Airway Management - Pathophysiology of Respiration Flashcards by Kay H

Monitor levels of oxygen, CO2, hydrogen ion concentration, and the pH of the CSF and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time

Chemoreceptors

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Central chemoreceptors are located ___

In the medulla

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Peripheral chemoreceptors are located ___

In the carotid arteries and the aortic arch

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Central chemoreceptors respond quickly to ___

Slight elevations in the CO2 level or a decrease in the pH of the CSF

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Peripheral chemoreceptors are sensitive to ___

Decreased levels of oxygen in arterial blood as well as to low pH levels

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When serum CO2 or hydrogen ion levels increase because of medical or traumatic conditions involving the respiratory system, chemoreceptors ___

Stimulate the medulla to increase the respiratory rate, thus removing more CO2 or acid from the body

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One area in the medulla is responsible for ___. Another area of the medulla is primarily responsible for ___

Initiating inspiration based on the info received from the chemoreceptors
Motor control of the inspiratory and expiratory muscles

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In addition to the medulla, stimulation from the pons affects the ___ of respirations

Rate and depth

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The lung has a functional role of ___

Placing ambient air in proximity to circulating blood to permit gas exchange by simple diffusion

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Ventilation and perfusion must be ___

Matched

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V̇

Ventilation

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Q̇

Perfusion

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When ventilation is compromised but perfusion continues ___

Blood passes over some alveolar membranes without gas exchange taking place. This results in a lack of oxygen diffusing across the membrane and into the bloodstream. CO2 is also not able to diffuse across the membrane into the lungs and is recirculated within the blood stream. This leads to hypoxemia

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What happens with perfusion across the alveolar membrane is disrupted?

Alveoli are filled with oxygen, but disrupted blood flow does not allow for optimal exchange of gases across the membrane. This results in less oxygen absorption in the bloodstream and less CO2 removal. Can lead to hypoxemia

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Thrombus

Blood clot

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Two types of factors that cause airway obstructions

Intrinsic and extrinsic

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Intrinsic factors to airway obstructions

Infections, allergic reactions, and unresponsiveness (tongue obstruction)

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Medications that depress the CNS lower the respiratory ___

Rate and volume

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Increased CO2 level in the blood

Hypercarbia

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Most common airway obstruction in an unresponsive patient

The tongue

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___ are good indicators that the tongue may be obstructing the airway

Snoring respirations and the position of the head or neck

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Patients with allergic reactions not only have a potential airway obstruction from swelling, but may also have a ___

Decrease in pulmonary ventilation from bronchoconstriction

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As the bronchioles constrict, air is ___

Forced through smaller lumens, resulting in decreased ventilation

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Extrinsic factors affecting pulmonary ventilation can include ___

Trauma or foreign body airway obstruction

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Unconscious patients with a fractured mandible may require ___ to maintain an open airway

The insertion of an airway adjunct

Blunt or penetrating trauma and burns can disrupt airflow through the ___, resulting in ___

1. Trachea and into the lungs 2. Oxygenation deficiencies

___ are crucial to the patient's outcome in situations involving extrinsic factors

Proper airway management and high concentrations of oxygen

Result of nonfunctional alveoli

Inhibit the diffusion of oxygen and CO2

Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart

Intrapulmonary shunting

The greater the degree of intrapulmonary shunting, the greater the degree of ___

Hypoxemia

Drowning victims and patients with pulmonary edema have fluid in the ___

Alveoli

Two kinds of factors affecting respiration

Internal and external

When circulation is inadequate, ___ is inadequate to meet the metabolic needs of the body

Perfusion

An accumulation of gas or air in the pleural cavity

Pneumothorax

A collection of blood in the pleural cavity

Hemothorax

An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and that interferes with cardiac function, with potentially fatal results

Tension (simple) pneumothorax

Open pneumothorax

Sucking chest wound

Deficiency in red blood cells

Anemia

An abnormal decrease in circulating volume that causes inadequate oxygen delivery to the body

Hypovolemic shock

Vasodilatory shock is caused by ___

The size of the blood vessels

Poor tissue perfusion leads to ___

Anaerobic metabolism

Wear ___ whenever airway management involves suctioning or an aerosol-generating procedure (AGP)

A mask and protective eyewear that includes eye shields (not glasses)

Any airway manipulation that induces the production of aerosols constitutes and ___

AGP

Wear ___ if conducting an AGP or if the patient has a highly contagious disease

N95 or powered, air-purifying respirator and gown in addition to the normal PPE

Adult respiratory rate range

12 to 20 breaths/min

Child respiratory rate range

12 to 40 breaths/min

Infant respiratory rate range

30 to 60 breaths/min

The respiratory rate of a patient is so important that it should be noted at the beginning of your radio report, after ___

Mental status

Skin pulling in around the ribs or above the clavicles during inspiration

Retractions

Occasional gasping breaths after the heart stopped

Agonal gasps

When assessing a patient with a potential airway compromise, pay particular attention to the ___ environment

External

Conditions such as high altitude and enclosed spaces alter the ___ of oxygen in the environment

Partial pressure

A cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea

Cheyne-Stokes respirations

Cheyne-Stokes respirations are often seen in patients with ___

Stroke and patients with serious head injuries

Lack of spontaneous breathing

Apnea

Irregular, ineffective respirations that may or may not have an identifiable pattern

Ataxic respirations

Patients experiencing a metabolic or toxic disorder may display ___ respirations

Kussmaul

Characterized as deep, rapid respirations commonly seen in patients with metabolic acidosis

Kussmaul respirations

If a patient can speak using only minimal words while at rest is attempting to ___. This is a sign of ___

1. Preserve residual volume in the lungs 2. Inadequate ventilation

Patients with inadequate breathing have inadequate ___

Minute volume

Slow or fast respiratory rate may result in a reduction in ___

Tidal volume and decreased ventilation adequacy

Ventilation issue care includes ___

Supplemental oxygen and ventilatory support

If there is more than one patient with respiratory issues, consider ___

The presence of poisonous or toxic gases or an infections cause such as pneumonia affecting the community

___ are excellent indicators of respiration

LOC and skin color

Pale skin and mucous membranes

Pallor

Pallor is typically associated with ___

Poor perfusion caused by illness or shock

Progression of cyanosis from poor perfusion

1. Peripherally in the fingertips 2. Centrally in the mucous membranes and around the lips 3. Anaerobic metabolism occurs

Skin I marked with blotches of different colors

Mottling

Hemoglobin delivers ___ of the oxygen to the tissues, oxygen dissolved in plasma delivers the other ___

1. 97% 2. 3%

An oxygen saturation of ___ or lower generally requires treatment unless the patient has ___

1. 94% 2. A chronic condition causing perpetually low oxygen saturation levels

In conditions such as stroke or heart attack, oxygen is applied when the Spo2 drops below ___

94%

Pulse oximeters are inaccurate below ___

85%

How long for pulse oximeter to update

Typically as long as 60 seconds

Patient with ___ may not have enough peripheral perfusion to be detected by the pulse oximeter

Significant vasoconstriction or very low perfusion (including decompensated shock and cardiac arrest)

If there is not enough peripheral perfusion for the pulse oximeter in the finger ___

Move it to a more central location such as the bridge of the nose or earlobe

Causes of inaccurate pulse oximeter readings

1. Hypovolemia 2. Anemia 3. Severe peripheral vasoconstriction 4. Time delay in detecting respiratory deficiency 5. Dark or metallic nail polish 6. Dirty fingers 7. CO poisoning

To assess ventilation, you will need to measure ___

Exhaled CO2 levels

Measure of the maximal concentration of CO2 at the end of an exhaled breath

End-tidal CO2

Low end-tidal CO2 could indicate ___

1. Hyperventilation 2. Decreased CO2 return to the lungs because of reduced CO2 production at the cellular level secondary to conditions such as shock or cardiac arrest

When cardiac output increases, end-tidal CO2 levels generally ___

Increase

High end-tidal CO2 could indicate ___

Retaining CO2 secondary to ventilation inadequacy

An absence of end-tidal CO2 could indicate ___

The patient is not breathing at all

Normal range of end-tidal CO2

35 to 45 mm/Hg

Use of capnography

Determine proper placement of an advanced airway, assess a patient's ventilatory status, and avoid inadvertent hyperventilation of patient's with head injuries

Waveform capnography can be used to determine changes in ___

Cardiac output

Waveform capnography provides the first indication of return of ___

Spontaneous circulation after cardiac arrest

ROSC

Return of spontaneous circulation

A normal capnographic waveform has ___ distinct phases

Phases of a normal capnographic waveform

Phase I: Respiratory baseline Phase II: Expiratory upslope Phase III: Alveolar plateau Phase IV: Inspiratory downstroke

The duration of each capnographic waveform corresponds to ___

The duration of ventilation

The space between each capnographic waveform corresponds to ___

The respiratory rate