Airway, Respiration, and Artificial Ventilation Flashcards
(110 cards)
1
Q
Define ventilation. Why is ventilation significant?
A
Ventilation is the moving of air in and out of the lungs. Proper ventilation is required for effective oxygenation and respiration. However, ventilation does not ensure oxygenation. For example, in cases of smoke inhalation and carbon monoxide poisioning, ventilation occured, but not oxyenation.
2
Q
What is inhalation in the respiratory system?
A
Inhalation is the active part of ventilation (energy is required).
3
Q
What happens during inhalation?
A
During inhalation, the diaphragm and intercostal muscles contract, intrathoracic pressure decreases, and a vacuum is created.
4
Q
What happens as the thorax enlarges, pertaining to inhalation?
A
As the thorax enlarges, air passes through the upper airway into the lower airway and finally into the alveoli.
5
Q
What is exhalation in the respiratory system?
A
Exhalation is the passive part of ventilation (energy is not required).
6
Q
What happens during exhalation?
A
During exhalation, the diaphragm and intercostal muscles relax, the thorax decreases in size, and air is compressed out of the lungs.
7
Q
What happens to the intrathoracic pressure, pertaining to exhalation?
A
During exhalation, intrathoracic pressure exceeds atmospheric pressure.
8
Q
Describe the factors that cause an airway obstruction.
A
An airway obstruction is the blockage of an airway structure leading to the alveoli, which will prevent effective ventilation. Causes of an airway obstruction include the tongue (the number one cause of an airway obstruction), fluid, swelling, or foreign bodies.
9
Q
What are the primary methods of controlling oxygen delivery?
A
The need for oxygen can rise or fall based on activity, illness, injury, etc. The primary methods of controlling oxygen delivery are increasing or decreasing the rate of breathing, and increasing or decreasing the tidal volume of breaths.
Tidal volume is the amount of air inhaled or exhaled in one breath.
10
Q
What is hypoxia? Why is hypoxia important?
A
Hypoxia is the inadequate delivery of oxygen to the cells.
11
Q
What are the early indications of hypoxia?
A
Early indications of hypoxia include restlessness, anxiety, irritability, dyspnea, and tachycardia.
12
Q
What are the late indications of hypoxia?
A
Late indications of hypoxia include altered or decreased level of consciousness, severe dyspnea, cyanosis, and bradycardia (especially in pediatric patients).
13
Q
How does the body monitor breathing status? Why is this important?
A
The carbon dioxide drive is the body’s primary system for monitoring breathing status. The body monitors carbon dioxide levels in the blood and cerebrospinal fluid.
14
Q
What is the hypoxic drive? How does the hypoxic drive correlate to chronic obstructive pulmonary disease (COPD) patients?
A
The hypoxic drive is a backup system to the carbon dioxide drive. It monitors oxygen levels in plasma. As a result, the hypoxic drive may be used by end-stage chronic obstructive pulmonary disease patients who have chronically high levels of carbon dioxide.
15
Q
What may occur from prolonged exposure to high concentrations of oxygen in hypoxic-drive patients?
A
Prolonged exposure to high concentrations of oxygen in hypoxic-drive patients may depress spontaneous ventilations.
16
Q
What is oxygenation? Why is oxygenation important in the respiratory system?
A
Oxygenation is the delivery of oxygen to the blood. Oxygenation is required for respiration but does not ensure respiration.
17
Q
What percentage of oxygen does surrounding air contain?
A
Surrounding air contains about 21% oxygen.
18
Q
What percentage of oxygen does expired air contain?
A
Expired air contains about 16% oxygen.
19
Q
What is respiration?
A
Respiration is the exchange of oxygen and carbon dioxide.
20
Q
The heart and brain become irritable due to lack of oxygen.
What are the different stages of brain damage? How long does it take to develop brain damage from lack of oxygen?
A
- Brain damage begins within about 4 minutes.
- Permanent brain damage likely occurs within 6 minutes.
- Irrecoverable brain injury likely occurs within 10 minutes.
21
Q
Assessment of breathing includes looking, listening, and feeling.
What are the components of a respiratory assessment?
A
- Look for chest rise and fall.
- Listen for breathing, ability to speak, and lung sounds.
- Feel for air movement and chest rise and fall.
- Place your ear near the victim’s mouth and nose, and place your hand on the victim’s chest.
22
Q
What are the indications of adequate breathing?
A
Adequate breathing involves normal respiratory rate and rhythm, non-labored breathing, adequate tidal volume, and clear bilateral lung sounds.
23
Q
What are the indications of inadequate breathing?
A
Inadequate breathing involves abnormal respiratory rate or breathing pattern, nasal flaring (enlargement of the nostrils while breathing), abnormal, diminished, or absent lung sounds, paradoxical motion (flail chest segment moves in opposite direction of the thorax), unequal rise and fall of the chest, dyspnea, accessory muscle use, retractions, cyanosis, and agonal respiration (dying gasps), or apnea (no breathing).
24
Q
What is auscultation? What is the correct way to auscultate the lungs?
A
Auscultation is the use of a stethoscope to listen for lung sounds. The top left lung field is compared to the top right lung field. Same for mid- and lower lung fields. Lung sounds are compared side to side, not top to bottom. Auscultation of the lungs should be systematic, including all lobes of the anterior, lateral, and posterior chest. Normal lung sounds are clear and equal bilaterally.
25
What is the proper way to auscultate the lobes of the anterior chest?
Place the stethoscope at the *midclavicular line* (about the second intercostal space). This is about 2 inches below the clavicle but above the nipple line. Auscultate bilaterally (on both sides of the chest). Next, place the stethoscope at the *midaxillary line* (about the fourth intercostal space). This is below the armpit at about the nipple line. Auscultate bilaterally.
26
# Lung sounds are often easier to access or hear on the posterior chest.
What is the proper way to auscultate the lobes of the posterior chest?
Place the stethoscope at about the *midclavicular line* (above and below the scapula bilaterally). Auscultate for lung sounds and equality.
27
What do absent or diminished lung sounds indicate?
Absent or diminished lung sounds indicate little or no air exchange. Wheezing
28
What is wheezing? Where is wheezing auscultated?
*Wheezing* is a high-pitched sound usually heard during exhalation, auscultated in the lower airway. However, inspiratory wheezing is heard over the neck, this indicates a narrowing in the large, upper airways in the neck.
29
What is rales? Where is rales auscultated?
*Rales* is a "wet" or "crackling" sound usually heard during inhalation.
30
What is stridor? Where is stridor auscultated?
*Stridor* is a high-pitched sound indicating partial upper airway obstruction. Stridor is auscultated in the upper airway (neck), not the lower lung fields.
31
Describe pulse oximetry. What is a normal pulse oximetry reading?
Pulse oximetry is onsidered the "sixth vital sign." *Oxygen saturation* is a measure of the amount of oxygen-carrying hemoglobin (red blood cells) in the blood relative to the amount of hemoglobin not carrying oxygen. It does not identify definitively how much oxygen is in the blood, however, it is an indication of respiratory efficiency. Normal oxygen saturation is 98% or above. Below 94% indicates the need for supplemental oxygen.
32
List the limitations of pulse oximetry.
* It is an indication of respiratory efficiency, not confirmation.
* Pulse oximetry cannot measure the amount of heomglobin only the oxygen saturation of the hemoglobin that is present.
* A measurement may be difficult to obtain on some patients due to hypovolemia, hypothermia, anemia, nail polish, or carbon monoxide poisoning.
* Pulse oximetry cannot distinguish between oxygen saturation and carbon monoxide saturation.
* There can be a time delay between the patient's pulse oximeter readingand the patient's current respiratory status.
33
What are the indications for head tilt-chin lift airway technique?
Indications for head tilt-chin lift airway technique includes patients with altered or decreased level of consciousness, patients with suspected airway obstruction, and patients requiring suction.
34
What is a contraindication for head tilt-chin lift airway technique?
The head tilt-chin lift airway technique is contraindicated if there is suspected cervical-spine (c-spine) injury.
35
What are the indications for jaw-thrust airway technique?
Indications for jaw-thrust airway technique includes patients with altered or decreased level of consciousness and suspected c-spine injury.
36
What are the contraindications for jaw-thrust airway technique?
The jaw-thrust airway technique is contraindicated if the patient is conscious.
37
What is an oropharyngeal airway (OPA) adjunct used for?
An *oropharyngeal airway adjunct* is used to prevent the tongue from obstructing the airway. Failure to size or insert the oropharyngeal airwway correctly can cause the tongue to block the airway.
38
What is an indication to the use of an oropharyngeal airway (OPA) adjunt?
An *oropharyngeal airway adjunct* can only be used on an unresponsive patient without a gag reflex.
39
What is a contraindication to the use of an oropharyngeal airway (OPA) adjunct?
An *oropharyngeal airway adjunct* cannot be used on a conscious patient or any patient with an intact gag reflex.
40
Explain how to properly size an oropharyngeal airway (OPA) adjunct.
Measure from the corner of the mouth to the earlobe. The *oropharyngeal airway adjunct* should be positioned during measuremet as it will reside upon insertion.
41
# Remove oropharyngeal airway immediately if the patient gags.
Explain how to properly insert an oropharyngeal airway (OPA) adjunct in an adult patient.
* Manually open the airway and suction as needed.
* Insert the oropharyngeal airway adjunct upside down with the distal end pointing toward the roof of the mouth.
* Rotate 180 degrees while advancing the oropharyngeal airway adjunct until flange (flat proximal portion) rests on the patient's lips.
| Always have suction available.
42
# Remove oropharyngeal airway adjunct immediately if the patient gags.
Explain how to properly insert an oropharyngeal airway (OPA) adjunct in a pediatric patient.
* Manually open the airway and suction as needed.
* Depress tongue with a tongue depressor and insert directly (without rotating), or insert oropharyngeal airway sideways adjunct and rotate 90 degrees until flange (flat proximal portion) rests on the lips.
| Always have suction available.
43
What is a nasopharyngeal airway (NPA) adjunct used for?
A *nasopharyngeal airway adjunct* is used to prevent the tongue from obstructing the airway in patients who may not be able to protect their own airway.
44
What are the indications to the use of a nasopharyngeal airway (NPA) adjunct?
A *nasopharyngeal airway adjunct* can only be used on a patient without a gag reflex, a patient with a deacreased level of consciousness, but with an intact gag reflex preventing the use of the oropharyngral airway adjunt.
45
What are the contraindications to the use of a nasopharyngeal airway (NPA) adjunct?
A *nasopharyngeal airway adjunct* cannot be used on a conscious patient with an intact gag reflex capable of protecting their own airway, a patient with severe head injury or facial trauma, a patient with resistance to insertion in both nostrils, and patients typically under one year of age.
46
Explain how to properly size a nasopharyngeal airway (NPA) adjunct.
Measure from the tip of the nose to the earlobe. The nasopharyngeal airway adjunt should be positioned during measurement as it will reside upon insertion.
47
# Remove nasopharyngeal airway adjunct immediately if the patient gags.
Explain how to properly insert a nasopharyngeal airway (NPA) adjunct in an adult patient.
* Lubricate the nasopharyngeal airway adjunct with a water-soluble lubricant prior to insertion. Do **not** use petroleum-based products.
* Always insert the nasopharyngeal airway adjunct with bevel toward the septum.
* Try larger nostril first. Switch if resistance is met. If resistance is met upon insertions in both nostrils, discontinue use.
* Advance gently, rotating as necessary, until flange (flat proximal portion) rests against the nostril. Do **not** force the nasopharyngeal airway adjunct.
| Always have suction available.
48
What is aspiration? Why is aspiration detrimental to a patient?
*Aspiration* is the inhalation of saliva, food, liquid, vomit, and even small foreign objects into the respiratory tract. In other words, the entry of matter into the lungs. This drastically increases the risk of death.
49
What are the indications for suction use?
*Suction* is indicated if there are secretions (blood, vomit, mucus, oral secreations, etc.) in the airway that could be aspirated, obstruct the airway, or interfere with ventilations or insertion of a mechanical airway adjunct. Larger substances that cannot be suctioned (debris, foreign bodies, teeth, undigested food, etc.) should be removed manually. Suction should generally be performed after the airway is opened manually and before insertion of a mechanical airway adjunct.
50
What is a suction unit?
All suction units should have a disposable suction canister. Portable and fixed suction units should be able to generate a vacuum of 300 mmHg when tubing is clamped.
51
What is the difference between a portable suction and a fixed suction?
A *portable suction* can be carried to the patient and a *fixed suction* is a suction unit permanently mounted in vehicle, hospital, etc.
52
What is a hand-powered suction?
A *hand-powered suction* is a manually powered portable suction unit.
53
What is a suction catheter?
A suction catheter attaches to the suction unit ans is inserted into the patient's airway to remove secretions. Suction catheters, tubing, and disposable canisters are all single-patient use only.
54
What is a rigid suction catheter?
A *rigid suction catheter* is also referred to as a "tonsil tip" or Yankauer. It is best suited for suctioning the oral airway.
55
What is a french suction catheter?
A *french suction catheter* is also known as a whistle-tip, a flexible catheter that comes in several sized. It is best suited for suctioning the nose, stoma, or the inside of an advanced airway device.
56
Describe suction procedures.
Suctioning increases the risk of hypoxia. Suction time cannot exceed 15 seconds for adults, 10 seconds for pediatric patients, and 5 seconds for infants. Insert rigid suction catheter only as far as you can see. For French catheter, measure from corner of the mouth to the earlobe. Apply suction upon withdrawl of the catheter. Rinse the suction catheter and tubing with water after use to reduce risk of obstruction.
57
What is the goal of supplemental oxygen?
The goal os supplemental oxygen is to maintain a pulse oximetry reading of at least 94%.
58
What are the indications for supplemental oxygen use?
A patient in cardiac arrest, a patient receiving artificial ventilation, a patient with suspected hypoxia, a patient with signs of shock (hypoperfusion), a patient with a pulse oximetry reading below 94%, a patient with a medical condition or traumatic injury that may benefit from supplemental oxygen, a patient with an altered or decreased level of consciousness.
59
What is a contraindication for supplemental oxygen use?
The only contraindication for supplemental oxygen use is an unsafe environment.
60
List the different types of oxygen cylinders and their respective capacities.
* D cylinder: about 350-liter capacity
* E cylinder: about 625-liter capacity
* M cylinder: about 3,000-liter capacity
* G cylinder: about 5,000-liter capacity
* H cylinder: about 7,000-liter capacity
61
Oxygen cylinders should never be left standing unattended. The pin indexing system is a safety feature that prevents a carbon dioxide cylinder from being connected to an oxygen regulator.
62
How is the amount of oxygen in a cylinder measured?
The amount of oxygen in a cylinder is measured in pounds per square inch (psi). A full cylinder is about 2,000 psi. The cylinder should be taken out of service and refiled if below 200 psi.
63
Flow meters are connected to pressure regulators. In combination, they reduce the pressure coming from the tank to safe levels and allow a specific flow rate. The flow rate is measured in liters per minute (lpm or L/min).
64
A *non-rebreather mask* is a device used to assist in the delivery of oxygen therapy, referred to as "high-flow" oxygen administration, 10- 15 lpm, delivers 90% oxygen. A non-rebreather mask requires that the patient can breathe unassisted, but unlike the "low-flow" nasal cannula, the non-rebreather allows for the deliver of higher concentrations of oxygen.
65
What precautions are taken with a non-rebreather mask?
* The reservoir must be full before applying mask to patient.
* Never administer less than 10 lpm.
* If the reservoir completely deflates during inhalation, the flow rate must be increased.
* Immediately remove mask if oxygen source is lost.
66
A *nasal cannula* is referred to as "low-flow" oxygen administration, 1 to 6 lpm, delivers 24% to 44% oxygen. The nasal cannula delivers about 4% per liter. Prolonged use can dry and irritate nasal passages if oxygen is not humidified.
67
The *simple face mask* is similar to a non-rebreather, but without the oxygen reservoir, 6 to 10 lpm, delivers 40% to 60% oxygen.
68
A *venturi mask* is a mask that delivers precise concentration of "low-flow" oxygen.
69
A *tracheostomy* is a surgical procedure that creates an opening through the neck into the trachea. Patients with a tracheostomy ventilate through their stoma, not the mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask (not common in the pre-hospital environment) or a non-rebreather mask.
70
*Humidification* of oxygen increses the moisture of supplemental oxygen by flowing it throguh water prior to inhalation by the patient.
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Hazards of oxygen administration.
* Oxygen supports combustion, high concentrations of oxygen accelerate combustion.
* Oxygen cylinders contain a highly compressed gas and should be treated with great caution.
* Never leave an oxygen cylinder standing unattended.
* The alveoli can collapse due to long-term exposure to high concentrations of oxygen.
* Respiratory depression is a risk for chronic obstrutive pulmonary disease patients on the hypoxic drive. However, it typically requires long-term exposure to high-concentration oxygen.
72
*Assisted ventilation,* also called artificial ventilation or positive pressure ventilation (PPV) includes, mouth to mask, flow-restricted, oxygen-powered ventilation device and automatic transport ventilators, bag valve mask (BVM), and mouth to mouth (continuous positive airway pressure device, used in special circumstances).
73
What are the indications for artificial ventilation use?
Artificial ventilations are indicated for any patient with inadequate spontaneous breathing leading to severe respiratory distress or respiratory failure. Patients will demonstrate one of the following: apnea, agonal breaths, bradypnea, tachypnea, hypoventilation.
74
What can cause severe respiratory distress or respiratory failure?
Central nervous system injury, disease, or impairment, foreign-body airway obstruction, chest trauma, such as a flail chest or sucking chest wound, increased airway resisance due to bronchoconstriction, pulmonary edema, or inflammation.
75
Define apnea.
*Apnea* refers to no spontaneous breathing.
76
Define agonal breaths.
*Agonal breaths* are shallow, ineffective gasps.
77
Define bradypnea.
*Bradypnea* refers to slow breathing.
78
Define tachypnea.
*Tachypnea* refers to fast breathing.
79
Define hypoventilation.
*Hypoventilation* is breathing at an abnormally slow rate, resulting in an increased amount of carbon dioxide in the blood.
80
Define hyperventilation.
*Hyperventilation* is rapid or deep breathing, usually caused by anxiety or panic. The act of hyperventilating a patient occurs when ventilations are provided too fast, too deep, or both.
81
Consider providing artificial ventilations for any patient breathing less than 8 times per minute.
82
Consider providing artificial ventilations for any adult patient breathing more than 24 times per minute.
83
Any unresponsive patient receiving artificial ventilations should have an airway adjunct in place to prevent the tongue from obstructing the airway.
84
What is the difference between spontaneous breathing and artificial ventilations?
Normal spontaneous breathing is done through negative pressure and artificial ventilations are accomplished through positive pressure ventilations.
85
What are the complications of positive pressure ventilations (PPV)?
Complications of positive pressure ventilations include, increased intrathoracic pressure, which reduces circulatory efficiency, and gastric distention, which increases the risk of vomiting and can compromise ventilatory efficiency.
86
What are the risks of hyperventilation?
Risks of hyperventilation include circulatory and ventilatory compromise, gastric distention due to esophageal opening, vomiting and aspiration, and barotrauma (such as pneomothorax).
87
What are the appropriate rates and volumes of artificial ventilations?
The best way to determine appropriate tidal volume is rise and fall of the chest. Artificial ventilations should cause gentle chest rise and fall. It should take at least 1 second to inflate the chest.
88
What are the correct rates of artificial ventilation for apneic patients with a pulse?
* Adults: one breath every 5 to 6 seconds (10 to 12 times per minute).
* Infants and children: one breath every 3 to 5 seconds (12 to 20 times per minute).
* Neonates: one breath every 1 to 1 1/2 seconds (40 to 60 times per minute).
89
What is the correct compression to ventilaton ratio for an adult patient in cardiac arrest?
30 compressions: 2 breaths
90
What is the correct compression to ventilaton ratio for a child or infant patient in cardiac arrest?
15 compressions: 2 breaths
91
What is the correct compression to ventilaton ratio for a neonate patient in cardiac arrest?
3 compressions: 1 breath
92
It is not necessary to pause compressions for ventilatns once an advanced airway has been placed. For patients in cardiac arrest with an advanced airway, provide one breath every 6 to 8 seconds (8 to 10 breaths per minute).
93
What is a barrier device? What are the advantages of having a barrier device?
A *barrier device* is a personal protective equipment used during artificial ventilations to protect the rescuer from exposure to infection when in close contact with victims. It is safer than mouth-to-mouth when used with a one-way valve.
94
What is a bag valve mask (BVM) device?
A *bag valve mask device* is a handheld tool that is used to deliver positive pressure ventilation to any subject with insufficient or ineffective breaths. It consists of a self-inflating bag, one-way valve, mask, and an oxygen reservoir.
95
What is an advantage of using a bag valve mask device?
When used effectively with supplemental oxygen at about 15 lpm, the patient receives nearly 100% oxygen.
96
What is a disadvantage of using a bag valve mask device?
Single rescuers typically deliver less tidal volume with the bag valve mask device than with a barrier device.
97
* Adult BVM: 1,200 to 1,600 mL
* Child BVM: 500 to 700 mL
* Infant BVM: 150 to 240 mL
98
The "EC-clamp" technique is recommended for single-rescuer bag valve mask device usage. Thumb and index finger make a "C" around the mask. The remaining three fingers form an "E" and are placed along the angle of the jaw.
99
* One rescuer uses both hands to control the mask seal. This makes it considerably easier to maintain a good seal during ventilations.
* The other rescuer uses oth hands to squeeze the bag. This makes it considerably easier to ventilate slowly, control tidal volume, and reduce gastric distention.
100
What is continuous positive airway pressure (CPAP)?
*Continuous positive airway pressure* is used to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress. It is often used for patients with sleep apnea, chronic obstructive pulonary disease, and pulmonary edema.
101
What are the indications for continuous positive airway pressure (CPAP)?
The indications for continuous positive airway pressure include conscious patients in moderate to severe respiratory distress, tachypnic patients with reduced respiratory efficiency, and a pulse oximetry reading below 90%.
102
What are the contraindications for continuous positive airway pressure (CPAP)?
The contraindications for continuous positive airway pressure include apneic patients or patients unable to follow verbal commands, chest trauma, suspected pneumothorax, or patients with a tracheostomy, vomiting or suspected gastrointestinal bleeding, and hypotension.
103
The pediatric head is larger in proportion to the body. Padding should be placed behind the shoulders in a supine patient to maintain alignment of the airway.
104
Tidal volume provided during artificial ventilations is reduced. The risk of gastric distention, vomiting, and barotraumas is higher due to hyperventilation during artificial ventilations.
105
Infants and children have less oxygen reserves and a higher metabolic rate than adults. Bradycardia is common in pediatric patients experiencing significant hypoxia. Always assume a bradycardic infant or child is hypoic and support oxygentatio and ventilations aggresively. Airway and respiratory problems are the primary cause of circulatory collapse.
106
What are signs of respiratory failure in pediatric patients?
Signs of repiratory failure in pediatric patients include, bradycardia and poor muscle tone, altered level of consciousness, head bobbing and grunting on exhalation, and seesaw breathing (chest and abdomen moving in opposition).
107
Explain the process of ventilating a patient with a tracheostomy tube or stoma.
The bag valve mask device will connect diectly to a tracheostomy tube. To ventilate a patient with a stoma and
108
What is the number one cause of airway obstruction?
The *tongue* is the number one cause of airway obstruction. However, foreign bodies such as vomit, food, latex balloons, and toys can also obstruct the airway.
109
* For conscious adults and children, administer conscious abdominal thrusts until the obstruction is relieved or until the patient loses consciousness.
* For conscious infants, administer a series of five back blows and five chest thrusts until the obstruction is relieved or until the patient loses consciousness.
* For unconscious patients (all ages) initiate cardiopulmonary resuscitation, inspect and remove visible foreign bodies before attempting ventilations.
110
Dentures are often secured in place and can be left alone. If dentures are loose, they should be removed.
