung disease and chronic hypoxia
Polycythemia
Alveolar collapse that prevents use of that portion of lungs for ventilation and oxygenation
Atelectasis
A proteinaceous substance that lines alveoli; decrease alveolar surface tension and keeps alveoli expanded; in the context of neonatology, low level in premature infant contributes to respiratory distress syndrome
Surfactant
Substance of a gland or solid organ
Parenchyma
Hairlike microtubule projections on the surface of a cell that can move materials over cell’s surface
Cilia
Cells that produce protective mucous lining
Goblet Cells
A portion of the tidal volume does not reach alveoli and doesn’t participate in gas exchange. Includes trachea and larger bronchi; air remaining in these areas is the result of residual gas in the upper airway at the end of inhalation
Anatomic Dead Space
A thin, superficial membrane located between thyroid and cricoid cartilages that is relatively avascular and contains few nerves. Site for emergency surgical/non-surgical advanced airway
Cricothyroid Membrane
Forms lowest portion or larynx
Cricoid Cartilage
Hollow pockets of tissue on the lateral borders of the glottic opening
Piriform Fossa
Pyramid-like cartilaginous structure that forms posterior attachment for vocal cords
Arytenoid Cartilages
The space between vocal cords is the narrowest portion of an adults airway. AKA glottic opening
Glottis
A complex structure composed of many independent cartilage structures that all work together to produce voice; located where upper and lower airways meet
Larynx
Balloon-like clusters of single-layer air sacs that are functional site for the exchange in O2 and CO2 in lungs
Alveoli
RODS
Restricted mouth opening
Obstruction
Distorted airway
Stiff lungs or C-spine
