ch11 (airway management) Flashcards
1
Q
brain tissue will begin to die ______ without oxygen
A
4 to 6 minutes
2
Q
diffusion
A
molecules move into an area of high concentration to lower concentration
3
Q
airway
A
the upper airway tract or the passage above the larynx (nose, mouth, throat)
4
Q
the diaphragm and intercostal muscles are responsible for….
A
rise and fall of the chest that accompany normal breathing
5
Q
the upper airway includes the:
A
nose
mouth
jaw
oral cavity
pharynx
larynx
6
Q
what is the function of the upper airway?
A
to warm, filter, and humidify air as it enters the body through the nose and mouth
7
Q
nasopharynx
A
keeps dust and other small particles out of the respiratory tract
-warms and humidifies air as it enters the body
8
Q
oropharynx
A
allows air, food and fluid to pass through
9
Q
epiglottis
A
separates the digestive system from the respiratory system
-prevents food and liquid from entering the larynx during swallowing
10
Q
aspiration
A
the introduction of vomit or other foreign material in the lungs
11
Q
larynx
A
marks where the upper airway ends and lower airway begins; voice box
12
Q
glottis
A
space between the vocal chords and the narrowest portion of the adult’s airway
13
Q
vocal chords
A
primary center for speech production; contain defense reflexes that protect the lower airway
-lateral borders of the glottis
14
Q
the function of the lower airway is to…
A
deliver oxygen to the alveoli
15
Q
trachea
A
windpipe
-conduit for air entry into the lungs
16
Q
carina
A
where the trachea divides into the left and right main stem bronchi
17
Q
the lungs consist of…
A
smaller bronchi, bronchioles, and alveoli
18
Q
visceral pleura
A
covers the outer surface of the lung tissue
19
Q
parietal pleura
A
lines the inside of the thoracic cavity
20
Q
bronchioles
A
thin, hollow tubes made of smooth muscle
-branch into alveolar ducts
21
Q
alveoli
A
functional site for the exchange of oxygen and carbon dioxide
-surrounded by pulmonary capillaries
22
Q
describe how oxygen diffuses throughout the body
A
- oxygen diffuses through the lining of the alveoli into the pulmonary capillaries
- from the pulmonary capillaries it is carried back to the heart for distribution throughout the body
- at the same time, carbon dioxide diffuses from the pulmonary capillaries into the alveoli, where it’s exhaled and removed from the body
23
Q
mediastinum
A
-between the lungs; separates the right lung from left lung
24
Q
what is in the mediastinum
A
- heart
- great vessels
- esophagus
- trachea
- major bronchi
- nerves
25
phrenic nerves
found in the thorax
-innervate the diaphragm muscle, allowing it to contract
-necessary for adequate breathing
26
ventilation
act of moving air into and out of the lungs
27
oxygenation
the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream
28
respiration
the actual exchange of oxygen and carbon dioxide in the alveoli and tissues of the body
29
inhalation
the active muscular part of breathing
-diaphragm and intercostal muscles retract (allowing air to enter the body and travel to the lungs)
30
accessory muscles
secondary muscles of respiration
31
partial pressure
the amount of gas in air or dissolved in fluid (blood)
32
tidal volume
amount of air that is moved into or out of the lungs during one breath
33
residual volume
the air that remains in the lungs after maximal expiration
34
alveolar ventilation
volume of air that reaches the alveoli
(dead space air - tidal volume)
35
minute volume
volume of air moved through the lungs in 1 minute
(tidal volume x respiratory rate)
36
alveolar minute volume
volume of air moved through the lungs in 1 minute
(multiply tidal volume - dead space and respiratory rate)
37
vital capacity
the amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible
38
dead space
portion of tidal volume that does not reach alveoli and does not participate in gas exchange
39
exhalation
does not require muscular effort; a passive process
-diaphragm and intercostal muscles relax
40
air will reach the lungs only if...
it travels through the trachea
41
patent
maintaining the airway so air can enter and leave the lungs freely
42
hypoxia
tissues+cells in the body do not get enough oxygen
43
hypoxic drive
secondary control of breathing
-detects drops in the oxygen level in the blood
44
dyspnea
shortness of breath
45
the best time to give a patient oxygen is...
before signs and symptoms of hypoxia appear
46
metabolism
cellular respiration
-cells combines nutrients (sugar) and oxygen and produces energy (ATP) and waste products (water+CO2)
47
external respiration
pulmonary respiration
-gas exchange between lungs and in pulmonary capillaries
48
surfactant
reduces surface tension within the alveoli and keeps them expanded
-makes it easier for gas exchange to occur
49
how much of hemoglobin receptor sites contain oxygen?
96-100%
50
internal respiration
exchange of oxygen and carbon dioxide between the systemic circulatory system and the cells of the body
51
aerobic metabolism
-with oxygen
cells convert glucose into energy
52
anaerobic metabolism
-without oxygen
-cells do not completely convert glucose into energy and lactic acid
-cannot meet the metabolic demands of the cell and they will eventually die
53
chemoreceptors
monitor the levels of oxygen, CO2, hydrogen ions, and pH of CSF provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body's needs at any given time
54
hypercarbia
oxygen levels in the blood DECREASE, carbon dioxide levels INCREASE
55
intrapulmonary shunting
blood enters the lungs from the right side of the heart, bypasses the alveoli, and goes to the left side of the heart in an unoxygenated state
56
hemothorax
a collection of blood in the pleural cavity
57
pneumothorax
accumulation of air/gas in the pleural cavity
58
tension pneumothorax
accumulation of air/gas in the pleural cavity that gradually increases the pressure in the chest and interferes with cardiac function
59
aerosol-generating procedure (AGP)
any airway manipulation that induces the production of aerosols that may present a risk for airborne transmission of pathogens (ex: CPR)
60
bilateral
a body part or condition that appears on both sides of the midline
61
bag-mask device
device with a one-way valve and a face mask attached to a ventilation bag (delivers 90% more supplemental oxygen)
62
labored breathing
working hard to breath, using accessory muscles (chest, back, abdomen)
63
what is the normal respiratory rate in adults?
12-20 breaths/min
64
what is the normal respiratory rate in children?
12-40 breaths/min
65
what is the normal respiratory rate in infants?
30 to 60 breaths/min
66
retractions
movements in which the skin pulls in around the ribs during inspirations
67
agonal gasps
occasional gasping breaths
68
Cheyne-Stokes respirations
irregular respiratory pattern of abnormal breathing that increases and then decreases in rate and depth followed by a period of apnea
69
where are Cheyne-Stokes respirations seen?
in patients with stroke or head injuries
70
apnea
lack of spontaneous breathing
71
ataxic breathing
irregular, ineffective respirations that may or may not have an identifiable pattern
72
Kussmaul respirations
deep rapid respirations (seen in patients with metabolic acidosis)
73
pallor
pale skin (associated with poor perfusion caused by illness or shock)
74
pulse oximetry
measures patient's oxygenation status
75
SpO2
the percentage of hemoglobin molecules that are bound in arterial blood
76
end-tidal CO2
the amount of CO2 present at the end of an exhaled breath
77
capnometry
digital numeric reading of the end-tidal CO2 level
78
capnography
numeric reading+graph of the end tidal CO2 levels from breath to breath
79
what is the normal range of end-tidal CO2?
35-45mmHg
80
head-tilt chin lift maneuver
tilting the patient's head back and lifting the chin
81
jaw thrust maneuver
opens the airway by placing the fingers behind the angle of the jaw and lifting the jaw upward; used for patients with spinal injuries
82
tonsil tips
plastic, rigid pharyngeal suction tip; best for children and infants
83
suction catheter
used to remove fluids from the patient's airway
84
stoma
opening through the skin that goes into an organ or other structure
85
oropharyngeal (oral) airway
1. keeps the tongue from blocking the upper airway
2. make it easier to suction to oropharynx if necessary
86
gag reflex
protective reflex mechanism that prevents food and other particles from entering the airway
87
nasopharyngeal (nasal) airway
used with an unresponsive or patient with an altered LOC, who has an intact gag reflex and is not able to maintain his or her airway spontaneously
88
recovery position
maintain a clear airway in an unconscious patient who is not injured and breathing on their own; lay patient on their side
89
pin-indexing system
system for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas
90
American Standard Safety System
safety system for large cylinders to prevent accidental attachment of a regulatory to a cylinder containing the wrong type of gas
91
oxygen toxicity
damage to cellular tissue due to excessive oxygen levels in the blood
92
nonrebreathing masks
administer high concentrations of oxygen to significantly hypoxemic patients who are otherwise breathing adequately
(provides up to 90% inspired oxygen)
93
nasal cannula
delivers oxygen through two small, tubelike prongs that fit into the patients nostrils
(provides 24-44% inspired oxygen)
94
cardiac output=
stroke volume x heart rate
95
stroke volume
the amount of blood ejected by the ventricle in one cardiac cycle
96
cardiac output
amount of blood ejected by the left ventricle in 1 minute
97
adult ventilation rate
1 breath every 6 seconds
98
child ventilation rate
1 breath every 2-3 seconds
99
infant ventilation rate
1 breath every 2-3 seconds
100
the volume of air delivered to the patient is based on...
chest rise and fall
101
gastric distention
inflation of the stomach with air
102
when does gastric distention occur?
when you ventilate a patient too forcefully or rapidly
103
passive ventilation
air movement into and out of the chest occurs passively from chest compressions
104
automatic transport ventilator (ATV)
ventilation device attached to a control box that allows the variables of ventilation to be set; frees the EMT to perform other tasks while PT is being ventilated
105
compliance
ability of alveoli to expand when air is drawn in during inhalation
106
poor lung compliance
inability of alveoli to fully expand during inhalation
107
positive pressure ventilation
forcing air into the lungs under pressure during inspiration
108
negative pressure ventilation
creates a sub-atmospheric pressure around the chest, drawing air into the lungs
109
continuous positive airway pressure (CPAP)
noninvasive means of providing ventilatory support for patients experiencing respiratory distress; prevents the need for endotracheal intubation
110
tracheostomy
an opening in the neck that connects the trachea directly to the skin
111
mild airway obstruction
able to exchange air but will have varying degrees of respiratory distress; noisy breathing + coughing
112
severe airway obstruction
cannot breathe, talk or cough
113
good air exchange
patient can cough forcefully; may hear wheezing
114
wheezing
whistling sounds during respiration between coughs
115
wheezing is indicative of...
mild lower airway obstruction
116
stridor
high pitched noise heard on inspiration
117
stridor is an indication of...
mild upper airway obstruction
118
endotracheal intubation
inserting a tube into the trachea to maintain and protect the airway
119
preoxygenation
providing oxygen prior to intubation to raise oxygen levels of body tissues
120
apneic oxygenation
oxygen in a high-flow nasal cannula is left in local during an incubation attempt; allowing for continuous oxygen delivery into airways during all phases of the procedure
121
direct laryngoscopy
visualization of the vocal chords with a laryngoscope
122
video laryngoscopy
visualization of the vocal cords using a video camera and monitor
123
gum elastic bougie
flexible device inserted between the glottis under direct laryngoscopy
124
BE MAGIC
B: perform Bag-mask preoxygenation
E: Evaluate for airway difficulties
M: Manipulate the patient
A: Attempt first-pass intubation
GI: use a supraGlottic airway if unable to intubate
C: Confirm successful intubation/Correct any issues
125
esophageal intubation
airway device has been placed into the esophagus rather than into the trachea; causes air being pumped into the stomach and gastric distention
126
barrier device
protective device that limits exposure to patient's body fluids
127
denitrogenation
replacing nitrogen in the lungs with oxygen
