Visceral Pleura and Parietal Pleura
Visceral Pleura: the slippery outer membrane encompassing the lung tissue.
Parietal Pleura: lines the inside of the thoracic cavity.
What is the fluid between the two pleura membranes called?
What nerve stimulates the diaphragm muscle to contract?
Where is the heart located in the thoracic cavity?
Ventilation is the physical action of moving air in and out of the lungs.
Oxygenation is the loading of oxygen molecules onboard the hemoglobin in the bloodstream.
Respiration is the exchange of oxygen (O2) and carbon dioxide (CO2) in the capillaries on the alveoli and other tissues of the body.
What are the two actions of ventilation?
Inhalation and exhalation
Why is it important to create or secure a patent airway for a patient without a gag reflex?
A patient with no gag reflex cannot maintain a patent airway. We must provide a patent airway for oxygenation and possible positive pressure ventilation (PPV) if needed.
There is no difference between internal and external respiration.
Internal respiration occurs at a cellular level for tissues and organs.
External respiration is the initial action of breathing air in, and the gas exchange at the alveolar level.
What is it called when the cells can no longer metabolize the oxygen deprivation?
The ________ is the most common airway obstruction.
If the patient has a suspected spinal injury, it is appropriate to use a jaw-thrust maneuver.
The head-tilt, chin-lift maneuver may complicate any underlying injuries to the cervical spine.
A patient who has adequate breathing will have:
- a normal respiratory rate (12 to 20 breaths/min),
- a regular pattern of inhalation and exhalation,
- lung sounds will be clear and equal bilateral,
- equal chest rise and volume
Your initial impression of the patient is that they present with snoring respirations at a rate of 5 breaths/min, and is unconscious/unresponsive.
Prioritize the steps of airway and ventilation management.
Steps of airway and ventilation management:
1. If there is a suspected spinal injury, open the airway with a jaw-thrust maneuver maintaining c-spine alignment.
2. If no injury is suspected, open the airway with a head-tilt/chin-lift maneuver.
3. Suction as necessary.
4. Size and insert an oral pharyngeal airway, and place the mask of the bag-valve-mas over the patient's mouth and nose.
5. Ventilate while watching for equal chest rise and fall.
Agonal gasps and/or breathing
Agonal gasps/breathing is described as intermittent and inadequate gasps.
The muscles used when the patient is demonstrating labored or difficulty breathing (Dyspnea).
Accessory muscles used during Dypsnea:
- Pectoralis major
What is the breathing pattern called that has irregular pattern(s) with periods of apnea?
The causes of inaccurate pulse oximetry readings
Causes of inaccurate pulse oximetry readings:
- Nail polish
- Carbon monoxide poisoning
- Severe distal vasoconstriction (chronic hypoxia, smoking, hypothermia)
- Dirty fingers/nail beds
Can you think of any more?
Capnography measures end-tidal carbon dioxide (CO2) and provides a numerical reading and graph of CO2 in the patient's respirations.
What is the normal capnography mm Hg reading range?
35 to 45 mm Hg
The types of airway obstruction(s)
- Relaxed tongue
- Foreign bodies (food, objects, dentures)
- Swelling of the airway tissues
Can you think of any more?
What is the concern if we insert the suction catheter too far into the semi-conscious patient's oropharynx?
Stimulation or triggering of the patient's gag reflex, inducing vomiting.
When is inserting an oropharyngeal (OPA) indicated?
In unresponsive patients (breathing or apneic) when their gag reflex is no longer intact.
When measuring the appropriate size of an oropharyngeal airway for placement, we measure from the corner of the mouth to the tip of the earlobe.
The measurement of a nasopharyngeal airway (NPA).
An NPA should be measured from the tip of the patient's nose to the tip of their earlobe.
When providing positive pressure ventilation (PPV), you notice the patient's dentures have come loose. Should you continue to ventilate or remove the dentures and then continue to ventilate?
Remove the dentures. If left loose in the patient's mouth, the dentures have become an airway obstruction.
What type of lubricant is used when preparing a nasopharyngeal airway for insertion?
A water-soluble lubricant
The BVM should be hooked up to 15 LPMs of oxygen (O2).
Upon inhalation, does the diaphragm contract or relax?
When inhaling, the diaphragm will contract to pull downward, drawing air inward.