Airway management Flashcards
Concepts (136 cards)
1
Q
Boyles Law
A
As altitude increases, ambient pressure decreases, and therefore,
volume expands
2
Q
Daltons Law
A
States that for a mixture of non-reacting gases, the sum of the partial
pressure of each gas is equal to the total pressure exerted by the
mixture
3
Q
States that at a constant pressure, the volume is directly proportional
to absolute temperature for a fixed mass of gas
A
Charles Law
4
Q
As the temperature decreases, the total volume of a gas in a
container will decrease
A
Charles Law
5
Q
States that for a constant volume, the pressure is directly
proportional to absolute temperature
As the the temperature increases, the temperature applied to a fix
gas cylinder, the pressure increases.
A
Gay-Lussac’s Law
6
Q
States that for a constant temperature, the amount of dissolved gas in a liquid is directly proportional to the partial pressure of that gas
As you increase in altitude, there is less atmospheric pressure
pushing oxygen into the alveoli.
A
Henry’s Law
7
Q
Diving 33 ft equals
A
1 atm.
8
Q
The rate of diffusion of a gas is inversely proportional to the square
root of the mass of its particles
When a gas has a particularly large particle, it will mix more slowly
with other gases, and oozes more slowly from its containers
A
Graham’s Law
9
Q
Condition of the body in which the tissues are starved of
oxygen
A
Hypoxia
10
Q
Not enough oxygen that enters the body
High altitude
Pneumonia
A
Hypoxic hypoxia
11
Q
Blood is not able to carry
oxygen
Anemia
Carbon monoxide poisoning
A
Hypoxiemia or hypemic hypoxia
12
Q
There is not enough blood flow to deliver
sufficient oxygen
Cardiogenic shock
A
Stagnant hypoxia
13
Q
Oxygen is delivered to cells, but the
cells cannot use it
Cyanide toxicity
A
Histotoxic Hypoxia
14
Q
restlessness, irritability, apprehension, tachycardia, and anxiety. Are ____ signs of hypoxia
A
Early signs
15
Q
Late signs include
A
mental status changes, a weak pulse, and cyanosis
16
Q
PaO2. Mild Hypoxia
A
60-79 mmHg
17
Q
PaO2. Moderate Hypoxia
A
40-59 mmHg
18
Q
PaO2.Severe Hypoxia
A
<40 mmHg
19
Q
If you have a PaO2 of 40 you would have what percentage of SpO2
A
70
20
Q
If you have a PaO2 of 50 you would have what percentage of SpO2
A
80
21
Q
If you have a PaO2 of 60 you would have what percentage of SpO2
A
90
22
Q
Oxyhemoglobin
dissociation curve. an increase of ph, low temp or low DPG, shifts curve to the
A
left
23
Q
Oxyhemoglobin
dissociation curve. Oxyhemoglobin
dissociation curve. a low ph, high temp or high DPG, shifts curve to the
A
right
24
Q
You might have good saturation but your not getting it into the tissues. This is related to:
A
Oxyhemoglobin
dissociation curve
25
Alveolar collapse that prevents use of that
portion of the lungs for ventilation and
oxygenation
Atelectasis
26
Oxygenation can be measured by
SpO2 and PaO2
27
Oxygenation is controlled by
FiO2 and PEEP
28
Ventilation is controlled by
Respiratory rate and tidal volume
29
End-Tidal CO2 is controlled by
ventilation
30
Expiration is ______ in duration than inspiration
longer in duration
31
occurs when CO2 production exceeds CO2 elimination
Hypoventilation
32
occurs when carbon dioxide elimination exceeds carbon dioxide production
Hyperventilation
33
Decrease in minute volume _______ CO2 elimination.
decreases
34
Called intrapulmonary shunting
Nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide.
35
The renal system regulates pH by filtering out more hydrogen and retaining bicarbonate when needed, or doing the reverse.
i. Fastest way to eliminate excess H+ ions is to
create water and carbon dioxide.
36
Fastest way to eliminate excess acid is through the
Fastest way to eliminate excess acid is through the
37
To properly manage an airway, perform the following steps in order:
a. Open the airway
b. Clear the airway
c. Assess breathing
d. Provide appropriate intervention(s)
38
Signs of inadequate ventilation:
a. Respiratory rate of fewer than 12 breaths/min or more than 20 breaths/min in the presence of dyspnea
b. Irregular rhythm
c. Diminished, absent, or noisy breath sounds
d. Abdominal breathing
e. Reduced flow of exhaled air at the nose and mouth
f. Unequal or inadequate chest expansion
g. Increased effort of breathing
h. Shallow depth of breathing
i. Pale, cyanotic, cool, moist, or mottled skin
j. Retractions
k. Staccato speech patterns (one- or two-word dyspnea)
39
pulsus paradoxus
characterized by a systolic pressure drop exceeding 10 mm Hg during inspiration, stems from altered mechanical forces affecting cardiac chambers and pulmonary vasculature. Pulsus paradoxus is a manifestation of an underlying disease process rather than a disease state.
40
. Crackles (formerly known as rales)
Occur when airflow causes mucus or fluid in the airways to move in the smaller lower airways
40
protective reflexes of the airway
protective reflexes of the airway
41
Continuous, low-pitched sounds
ii. Indicate mucus or fluid in larger lower airways
Rhonchi
42
Late inspiratory crackles
) Occur when peripheral alveoli and airways pop open
43
Early inspiratory crackles
Usually occur when larger, proximal bronchi open
44
Formed by oxidation of the iron on hemoglobin
Methemoglobin (metHb)
45
Methemoglobin (metHb)
Carboxyhemoglobin (COHb):
46
Peak expiratory flow measurement is
measuring the peak rate of a forceful exhalation
47
. Increasing peak expiratory flow: Suggests patient is
responding to treatment
48
Decreasing peak expiratory flow: Suggests patient’s condition is
deteriorating
49
is the maximal amount of carbon dioxide that leaves the body at the end of exhalation.
a. A normal level is 35 to 45 mm Hg.
ETCO2
50
In a patient in prolonged cardiac arrest, low ETCO2 despite adequate chest compressions indicated
the presence of severe acidosis and minimal CO2 return to the lungs.
51
provides quantitative information, in real time.
a. Displays a numeric reading of exhaled carbon dioxide levels
b. A special adapter attaches between the advanced airway and ventilation devices.
capnometer
52
provides a graphic representation of exhaled carbon dioxide.
capnographer
53
Phase I (A-B): Known as the respiratory baseline, initial stage of exhalation
ii. Phase II (B-C): Expiratory upslope
iii. Phase III (C-D): Expiratory or alveolar plateau
iv. Phase IV (D-E): Inspiratory downstroke
Phase I (A-B): Known as the respiratory baseline, initial stage of exhalation
ii. Phase II (B-C): Expiratory upslope
iii. Phase III (C-D): Expiratory or alveolar plateau
iv. Phase IV (D-E): Inspiratory downstroke
54
Respiratory Rates Adults
12-20
55
Respiratory Rates Children
12-37
56
Respiratory Rates Infants
30-53
57
If the patient is rebreathing previously exhaled carbon dioxide, then ETCO2 values increase, and the waveforms elevate and never return to the baseline at the end of the inspiratory downstroke. Causes include
If the patient is rebreathing previously exhaled carbon dioxide, then ETCO2 values increase, and the waveforms elevate and never return to the baseline at the end of the inspiratory downstroke.
58
Waveforms are small and the ETCO2 value correspondingly low (less than 35 mm Hg).
ii. Tachypnea produces a short alveolar plateau (phase III [C-D]) and shorter-than-normal intervals between waveforms.
This describes what problem in ventilation
Waveforms are small and the ETCO2 value correspondingly low (less than 35 mm Hg).
ii. Tachypnea produces a short alveolar plateau (phase III [C-D]) and shorter-than-normal intervals between waveforms.
59
Waveforms are small and the ETCO2 value correspondingly low (less than 35 mm Hg).
ii. Tachypnea produces a short alveolar plateau (phase III [C-D]) and shorter-than-normal intervals between waveforms.
Waveforms are small and the ETCO2 value correspondingly low (less than 35 mm Hg).
ii. Tachypnea produces a short alveolar plateau (phase III [C-D]) and shorter-than-normal intervals between waveforms.
60
A sudden rase in ETCO2 during cardiac arrest means
ROSC
61
Head tilt-chin lift maneuver. Indications
Indications
(a) Unresponsive patient
(b) No mechanism for cervical spine injury
(c) Patient is unable to protect the airway.
62
Curved, hard plastic device that fits over the back of the tongue Indications: Unresponsive patients who have no gag reflex
Oropharyngeal (oral) airway
63
Other causes of airway obstruction
Tongue
b. Laryngeal edema
c. Laryngeal spasm
d. Trauma
e. Aspiration
64
what position should a patient have if they had facial trauma
semifowlers
65
With Partial tongue obstruction you'll have
Snoring respirations
66
Complete obstruction
No respirations
67
Recognition of an airway obstruction
1. Mild obstruction
Patient is responsive.
b. Able to exchange air
c. Have noisy respirations and may be coughing
d. Should be left alone
i. Forceful cough is the most effective means of dislodging the obstruction.
ii. Attempts to manually remove the object could force it farther down into the airway.
e. Closely monitor the patient’s condition.
f. Be prepared to intervene if you see signs of severe airway obstruction.
68
Recognition of an airway obstruction. Severe obstruction
Sudden inability to breathe, talk, or cough
b. May grasp at the throat
c. May begin to turn cyanotic
d. May make frantic, exaggerated attempts to move air
e. Weak, ineffective, or absent cough
f. Marked respiratory distress
g. Weak inspiratory stridor and cyanosis often present
69
Supplemental oxygen should be administered to any patient with potential hypoxia.
1. Indications:
Respiratory distress
b. Suspected or documented hypoxemia
c. As determined by EMS system protocols
70
A. Nonrebreathing mask
FIO2 delivery
90% and 100%
71
A. Nonrebreathing mask . Indications: S
Spontaneously breathing patients who require high-flow oxygen concentrations and
are breathing adequately
72
A. Nonrebreathing mask Contraindications
Apnea and poor respiratory effort
73
Nasal cannula. . Ineffective with:
Apnea
b. Poor respiratory effort
c. Severe hypoxia
d. Mouth breathing
74
Similar to the nonrebreathing mask but lacks a one-way valve between the mask and the reservoir. Residual exhaled air is mixed in the mask and rebreathed.
Partial rebreathing mask
75
Indications for assisted ventilation:
Depressed mental status
b. Inadequate minute volume
76
signs of potential respiratory failure:
Excessive accessory muscle use
b. Fatigue from labored breathing
77
Bag-mask device. Evaluate the effectiveness of your ventilations if Not adequate:
a) Chest does not rise and fall with each ventilation
(b) Unable to hear breath sounds when auscultating the chest
(c) Rate of ventilation is too slow or too fast
(d) Pulse rate and/or oxygen saturation level do not improve
78
Bag-mask device. If the chest does not rise and fall:
Reposition the head or insert an oral or nasal airway
79
Bag-mask device. If the stomach seems to be rising and falling
reposition the head.
80
Bag-mask device.. If chest still does not rise and fall
check for an airway obstruction.
81
. Functions of CPAP:
Increases pressure in the lungs
b. Opens collapsed alveoli and prevents further alveolar collapse
c. Pushes more oxygen across the alveolar membrane
d. Forces interstitial fluid back into the pulmonary circulation
82
Indications for CPAP
Patient is alert and able to follow commands.
b. Obvious signs of moderate to severe respiratory distress from an underlying disease
c. Respiratory distress after submersion
d. Rapid breathing that affects overall minute volume
e. Pulse oximetry reading less than 90%
3. Always follow local guidelines and protocols.
83
Contraindications to CPAP
General contraindications:
a. Unresponsive or otherwise unable to follow verbal commands
b. Respiratory arrest or agonal respirations
c. Inability to speak
d. Patient is unable to protect his or her own airway.
e. Hypoventilation
f. Hypotension
g. Pneumothorax or chest trauma
h. Closed head injury
i. Facial trauma
j. Cardiogenic shock
k. Tracheostomy
l. Active GI bleeding, nausea, or vomiting
m. History of recent GI surgical procedure
n. Patient is unable to sit up.
o. Inability to properly fit the CPAP system mask and strap
84
Complications of CPAP
Some patients may find CPAP claustrophobic and will resist it.
High volume of pressure generated by CPAP can cause a pneumothorax due to barotrauma.
Increased pressure in the chest cavity can result in hypotension.
a. Not common with lower levels of CPAP, but continuous monitoring of blood pressure is
essential.
4. Air may enter the stomach, which increases risk of aspiration if vomiting occurs.
85
Gastric Distention. Likely to occur when:
a. Excessive pressure is used to inflate the lungs
b. Ventilations are performed too fast or too forcefully
c. Airway is partially obstructed during ventilation attempts
86
Gastric Distention. Signs include:
Increase in the diameter of the stomach
b. Increasingly distended abdomen
c. Increased resistance to bag-mask ventilations
87
Gastric Distention happens what should you do
Reassess and reposition the airway as needed.
b. Observe the chest for adequate rise and fall as you continue ventilating.
c. Limit ventilation times to 1 second or the time needed to produce adequate chest rise.
Invasive gastric decompression
88
A laryngectomy is a surgical procedure in which the larynx is removed. Can you use a BVM?
Can no longer ventilate with a bag-mask device
89
People breathe through a stoma
A laryngectomy
90
People breathe through the stoma and the nose or mouth.
A partial laryngectomy entails surgical removal of a portion of the larynx.
91
Dental appliances. if it fits well.
Leave in place
92
Patients primarily require advanced airway management for two reasons:
Failure to maintain a patent airway
b. Failure to adequately oxygenate and ventilate
93
Mnemonic to guide assessment of the difficult airway
LEMON:
94
Anatomic findings suggestive of a difficult airway may include:
a. Congenital abnormalities (ie, dysmorphic face)
b. Recent surgery
c. Trauma
d. Infection
e. Neoplastic diseases (such as cancer)
95
(a) Short, thick necks
(b) Morbid obesity
(c) Dental conditions, such as an overbite or “buck” teeth
will make intubation
more difficult:
96
Evaluate 3-3-2
First “3” refers to mouth opening.
(a) A width of less than three fingers indicates a potentially difficult airway.
ii. Second “3” refers to mandible length.
(a) At least three fingerbreadths is optimal.
(b) Measure from the tip of the chin to the hyoid bone.
(c) Smaller mandibles:
(1) Have less room for displacement of the tongue and epiglottis
(2) Can make airway management more difficult
iii. “2” refers to the distance from the hyoid bone to the thyroid notch; should be at least two
fingers wide
97
Predicts the relative difficulty of intubation. Notes the oropharyngeal structures visible in an upright, seated patient who is fully
able to open the mouth
. Mallampati
98
LEMON. Note anything that might interfere with visualization or ET tube placement.
(a) Foreign body obstruction
(b) Obesity
(c) Hematoma
(d) Masses
corresponds to
Obstruction
99
Passing an ET tube through the glottic opening and sealing the tube with
a cuff inflated against the tracheal wall
Endotracheal intubation:
100
is the best means of achieving complete control of the airway.
Intubation of the trachea
101
Endotracheal intubation. . Advantages
Secure airway
ii. Protection against aspiration
102
Endotracheal intubation. Disadvantages
Special equipment required
ii. Physiologic functions of the upper airway bypassed
103
Endotracheal intubation. Complications
Bleeding
ii. Hypoxia
iii. Laryngeal swelling
iv. Laryngospasm
v. Vocal cord damage
vi. Mucosal necrosis
vii. Barotrauma
104
ET Tubes range in size.
2.0 to 10.0 mm in inside diameter
12 to 32 cm in length
105
Size ranging ___________ are equipped with a distal cuff that inflates to make an
airtight seal with the tracheal wall.
from 5.0 to 10.0 mm
106
Semirigid wire inserted into the ET tube to mold and maintain the shape of the tube.
Stylet
107
Pediatric patients, ET Tube ranges from
2.5 to 5.0 mm
108
Endotracheal intubation. Anatomic clues can help determine the proper tube size.
Internal diameter of the nostril is a good approximation of the diameter of the glottic
opening.
ii. Diameter of the little finger or the size of the thumbnail is a good approximation of airway size
109
Always have three ET tubes ready.
(1) One you think will be appropriate
(2) One a size larger
(3) One a size smaller
110
Straight laryngoscope blade is
(Miller)
111
Curved laryngoscope blade is
(Macintosh)
112
Tip will extend beneath the epiglottis and lift it up.
(a) Useful with infants and small children, who often have a long, floppy epiglottis
Straight laryngoscope blade
113
Tip is placed in the vallecula.
Less likely to be levered against the teeth by an inexperienced paramedic
ii. Direction of the curve conforms to that of the tongue and pharynx.
. Curved laryngoscope blade
114
Blade size range
For children and adults
Ranges from 0 to 4
0, 1, and 2 are appropriate for infants and children
. 3 and 4 are considered adult sizes.
115
Orotracheal intubation by direct laryngoscopy. Indications
Airway control needed as a result of coma, respiratory arrest, and/or cardiac arrest
ii. Ventilatory support before impending respiratory failure
iii. Prolonged ventilatory support
iv. Traumatic brain injury
v. Unresponsiveness
vi. Impending airway compromise (burns or trauma)
116
Orotracheal intubation by direct laryngoscopy. Contraindications
Intact gag reflex
ii. Inability to open the patient’s mouth because of trauma, dislocation of the jaw, or a
pathologic condition
iii. Inability to see the glottic opening
iv. Copious secretions, vomitus, or blood in the airway
117
Insert the blade into the ________ side of the mouth.
Sweep the tongue gently to the ______ while moving the blade into the midline.
right, left
118
. Used in epiglottis-only views to facilitate intubation
Gum bougie
119
to determine if ET tube migrated, you have to
Note the depth of the ET tube at the patient’s teeth
120
is the first (and most reliable) way to
confirm that the tube has entered the trachea.
Visualizing the ET tube passing between the vocal cords
121
is the next step to
confirm that the tube has entered the trachea.
Auscultation
122
In ET Unequal or absent breath sounds suggest:
(a) Esophageal placement
(b) Main stem bronchus placement
(c) Pneumothorax
(d) Bronchial obstruction
123
Bilaterally absent breath sounds or gurgling over the epigastrium indicates that you have
intubated the esophagus not the trachea.
If copious vomitus is being emitted from the ET tube,
, then do not remove it and instead, inflate the distal cuff, turn the tube to the side, and continue ventilation with
a bag-mask device.
124
Bilaterally absent breath sounds or gurgling over the epigastrium indicates that you have
intubated the esophagus not the trachea.
If vomitus is not being emitted:
remove the tube and resume bag-mask ventilation, Reoxygenate the patient, be prepared to suction the airway as needed, and consider
another intubation attempt.
125
If breath sounds are heard only on the right side of the chest, the tube has likely been
advanced too far, you should
While ventilation continues, slowly retract the tube (deflated cuff) while simultaneously listening for
breath sounds over the left side of the chest.
(d) Stop as soon as bilaterally equal breath sounds are heard.
126
ET. Increased resistance during ventilations may indicate:
(a) Gastric distention
(b) Esophageal intubation
(c) Tension pneumothorax
127
, is the most reliable
method of confirming and monitoring correct placement.
Continuous waveform capnography, in addition to a clinical assessment
128
Ideal time to attach the in-line capnography monitor is
when the bag-mask device is
attached to the ET tube.
129
Nasotracheal intubation. Indications
Indicated for patients who are breathing spontaneously but require definitive airway management
. Responsive patients
ii. Patients with altered mental status and intact gag reflex who are in respiratory failure
because of conditions such as:
(a) COPD
(b) Asthma
(c) Pulmonary edema
130
Nasotracheal intubation. Contraindicated
Apneic patients
(a) Should be orotracheally intubated
ii. Head trauma and possible midface fractures
iii. Anatomic abnormalities or frequent cocaine use
c. Avoid in patients with blood-clotting abnormalities and in patients who take anticoagulation
medications.
131
Nasotracheal intubation. Disadvantage
Blind technique, so major tube confirmation methods cannot be used
132
Failed intubation
Failure to maintain adequate ventilation and oxygenation, regardless of the technique(s) of
airway management being used
133
In the event of a failed airway,
consider a surgical airway, if permitted by local protocol.
134
Tracheobronchial suctioning. If it must be performed:
Use sterile technique.
ii. Monitor cardiac rhythm and oxygen saturation.
135
