Respiratory & Airway Flashcards
Ventilation (Key Terms)
The process of air movement into and out of the lungs
Perfusion (Key Terms)
The circulation of blood through the lung tissue
Diffusion (Key Terms)
The process of gas exchange (carbon dioxide and oxygen)
Respiratory Center
Medulla oblongata
Crackles/Rales
Fine, bubbling sound heard on auscultation of the lung. Produced by air entering the distal airways and alveoli that contain serious secretions
Rhonchi
abnormal, coarse, rattling respiratory sounds, usually caused by secretions in the bronchial airways
Stridor
abnormal, high-pitched, usical sound caused by an upper airway obstruction (subglottic)
Wheezing (Lung Sounds)
form of rhonchi, characterized by a high pitched, musical quality. Produced in the lower airways (bronchioles)
Eupnea (Respiratory Patterns)
Normal respirations
Tachypnea (Respiratory Pattern)
increased (fast) respirations
Bradypnea (Respiratory Patterns)
decreased (slow) respirations
Apnea (Respiratory Patterns)
no respirations (not breathing)
Cheyne Stokes (Respiratory Patterns)
abnormal
respirations with regular, periodic breathing with intervals of apnea and a crescendo-decrescendo pattern of respirations
Biot’s (Respiratory Patterns)
abnormal respirations characterized by regular deep inspirations followed by regular or irregular periods of apnea
Apneustic (Respiratory Patterns)
abnormal rapid respirations associated with deep, grasping inspirations - most often associated with stroke or trauma
Kussmaul’s (Respiratory Patterns)
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
Oropharyngeal airway (Airway Adjuncts & Devices)
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)
Nasopharyngeal airway (Airway Adjuncts & Devices)
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
Nasal Cannula (Airway Adjuncts & Devices)
Liters/Minute:1-6
Oxygen Concentration: 24-44%
Nebulizer (Airway Adjuncts & Devices)
Nebulized albuterol, ipratropium, and epinephrine
Liters/Minute: 4-6 (hand-held); 6-8 (mask)
Non-rebreather mask (Airway Adjuncts & Devices)
Liters/Minutes: 12-15
Oxygen Concentration: 80-100%
Bag Valve Mask (Airway Adjuncts & Devices)
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
CPAP (Airway Adjuncts & Devices)
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
Laryngeal mask airway
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
i-gel
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
King LT-D Airway (Supraglottic Airways)
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
Miller Blade
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
Macintosh Blade
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
Stylet
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”
Bougie
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)
Endotracheal Tube
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!
Endotrol
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
BAAM Device
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
