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PRIMARY CARE PARAMEDIC 2021/22 > EMER 112 Respiratory Care > Flashcards

EMER 112 Respiratory Care Flashcards

1
Q

Proper ventilation is necessary because

A

provide adequate oxygen to the blood stream and to remove carbon dioxide increasing the amount of available oxygen ensures that even a patient who is not moving adequate volumes of gas (hypoventilation) can still maintain adequate oxygen saturation

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2
Q

negative pressure vacuum effect

A

the expansion of the chest and downward movement of the diaphragm create negative pressure in the thorax areas pull through the mouth and the nose and is sucked into the trachea

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3
Q

negative pressure vacuum effect occurs because

A

the thorax is essentially an airtight box with a flexible diaphragm at the bottom and an open tube at the top which air is sucked into and fills the increasing space inside the thorax

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4
Q

sucking chest wound

A

holes in the thorax provides a place for air to be sucked in

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5
Q

When multiple ribs are broken in more than one place

A

causing a flail chest free-floating sections of the thorax get pulled in when you breathe limiting the amount of air that can be sucked into the trachea

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6
Q

Retraction

A

or in drawing of the intercostals in ribs when airflow is restricted by disease processes exhibited by infants and small children

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7
Q

what happens When you ventilate someone with positive pressure

A

air is forced into the upper airway and flows into both the trachea and esophagus unless steps are taken to help direct it into the trachea

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8
Q

Exhalation is normally a what kind of process

A

Exhalation is normally a passive process

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9
Q

exhalation is no longer passive process when

A

When a patient has trouble exhaling they may need to use a domino muscles to push air out when this occurs exhalation is no longer passive process and indicates obstructive disease

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10
Q

Difficulty in inhalation may indicate

A

upper airway obstruction

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11
Q

Four parts of the brain responsible for

A

the smooth rhythmic respirations one area helps control rate, another depth, another inspiratory pause, another rhythmicity Most of these respiratory centres are in and around the brain stem

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12
Q

Apneustic breathing

A

results from damage to the apneustic center in the brain which regulates inspiratory pause A patient exhibiting apneustic respirations will have a short, brisk inhalation with a long pause before exhalation which is indicative of severe pressure within the cranium or direct trauma to the brain

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13
Q

Biot respirations

A

are seen when the center that controls breathing rhythm is damaged Grossly irregular sometimes with lengthy apneic periods

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14
Q

Cheyne stroke respirations

A

are a high brain function Deep sleepers and intoxicated peoplewill exhibit this type of respiratory pattern The depth of breathing gradually increases then decreases followed by an apneic period Exaggerated Cheyne stroke respirations may be seen in patients who have a severe brain injury the apneic period may last 30 to 60 secs

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15
Q

Hering-breuer reflex

A

limits inspiration and may cause coughing if you take too deep a breath

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16
Q

Agonal respirations

A

irregular gasps that are a few and far between usually represent strain or logical impulses in the dying patient it’s not unusual for patients who are pulseless to have an occasional agonal gasp

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17
Q

Ataxic respirations

A

completely irregular respirations that indicates severe brain injury or brainstem herniation

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18
Q

Bradypnea

A

unusually slow respirations

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19
Q

Central neurogenic hyperventilation

A

rapid and deep respirations caused by increased intercranial pressure or direct Brain Injury drives CO2 levels down and pH levels up resulting in respiratory alkalosis

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20
Q

Hypernea

A

unusually deep breathing seen in various neurological or chemical disorders certain drugs may stimulate this type of breathing in patients who have overdosed it does not reflect respiratory rate only respiratory depth

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21
Q

Hypopnea

A

unusually shallow respirations

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22
Q

Kussmaul respirations

A

the same pattern as central neurogenic hyperventilation but caused by the body’s response to metabolic acidosis the body is trying to rid itself of blood at the tone via the lungs these are seen in patients who have diabetic keto acidosis and are accompanied by a fruity breath odour the mouth and lips are usually cracked and dry

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23
Q

Respiration

A

is the process by which oxygen is taken into the body distributed to the cells and used by the cells to make energy it takes place in each cell The primary by product of this process is carbon dioxide the respiratory system is involved in the delivery of the oxygen to the blood stream and the removal of waste carbon dioxide from the body

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24
Q

When the lungs are not working adequately carbon dioxide is not efficiently disposed of and accumulates in the blood

A

this combines with water to form bicarbonate ions and hydrogen ions also known as acid resulting in acidosis

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25
Q

Hyperventilation

A

the person breathe faster or deeper than normal and blows off more carbon dioxide than usual resulting in alkalosis

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26
Q

Anxiety

A

can be an early sign of hypoxia while confusion, lethargy and coma or typically later signs

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27
Q

Dizziness and tingling extremities

A

could signify hyperventilation

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28
Q

Injury high in the spinal cord

A

may paralyze the intercostal muscles and even the diaphragm resulting in the inability of respiratory muscles to function normally in response to the respiratory drive

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29
Q

Bodies immediate response to hypoxaemia

A

is to increase the heart rate to deliver a higher volume of blood to tissues to compensate for lower blood oxygen levels

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30
Q

Severe hypoxia often causes

A

bradycardia

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31
Q

Orthopnea

A

shortness of breath

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32
Q

Renal status

A

Fluid balance, acid base balance and blood pressure are controlled by the kidneys Each of these factors also affects of pulmonary mechanics and hence the delivery of oxygen to tissues patients with severe renal disease often present with a respiratory signs and symptoms so you should always note signs of severe renal disease when evaluating the condition of the patient

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33
Q

The classic presentation of a patient with emphysema

A

(pink puffer) includes a barrel chest, muscle wasting and pursed lip breathing search patients are often tachypneic and do not typically present with profound hypoxia and cyanosis

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34
Q

Patients who have chronic bronchitis tend to be

A

more stationary and may be obese these patients are often encountered in a chair or recliner they may be surrounded by cups full of mucus, inhalers, several medication’s

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35
Q

A spontaneous pneumothorax tends to occur in

A

tall, thin young adults and women who smoke and take birth control pills or predisposed to pulmonary embolus

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36
Q

Tripod position

A

involves leaning forward and rotating the scapula outward by placing the arms on a table or by placing the hands on my knees the stabilizes the shoulder girdle improves efficiency of accessory breathing muscles and decreases the total with a breathing

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37
Q

Purposeful hyperextension

A

occurs when a patient maximize airflow through the upper airway

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38
Q

Head tilt chin lift or sniffing position

A

This position may indicate upper airway swelling but is also commonly seen in patients who are trying to maximize airflow maintaining this position uses a valuable energy

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39
Q

head bobbing

A

A patient who is severely ill with respiratory disease begins to feel fatigue here she may hold her head up in the sniffing position during inhalation letting it fall during exhalation this head bobbing is very ominous sign signalling potential eminent decompensation

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40
Q

Chest wall retractions

A

these are most common in infants and small children with a rigid structure of the thorax is still flexible on an elation the child may pull the sternum and ribs into the chest causing a visible deformity with each breath

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41
Q

Soft tissue retractions

A

in most patients the bones are rigid and do not move but the soft tissue is pulled in around the bones

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42
Q

Tracheal tugging

A

the thyroid cartilage is pulled upward and the area just above the sternal notch is sucked in word with inhalation

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43
Q

Pyridoxal respiratory movement

A

the epigastrium is pulled in with inhalation while the abdomen pushes out creating a seesaw appearance as the two move in opposing directions

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44
Q

Pulses paradoxus

A

profound intrathoracic pressure changes caused the peripheral pulses to weaken on inspiration these pulses are easier to palpate during exhalation

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45
Q

Minute volume

A

respiratory rate X tidal volume

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46
Q

decline in PAO2

A

hypoxaemia will manifest initially as restlessness, confusion and in worst case scenario is a combative behaviour

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47
Q

increase in PaCO2

A

usually has sedative effects making the patient sleepy

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48
Q

Healthy adults have a haemoglobin level of

A

120 to 140 g/L

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49
Q

healthy persons will begin to exhibit the blue discolouration of cyanosis one about

A

50 g/L is desaturated meaning their oxygen saturation would be roughly 65%

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50
Q

Chocolate brown skin:

A

high levels of methemoglobin derive from nitrates in some toxic exposures may turn the mucous membranes brown This transformation is typically more evident in the patient’s venous blood then in the skin and mucous membranes

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51
Q

Hepatojugular reflux

A

occurs when mild pressure in the patient’s liver causes the jugular vein’s to engorge further this is a specific sign of right heart failure When a patient is in respiratory distress and they’re sitting up in a semi Fowler 45° position it is easy to check for hepatojugular reflux

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52
Q

Tracheal deviation is a classic sign of

A

tension pneumothorax

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53
Q

Tracheal breath sounds

A

are not commonly auscultated but know how harsh and tubular they sound

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54
Q

bronchial breath sounds

A

are also quite loud but no the exhalation predominates

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55
Q

peripheral bronchialvascular sounds

A

are softer and have equal inspiratory and expiratory sides

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56
Q

Sound moves better through

A

fluid than air

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57
Q

The breath sounds of a patient who has one sided pathological condition will sound

A

louder over the side with abnormality then they will over the healthy side

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58
Q

Managing patients with dyspnea

A

Supportive prehospital care, ensure airy adequacy, administer high concentration supplemental oxygen therapy and provide monitoring and transport for patients Treatment of bronchoconstriction with bronchodilators

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59
Q

Rehydration

A

is supplemental therapy for patients with respiratory problems who are dehydrated Always assess breath sounds before an after giving a fluid bolus to make certain you do not have volume overload

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60
Q

circulation potential common signs of anaphylaxis

A

Tachycardia, hypertension and shock

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61
Q

IV access anaphylaxis

A

IV access is important because the anaphylactic patient will need fluid replacement anaphylaxis causes leakage of fluid into tissues necessitating administration of large amounts of IV fluid

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62
Q

Puritis

A

itching

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63
Q

what does epinephrine do for anaphylaxis

A

vasoconstriction, improvement of cardiac contractility, bronchodilation and suspension of the release of histamine

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64
Q

If the patient is on a beta blocker and needs epilepsy

A

they may not be a good response Epnephrine so give glucagon

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65
Q

Tracheobronchial suctioning

A

Involves passing a suction catheter into the tracheal tube to remove pulmonary secretionsMonitor patient’s cardiac rhythm and oxygen saturation during the procedure

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66
Q

what can Tracheobronchial suctioning cause

A

cause cardiac dysrhythmias

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67
Q

Follow these steps for performing tracheobronchial suctioning as an in-line suction device:

A

Use routine precautions and wear PPE Check prepare and assemble your equipment Connect section to the in-line suction catheter Pre-oxygenate the patient Gently advance the in-line suction catheter down the tracheal tube until resistance is felt Action in a rotating motion while withdrawing the catheter into the side arm of the in-line device. Monitor patient’s cardiac rhythm and oxygen saturation during the procedure Resume ventilation and oxygenation

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68
Q

Causes of airway obstructions

A

the tongue laryngeal edema, laryngeal spasm, trauma and aspiration

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69
Q

Laryngeal spasm

A

Results in spasmodic closure of the vocal cords completely including the airway it is often caused by trauma during aggressive intubation relieved by positive pressure ventilation using a bag mask

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70
Q

Laryngeal edema

A

causes the glottic opening to become extremely narrow or totally close conditions that commonly causes problems include laryngeal trauma, epiglottis, anaphylaxis or inhalation injury relieved by positive pressure ventilation using a bag mask

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71
Q

Laryngeal injury

A

Airway patency depends on good muscle tone to keep the trachea open Fracture of the larynx increases airway resistance by decreasing airway size secondary to decreased muscle tone, laryngeal oedema and Ventilatory effort

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72
Q

Emergency medical care for foreign body airway obstruction

A

Manage any unresponsive person as if he or she has a compromised airway open and maintain the airway with appropriate manual maneuver assessed for breathing and provide artificial ventilation if necessary If after opening the airway you are unable to ventilate the patient will you feel resistance when ventilating re-open the airway and attempt to ventilate the patient

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73
Q

lung compliance

A

is the ability of the alveoli to expand when air is drawn into the lungs either during negative pressure ventilation or positive pressure ventilation poor lung compliance is characterized by increased resistance during ventilation attempts

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74
Q

If the response of patient with a severe airy obstruction becomes unresponsive

A

carefully position him or her supine on the ground and begin chest compressions perform 30 chest compressions and then open the airway and look in the mouth attempt to remove foreign body if you can see it

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75
Q

Surgical and nonsurgical cricothyrotomy

A

Two methods of securing a patient’s airway can be used when conventional techniques and methods fail the open surgical cric and Translaryngeal catheter ventilation nonsurgical or needle cric

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76
Q

Open cricothyrotomy

A

Involves opening the cricothyroid membrane with a scalpel and inserting a tracheal tube directly into the subglottic area of the trachea The open cric involves incising the patients skin and cricthyroid membrane and inserting a tracheal tube

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77
Q

Indications of open cric

A

Indicated only when you were unable to secure a patient’s airway with a more conventional mean and are unable to oxygenated ventilate the patient it is the last resort indications that may preclude conventional airway management include severe foreign body upper airway obstruction that cannot be extracted and direct laryngoscopy airway, obstruction from swelling, facial trauma and the ability to open the patient’s mouth

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78
Q

contraindications of open cric

A

the ability to secure a patent airway by less invasive means or lack of familiarity training to perform a cric Other contraindications include in ability to identify the correct anatomical landmarks, crushing injury to the larynx and trachea transection, you’re lying anatomical abnormalities and age younger than eight years

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79
Q

Advantages and disadvantages

A

Can be performed quickly and is easier than a tracheostomy Be performed without manipulating the cervical spine disdvantages include difficulty in performing the procedure and children and patients with short muscular or fat necks more difficult to perform than a needle cricothyrotomy

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80
Q

open cric complications

A

Bleeding is usually the result of inadvertent laceration of the external jugular vein After the incision has been made gently insert the tube will minimize the risk of perforating the esophagus or damaging the laryngeal nerves In too long results and hypoxia Expect to miss placement when subcutaneous emphysema is encountered after performing a cric

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81
Q

Subcutaneous emphysema

A

occurs when air infiltrates the subcutaneous layers of the skin and is characterized by crackling sensation when palpated

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82
Q

Technique for performing open cricothyrotomy

A

Identify the cricothyroid membrane by palpating the V notch of the thyroid cartilage which feels like a high sharp bump Stabilize the larynx between your thumb and middle finger while you palpate with your index finger slide your index finger down into the depression between the thyroid and cricoid cartilage While stabilizing the larynx with one hand make a 1 to 2 cm vertical incision over the cricothyroid membrane in bariatric patients the vertical incision may need to be longer and deeper Puncture the cricothyroid membrane and make a horizontal incision approximately 1 cm in each direction from the midline insert the scalpel handle into the opening and rotate Insert a tube into the trachea Manually stabilize the trachea tube with your thumb and index finger carefully remove the stylet and inflate the distal cuff Attach the bag mask device in ventilate Confirm correct to placement by attaching ET CO2

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83
Q

Needle Cricothyrotomy

A

Also uses the cricothyroid membrane as an entry pointed to the airway A 14 to 16 gauge over the needle IV catheter is inserted through the cricothyroid membrane and into the trachea Oxygen is achieved by attaching a high-pressure jet ventilator to help with the catheter Translaryngeal catheter ventilation is commonly used as a temporary measure to oxygenate a patient until more definitive airway can be obtained

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84
Q

needle cric indications

A

inability to ventilate the patient by less invasive techniques only when you were unable to secure a patent airway with more conventional means complete foreign body airway obstruction that cannot be extracted with forceps and direct laryngoscopy, airway obstruction from swelling, massive facial trauma, inability to open the patient’s mouth uncontrolled oropharyngeal bleeding

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85
Q

needle cric contraindications

A

in patients who have severe airway obstruction above the site of catheter insertion Only oxygenate the patient do not adequately ventilated as a result patients PaCO2 and ET CO2 levels will rise quickly

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86
Q

what does The high pressure ventilator used with needle cricothyrotomy do

A

increases intrathoracic pressure possibly resulting in barotrauma and risk for pneumothorax

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87
Q

Barotrauma

A

can be caused by over inflation of the lungs with the jet ventilator so care must be taken to open the release valve only until the patient’s chest adequately rises

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88
Q

Advantages of neeedle cric

A

Faster and easier to perform and is associated with lower risk of causing damage to adjacent structures Allows for subsequent intubation attempts because they use a small bore catheter allowing a tracheal tube to easily pass beside it

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89
Q

Disadvantages of needle cric

A

include using a small bore tube to ventilate the patient does not provide protection from aspiration as a tracheal tube would Requires specialized high-pressure jet ventilator to deliver adequate tidal volume

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90
Q

Complications of needle cric

A

improper catheter placement can result in severe bleeding secondary to damage of adjacent structures Excessive air leakage around the insertion site can cause subcutaneous emphysema especially if the patient has undetected laryngeal trauma

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91
Q

ventilating a patient with a jet ventilator

A

Extreme care must be exercise when ventilating a patient with a jet ventilator the release valve should be open just long enough for the adequate chest rise took her over inflation of the lungs can result in barotrauma which carries the risk of pneumothorax conversely opening the release valve for two short period of time can cause hypoventilation resulting in adequate oxygenation and ventilation

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92
Q

Technique for performing needle cricothyrotomy

A

Draw up approximately 3 mL of sterile water or saline into a 10 mL syringe and attach to the IV catheter Place the patient had in a neutral position and locate the cricothyroid membrane While you are stabilizing the patience lyrics carefully insert the needle into the midline of the membrane at a 45° angle toward the feet you should feel a pop After the pop is felt insert approximately 1 cm further and then aspirate the syringe if the catheter has been correctly place you should be able to easily aspirate air and see bubbling in the syringe if blood is aspirated you should reevaluate Attach one end of the oxygen tubing to the catheter in another end to the jet ventilator begin ventilation and observed adequate chest rise Auscultation of breath and epigastric sounds will confirm correct placement Secure the catheter by placing a folded gods pad under the catheter and taping it in place continue ventilation and reassess

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93
Q

Advanced Airway Management 2 reasons

A

Not a substitute for basic techniques and maneuvers 1. Failure to maintain a patent airway 2. Failure to adequately oxygenate and ventilate

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94
Q

MOANS

A

M mask seal: problems getting a good seal with the mask O obese: obese people are difficult to bag mask ventilate because of their increased body weight A aged- older people tend to be difficult to bag mask ventilate due to loss of connective tissue and bony structure on their face N no teeth: forming a good seal with the mask is difficult in edentulous patients S stiff lungs: patients underlying lung disease require higher pressures to ventilate and this may be difficult to do with bag mask ventilation

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95
Q

LEMON

A

L look: look externally for obvious anatomic deformities E Evaluate the 3-3-2 rule: the width from the front of the chin to the hyoid bone should be at least three fingerbreaths wide, the width of the patients mouth opening should be at least three fingerbreadths wide, and the distance from the mandible to the thyroid bones should be at least two fingerbreaths wide M Mallampati classification: oral access is assessed using the Mallampati classification O obstruction: you can anticipate a difficult intubation if there is obstruction in the airway such as epiglottis, neck injury, tumor N neck mobility: if a patient has limited neck mobility

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96
Q

Cormack- Lehane Classification

A

Has applicability in an emergent setting because it classifies views obtained by direct laryngoscopy based on the structures seen prior to inbutbation

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97
Q

Tracheal Intubation

A

passing a tracheal tube through the glottic opening and sealing the tube with a cuff inflated against the tracheal wall

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98
Q

Orotracheal intubation

A

when the tube is passed into the trachea through the mouth

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99
Q

Nasotracheal intubation

A

when the tube is passed into the trachea through the nose

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100
Q

indications of tracheal intubation

A

present or impending respiratory failure, apnea, inability of the patient to protect on airway, control of ventilation

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101
Q

contraindications for tracheal intubation

A

none in emergency situations however with inexperienced personnel other advanced airways may be easier

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102
Q

advantages/ disadvantages of tracheal intubation

A

advantages: provides a secure airway, protects against aspiration, provides an alternate route to IV/IO for certain medications disadvantages: special equipment required; physiological functions of the upper airway bypassed

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103
Q

complications of tracheal intubation

A

bleeding, hypoxia, laryngeal swelling, laryngospasm, vocal cord damage, mucosal necrosis, barotrauma, dental injury, inadvertent tube displacement

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104
Q

The basic structure of tracheal tube

A

includes the proximal end, the tube, the cuff and pilot balloon and distal tipSizes range from 5 to 9 mm

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105
Q

Murphy eye

A

the opening of the bevelled tip on the distal end of the tube to facilitate insertion It enables ventilation to occur even if the tip becomes included by blood, mucus, or tracheal wall

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106
Q

A tube that is too small for a patient will lead toa tube that is too large can

A

A tube that is too small for a patient will lead to an increase resistance to airflow and difficulty in ventilating a tube that is too large can be difficult to insert it may cause trauma

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107
Q

tracheal tube sizes

A

An adult woman will require a 7-8 mm tube while an adult man will require a 7.5 to 8.5 mm tube

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108
Q

good approximation of the diameter of the glottic opening

A

The internal diameter of the nostrils

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109
Q

Straight miller blade

A

Design so that the tip will extend beneath the epiglottis and lift it up particularly useful in infants

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110
Q

Curved macintosh blade

A

less likely to be levelled against the teeth by an inexperienced paramedic and is usually preferred by beginners the blade follows the outline of the pharynx the tip of the curved blade is placed in the valley Kula rather than beneath the epiglottis It directly lifts the epiglottis to expose the vocal cords

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111
Q

Blade sizes

A

range from 0 to 4 size 012 are appropriate for infants and children three and four are adult sizes

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112
Q

Stylet

A

a semi rigid wire that is inserted in the tracheal tube to mound and maintain the shape of the tube enables you to guide the tip of the tube over the arts annoyed cartilage even if you can’t see the entire glottic opening It should be lubricated and the end should be formed like a hockey stick curve

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113
Q

Magill forceps 2 uses

A

first they are used to remove area obstructions under direct visualization second they are used to guide the tip of the tracheal tube through the glottic opening

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114
Q

Orotracheal intubation by direct laryngoscopy

A

Involves inserting a tracheal tube through the mouth and into the trachea while visualizing the glottic opening with the laryngoscope

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115
Q

Orotracheal intubation indications

A

airway control needed as a result of coma, respiratory arrest/cardiac arrest, then territory support, absence of gag reflex, Trumatic brain injury, unresponsiveness or impending airway compromise

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116
Q

Orotracheal intubation contraindications

A

an intact egg reflects, in ability to open the patient’s mouth because of trauma, dislocation of the jar, inability to see the glottic opening, copious secretions or vomitus blood

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117
Q

Orotracheal intubation advantages and disadvantages

A

Advantages: Direct visualization of anatomy into placement, ideal method for confirming placement, may be performed in breathing or apnoeic patients Disadvantages: require special equipment

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118
Q

Orotracheal intubation Complications

A

dental trauma, laryngeal trauma, misplacement

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119
Q

Preoxygenation

A

Adequate preoxygenation with a bag mask device and 100% oxygen is critical step prior to intubating a patient Deoxygenate and apnoeic or hyper ventilating patient for 2 to 3 minutes monitor the SPO2 and she was closest 100% During the intubation attempt deliver high flow oxygen via nasal canula

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120
Q

Positioning the patient

A

The airway has three axis is the mouth, the pharynx, and the larynx which must all be aligned to visualize the airway This is most effectively achieved by placing the patient in the sniffing position

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121
Q

A bundle of care:

A

includes preoxygenation, passive high flow oxygen, the sniffling position and head elevation along with delayed sequence intubation agent

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122
Q

Laryngoscope blade insertion

A

Hold the laryngoscope cope with your left hand as far down the handles possible if the patient’s mouth is not open use the scissor technique or the tongue jaw lift maneuver insert the blade into the right side of the patient’s mouth and then sweep the tongue gently to the left side while moving the blade into the midline —This is a critical step because if you simply insert the blade in the midline the tongue will hang over both sides and all you’ll see is tongue Placed the little finger of your left hand under the patient’s chin to help lift the jaw and prevent levering against the patient’s teeth Slowly advance the blade while sweeping the tongue to the left exert gentle traction at a 45° angle to the floor as you lift the patient straw continue advancing until the epiglottis comes interview

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123
Q

Visualization of the glottic opening

A

After you identify the epiglottis placed the tip of the curved blade in the valecullar space which is above the epiglottis or the straight blade directly under the epiglottis and lift until you see the glottic opening You should see the vocal cords in the arytenoid cartilage

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124
Q

Bimanual laryngoscopy

A

if you’re having difficulty seeing the glottic opening take your right hand and manipulate the larynx directly observing after abuse optimize an assistant to maintain the optimum laryngeal position as you insert the tracheal tube

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125
Q

BURP maneuver

A

during external laryngeal manipulation the intubator plies backward upward rightward pressure to the lower 1/3 of the thyroid cartilage

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126
Q

Bougie

A

emi flexible device approximately 1 cm in diameter and 60 cm long it is rigid enough that it could be easily directed to the glottic opening but flexible enough that it does not cause damage to the trachea walls It is inserted through the glottic opening under direct laryngoscopy Enables you to feel the ridges of the trachea wall and becomes a guide for the tracheal tube by simply sliding the tracheal tube over it pass the cords and into the proper position

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127
Q

Tracheal tube insertion

A

After you visualize the glottic opening pick up the preselected tracheal tube in your right hand insert the tube from the right corner the patient’s mouth as you see the two passing the vocal cords rotate the tube to the right and direct the tip of the tracheal tube downward into the trachea Advance the tracheal tube until the proximal end of the cuff is 1 to 2 cm possible chords you must see the tip of the two past to the vocal cords if you cannot see the vocal cords do not insert the tube Do not try and pass the tube down the barrel of the laryngeal scope blade

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128
Q

Ventilation laraygnoscopy

A

After you have seen the cup of the tracheal to pass approximately 1.5 cm beyond the vocal cords gently remove the blade hold the tube securely and remove the stylet from the tube Inflate the distal cuff with 5 to 10 mL of air Play some in-line capnography monitor If the tube is properly position you were here quite epigastrium and equal breath sounds bilaterally however epigastric sounds may be transmitted to lungs in patients with obesity leading you to believe you have inadvertently intubated the esopha

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129
Q

Bilaterally absent breath sounds after tube placement

A

are gurgling over the epigastrium when auscultating during ventilation indicates that you have intubated the esophagus rather than the trachea you must remove the tube and be prepared to suction

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130
Q

If copious vomitus is being admitted from the tracheal tub

A

do not remove it instead inflate the distal calf turn the tube sideways to allow the bombers to be admitted and continue ventilation with bag mask device if vomitus is not being emitted from the tube you can remove it and resume bag ventilation

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131
Q

Breath sounds are heard only on the right side of the chest after tube insertion

A

the tube has likely been advance to far and entered the right mainstem bronchi us

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132
Q

Follow these steps to reposition the tube

A

Loosen or move the tube securing device Deflate the distal cuff Place your stethoscope over the left side of the chest Well ventilation continue slowly retract the tube while simultaneously listening for breath sounds over the left side of the chest Stop as soon as bilaterally equal breath sounds are heard Note the depth of the tube at the patient’s teeth Reinflate the distal cuff Secure the tube Resume ventilations –Increased resistance during ventilation’s may indicate gastric distention, oesophageal intubation or tension pneumothorax

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133
Q

Nasotracheal intubation

A

Insertion of a tube into the trachea through the nose Blind nasotracheal intubation is an excellent technique for establishing control over the airway and situation where does either difficult or hazardous to perform laryngoscopy

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134
Q

Nasotracheal intubation indications

A

indicated for patients who are breathing spontaneously but require definitive airway management to prevent further deterioration Responsive patients or patients with an altered mental status and with an intact gag reflects who are in respiratory failure secondary to condition such as COPD asthma or pulmonary oedema

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135
Q

Contraindicated Nasotracheal intubation

A

apnoea patients because they should receive oral tracheal intubation Contraindicated in patients with head trauma and facial fractures and evidence of cerebral spinal fluid drainage from nose Contraindications include anatomic abnormalities, patients with nasal polyps or patients who frequently use cocaine

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136
Q

Advantages and disadvantages of Nasotracheal intubation

A

primary advantage is that it can be performed to patients who are awake and breathing Another major advantage of needs a tracheal intubation is that there’s no need for laryngoscope which eliminates the risk of trauma to the teeth or soft tissues of the mouth Does not require the patient to be placed in a sniffing position which makes it ideal for spinal injuries Patient cannot bite tube Disadvantage you cannot use one of the major tube confirmation methods

137
Q

Technique for nasotracheal intubation

A

The tube is advance as a patient inhales at which point the vocal cords are open at the widest which facilitates placement of tube into trachea Insert the tube into the nostril with the bevel facing toward the nasal septum In the tip of the tube straight back toward the ear the goal is to follow the floor of the nasal cavity until the tube enters the nasal pharynx As a tube is advanced into the nasal pharynx you will begin to hear air rushing in and out of the tube as the patient breaths As the patient inhales the negative pressure created by inhalation facilitates movement of the tube for the glottic opening If you do not see soft tissue bulge and no air is moving through the tube the tube has been entered into the esophagus When the tube has been properly positioned inflate the distal calf with minimal amount of air necessary to achieve airtight seal

138
Q

Digital intubation

A

Involves directly palpating the glottic structures and evaluating the epiglottis with your middle finger while guiding the tracheal tube into the trachea by field does not require laryngoscope Most advantageous in cases of equipment failure

139
Q

Digital intubation indications and contra

A

only in patients who are deeply unresponsive and apnoeic and who have a bite block in their mouth This technique is absolutely contra indicated if the patient is breathing, it’s not deeply unresponsive or has an intact gag reflex

140
Q

Obstructive disease

A

can’t get air out Occurs when the positive pressure of exhalation causes the small airways to pinch shut trapping gas in the alveoli

141
Q

Signs of obstructive disease

A

Pursed lip breathing Increased inspiratory to expiratory ratio Abdominal muscle use Jugular venous distention

142
Q

Asthma Name from Greek work meaning

A

panting

143
Q

Asthma is characterized by

A

an inflammation in the bronchiole airways due to a variety of stimuli. Is a common chronic inflammatory disease of the airways.

144
Q

Hallmark of Asthma is

A

Airway Diameter Reduction

145
Q

key points of asthma

A

Reversible Must be triggered

146
Q

normal levels of C02 in blood

A

35-45mmhg

147
Q

CPAP rule

A

must have neb running

148
Q

HypoxiaHypoxemia

A

Hypoxia: area of the body that is short of oxygen Hypoxemia: entire body is short of oxygen

149
Q

Only way to fix Hypoxemia aka low spo2

A

02 and PEEP

150
Q

Bronchospasm/ Bronchoconstriction

A

Caused by the construction of smooth muscle that surrounds the larger bronchi in the lungs When air is forced through the constricted tubes it causes them to vibrate which creates wheezing

151
Q

The primary treatment of bronchospasm

A

is the administration of bronchodilator medication ex: Ventolin

152
Q

3 main symptoms of asthma

A

bronchoconstrictionmucous productioninflammation

153
Q

Signs and Symptoms of asthma

A

SOB Increase Work of Breathing Accessory Muscle use SPO2 abnormalities Adventitious lung sound, especially wheezing Decreased air entry Pallor or cyanosis ETCO2 reveals signs of bronchoconstriction

154
Q

treatment for asthma

A

Ventolin(Salbutimol) Atrovent(Ipratropium Bromide) epinephrine

155
Q

Potentially Fatal Asthma

A

Severely compromised ventilation all of the time Be alert for silent chest syndrome

156
Q

Potentially Fatal Asthma Ask if pt:

A

Previous intubation for respiratory failure or respiratory arrest 2 or more admissions to hospital despite oral corticosteroid use 2 or more episodes of pneumothorax

157
Q

Status asthmaticus

A

severe prolonged asthmatic attack that cannot be broken with conventional treatment Patient physically tired: accessory muscle use, cyanosis, chest hyperinflatedA despite treatment already given

158
Q

when is epinephrine used for asthma

A

silent lungs

159
Q

Mild asthma

A

Can form sentences Lungs: clear -Expiratory wheezes 2.5-5.0mg Ventolin -Contra: tachy arrythmia 250-500mcg Atrovent *won’t do anything after 2 doses (1000mcg)

160
Q

moderate asthma

A

Can speak few words at a time, tripod position Inspiratory and expiratory wheezes through all 4 lobes O2 immediately

161
Q

Severe asthma

A

Stridor —Upper airways already 50% closed wheezing upper lobes, silent lower lobes 02 5.0/500 Combivent- Atrovent and Ventolin CPAP: must have neb running 0.5mg EPI when you hear Silent chest —Call ALS

162
Q

Anaphylaxis

A

Serious allergic reaction that is rapid in onset and may cause death

163
Q

Risk factors: Anaphylaxis

A

Predisposition Substance Route and dosage Time between exposure

164
Q

AllergenAntibody (immunoglobulin)AntigenHypersensitivity

A

Allergen: antigen Antibody (immunoglobulin): attach to surface of mast cell and Antigen: proteins found on surface of cells Hypersensitivity: results from immune response to antigens

165
Q

Allergic Reaction vs Anaphylaxis

A

Allergic Reaction 1 body system Anaphylaxis 2 body systems EPI!!

166
Q

Sensitization

A

over production of IgE (antibodies) First exposure Antibodies attach to MAST cells and basophils –Mast cell: part of immune system and fights off stuff Release of chemical mediators

167
Q

Anaphylaxis Common causes

A

Drugs Foods and Additives Hymenoptera Stings

168
Q

Chemical Mediators cause and result in

A

Causes inflimation, bronchonstriction and mucous These substances result in bronchoconstriction, peripheral vasodilation and increased capillary permeability.

169
Q

Mediators that are stored include

A

*histamine, heparin and chemotactic factors. Other mediators are formed during degranulation such as prostaglandins, leukotriene’s, bradykinins and interleukins.

170
Q

Histamine Receptors H1

A

Bronchospasm increased peristalsis Vessel dilation Post capillary venule permeability Increases heart rate

171
Q

Histamine Receptors H2

A

Gastric acid secretion

172
Q

Anaphylaxis Presentation initial response

A

which occurs within the first 30 minutes after exposure and resolves within one hour consists of vasodilation, vascular leakage, and smooth muscle spasm

173
Q

Anaphylaxis Presentation delayed response

A

which can occur hours later and last for days consisting of more intense infiltration of tissues with inflammatory cells and more severe symptoms

174
Q

Anaphylaxis Presentation skin

A

Urticaria (Hives) Pruritus(itching) Angioedema (Swelling)

175
Q

Criteria for anaphylaxiss exist when one of the following are met:

A
  1. Acute onset symptoms involving hives, flushing, swelling of the mouth and throat, with at least one of the following: Respiratory concerns or distress, including difficulty breathing or speaking or decrease peak expiratory flow Declining blood pressure Symptoms of end organ disfunction2. Rapid occurrence of two or more of the following after exposure to likely Allergan: Skin and mucosal tissue symptoms including hives itchy and flushed skin and or swelling of the face and body respiratory concerns or distress including difficulty breathing or speaking or decreased peak expiratory flow Declining blood pressure Symptoms of an organ disfunction Severe gastrointestinal symptoms 3. Exposure of known allergin causing a decline in blood pressure
176
Q

COPD

A

General term (umbrella term): contains emphysema and chronic bronchitis

177
Q

copd spo2

A

Spo2 always lower than normal Goal is 94 but COPD pts goal is 90-92 Do not get COPD pt into 98Too much O2 will lower respiratory rate

178
Q

copd CO2

A

CO2 is always higher 50-60 mmhg

179
Q

Common Pathologies of COPD

A

Airflow obstruction Bronchospasm/bronchoconstriction Increased mucous production Impaired elasticity of airways

180
Q

Emphysema

A

is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli. Emphysema patients have damage to lung tissue in alveoli, which causes thickening and delays, or block entirely, the oxygen/carbon dioxide exchange.

181
Q

Pulmonary Emphysema (Pink Puffers)

A

Abnormal, permanent enlarged air spaces distal to terminal bronchiole Usually a non-productive cough Increased Anterior/Posterior diameter (barrel chest) due to hyperinflation and increased lung volume

182
Q

Emphysema Pathologies

A

 Destruction of alveoli walls Weakening and destruction of bronchioles Decreased alveoli surface area Decreased gas exchange

183
Q

Emphysema – Signs and Symptoms

A

“pink puffer”- respiratory distress: exhalation Pink color Pursed lip breathing Leaning forward Use of accessory muscles Tachypnea Distended neck veins Barrel chest Tachypneic Thin because they burn calories trying to breath

184
Q

Chronic Bronchitis

A

Inflammation, swelling and excessive mucous production in the bronchial tree. Minimal alveoli involvement Decreased ventilation of alveoli due to airflow obstruction

185
Q

Chronic Bronchitis - Signs and Symptoms

A

“blue bloater”- respiratory distress: inhalation Cyanotic Sweating Leaning forward Use of accessory muscles Tachypnea Distended neck veins

186
Q

COPD with right heart failure

A

Very difficult to push the patients thick blood through lungs destroyed by emphysema and through capillaries squashed by hyperinflated alveoli

187
Q

COPD with right heart failure Signs and symptoms

A

Peripheral edema JVD End inspiratory crackles

188
Q

Hypoxic Drive

A

Rare phenomenon that affects only a very small percentage Pts whose respiratory drive can be decreased by high levels of oxygen

189
Q

Bagging someone with COPD

A

Pts who have severe asthma or copd should be ventilated 4-6 breaths per pin to avoid bagging them to death

190
Q

Management of COPD

A

Primary goal is to reverse airflow obstruction through bronchodilation This is accomplished through use of sympathomimetics and anticholinergics. CPAP, if indicated, helps with medication administration PEEP: Positive End Expiratory Pressure

191
Q

Pleural effusion

A

is when fluid collects between the visceral and parietal pleura.

192
Q

Effusions can be caused by

A

infections, tumors, CHF, trauma

193
Q

what do pleural Effusions cause

A

can contain several litres of fluid, which can decrease lung capacity and cause dyspnea. They impair breathing by limiting lungs expansion and can cause partial or complete lung collapse.

194
Q

where do P effusions happen

A

Happens in pleural space

195
Q

what will you hear with a pleural effusionwhat will the spo2 be

A

When you listen you won’t hear anything SPO2 will be low (hypoxemic)

196
Q

P effusions Treatment

A

Prehospital treatment should consist of proper positioning, high fowlers most often, aggressive supplemental oxygen if required.

197
Q

Bronchitis

A

Is an inflammation of the mucous membranes of the bronchi

198
Q

bronchitis Is characterized by

A

development of cough or small sensation in the back of the throat, with or without production of sputum

199
Q

bronchitis Divided into two categories:

A

Acute Chronic

200
Q

bronchitis treatment

A

treat symptomatically

201
Q

Laryngitis

A

inflammation of voice box due to overuse, irritation or infection

202
Q

Croup

A

is the inflammation of the larynx and airwaves just below it it primarily affects children five years or younger it comes on strongest in the night time in the last 3 to 7 days

203
Q

symptoms and cause of croup

A

symptoms include loud harsh barking cough, fever, noisy inhalations, hoarse voice and dyspnea caused by a virus

204
Q

Pneumonia

A

Is an inflammatory condition of the lung, affecting primarily the alveoli

205
Q

Viral Pneumonia

A

In adults, viruses account for approximately a third and in children for about 15% of pneumonia cases Commonly implicated agents include rhinoviruses, coronaviruses, influenza viruses, respiratory syncytial virus (RSV)

206
Q

Pneumonia signs and symptoms systemic:skin:lungs;muscular:centralvascularheartgastricjoints

A

Systemic: -High fever -Chills Skin: -Clamminess -Blueness Lungs: -Cough with sputum or phlegm -SOB -Pleuritic chest pain -Hemoptysis Muscular: -Fatigue -Aches Central: -Headaches -Loss of appetite -Mood swings Vascular: -Low bp Heart: -High hr Gastric: -Nausea -Vomiting Joints: -Pain

207
Q

Pneumonia treatment

A

treat symptomatically

208
Q

V:Q normals and normal ratio

A

Ventilation 4l/min Perfusion 5l/min 0.8 is normal VQ ratio

209
Q

Pulmonary Embolism

A

is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism).

210
Q

P embolism most commonly results from

A

deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE)

211
Q

Pulmonary embolism Risk Factors

A

Estrogen-containing hormonal contraception Cancer (due to secretion of pro-coagulants) Alterations in blood flow: immobilization after surgery, injury, pregnancy, obesity (also procoagulant), cancer (also procoagulant) Smoking Travel

212
Q

Signs and Symptoms of pulmonary embolism

A

Dyspnea Short of breath but clear and equal lung sounds think pulmonary embolism Pleuritic chest pain on inspiration Pin point chest pain Low oxygen saturation Cyanosis Tachypnea Hemoptysis Usually clear sounding lung sounds About 15% of all cases of sudden death are attributable to PE Severity of symptoms depend on the vessel size and location

213
Q

pulmonary embolism treatment

A

symptomaticallyhigh O2

214
Q

Normal co2 levels

A

35-45 mmhg

215
Q

Acute Respiratory Failure

A

Respiratory failure is inadequate gas exchange by the respiratory system, with the result that levels of arterial oxygen, carbon dioxide, or both cannot be maintained within there normal ranges.

216
Q

hypoxemia

A

A drop in blood oxygenation

217
Q

hypercapnia

A

a rise in arterial carbon dioxide level

218
Q

Type 1 Respiratory Failure

A

Oxygenation Failure hypoxia without hypercapnia, and indeed the PaCO2 may be normal or low

219
Q

ventilation/perfusion (V/Q) mismatch

A

; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs

220
Q

the 5 causes of Type 1 Respiratory Failure

A
  1. V:Q mismatch 2. Low inp fiO2= 21% 3. Alveolar wall disease 4. Low resp rate 5. Shunt
221
Q

Type 1 Respiratory Failure treatment

A

oxygen

222
Q

conditions that affect oxygenation

A

Parenchymal disease (V/Q mismatch) Diseases of vasculature and shunts: right-to-left shunt Pulmonary embolism Interstitial lung diseases: ARDS, pneumonia, emphysema

223
Q

Type 2 Acute Respiratory Failure

A

Ventilation CO2 Failure to compensate: hypercapnia They will be breathing like 35 times per minute but their end tidal will still be high

224
Q

inadequate ventilation defined

A

the build up of carbon dioxide levels (PaCO2) that has been generated by the body

225
Q

Type 2 Acute Respiratory Failure underlying causes include

A

Increased airway resistance( COPD, Asthma, Suffocation) Reduced breathing effort (drug effects, brain stem lesion, extreme obesity) A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis). Neuromuscular problems (GB syndrome., myasthenia gravis, motor neurone disease)  Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.

226
Q

Respiratory failure resulting from hypoventilation

A

Conditions and impair lung function Conditions that impair mechanisms of breathing Conditions are impaired the neuromuscular apparatus Conditions that reduce respiratory drive

227
Q

Acute Respiratory Distress Syndrome

A

Is a life-threatening reaction to injuries or acute infection to the lung.nflammation of the lung parenchyma leads to impaired gas exchange with systemic release of inflammatory mediators, causing inflammation, hypoxemia and frequently multi organ failure

228
Q

Acute Respiratory Distress Syndrome death rate

A

This condition has a 90% death rate in untreated patients

229
Q

Acute Respiratory Distress Syndrome symptoms

A

People usually present with shortness of breath, tachypnea leading to hypoxia and providing less oxygen to the brain, occasionally causing confusion

230
Q

Aspiration

A

Is the inhalation of either oropharyngeal or gastric contents into the lower airways

231
Q

Aspiration Pneumonia

A

Migration of fluids and inflammatory cells into the area of irritation Fever, productive cough, radiographic findings Immunocompromised patients may not present the inflammatory response

232
Q

most common area if aspiration occurs in the sitting position Aspiration in supine position

A

Right lower lobemay produce infection in any lobe

233
Q

The severity of the symptoms of Aspiration Pneumonia is related to :

A

Volume of aspirant Amount of bacterial contamination Oropharyngeal contents with anaerobic bacteria pH of material pH less than 2.0 are associated with a much higher mortality rate

234
Q

Aspiration Pneumonia Management Acute symptomatic Aspiration

A

Remove airway obstruction Monitor CO2/SpO2 Correct hypoxia Ventilate as required Bronchodilators –Aspiration-induce bronchospasm Bronchoscopy

235
Q

Aspiration Pneumonia Treatment

A

Aggressively reduce the risk of aspiration by avoiding gastric distension when ventilating and by decompressing the stomach with an NG tube whenever appropriate Aggressively monitor the patient’s ability to protect his or her own airway and seek to protect the patient’s airway with an advanced airway if this is impossible Aggressively treat aspiration to suction and airway control if steps one and two fail

236
Q

BVM: ROMAN

A

restrictionobesitymask sealage over 55 (loss of muscle tone/ increase risk for disease)no teeth

237
Q

SGA: RODS

A

restrictionobesitydeformed anatomystiff neck

238
Q

nasal O2

A

1-6lpm24-44%

239
Q

simple o2

A

6-12lpm24-50%

240
Q

nrb o2

A

10-15lpm90-100%

241
Q

bvm 02

A

15lpm100%

242
Q

o2 consumption constantDEH

A

D= 0.16E= 0.28H= 3.14

243
Q

o2 consumption formula

A

psi in tank x constant—————————— flow rate

244
Q

fiO2

A

fraction of inspired oxygen

245
Q

Hyperventilation

A

Hyperventilation Syndrome is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly. The hyperventilation is self-promulgating as rapid breathing causes carbon dioxide levels to fall below healthy levels, and respiratory alkalosis (high blood pH) develops.

246
Q

Hyperventilation Signs and symptoms

A

Palpation Chest pain Paresthesia hand and muscle Light headed Weak Dizzy Carpo-pedal spasm

247
Q

One-Person Bag-Valve-Mask Ventilation indication and complications

A

Indicated for apnoeic patients and for patients who are breathing in adequately Complications associated with the one person bag mask ventilation technique are typically related to in adequate tidal volume delivery which usually occurs secondary to poor technique in adequate mask to face seal or gastric distension

248
Q

Ventilation rates by age Adult

A

Apneic with a pulse 10 to 12 breaths per minute with or without an advanced airway in place Apneic and pulseless 10 breaths per minute after an advanced airway has been inserted ventilations can be asynchronous with chest compressions

249
Q

Ventilation rates by age Infant and child

A

Apneic with a pulse 12 to 20 breaths per minute with or without an advanced airway in place Apneic and pulseless 10 breaths per minute after advanced airway has been inserted ventilations can be asynchronous with chest compressions

250
Q

Two person bag mask ventilation indications, contra and complications

A

Indications for the two apnea, in adequate breathing, inability to ventilate the patient with one paramedic and spinal injury Contra indications include patients who are in tolerant of the device The only major disadvantage of two-person bag mask technique is that it requires additional personnel Complications include hyper inflation of the patient’s lungs and gastric distension

251
Q

Gastric distention

A

The pressure in the airway forces open the esophagus and the air flows into the stomach First it promotes regurgitation of stomach contents and vomitus creeping up the back of the throat rapidly finds its way into the patient’s lungs Second a distended stomach pushes to die for an upward into the chest reducing the amount of space in which the lungs can expand

252
Q

signs of gastric distension

A

Signs of gastric distension include an increase in diameter of the stomach, an increasingly distended abdomen, and an increased resistance to bag mask ventilation If the signs are noted reassess and reposition the airway as needed, apply Cricoid pressure and observe the chest for adequate rise and fall as you continue ventilating

253
Q

Artificial ventilation of the pediatric patient

A

A paediatric bag mask device with a minimum title volume of 450 mL should be used for full term neonate and infants

254
Q

how to apply cricoid pressure

A

Locate the cricoid ring by palpating the trachea for prominent horizontal band inferior to the thyroid cartilage Apply gentle downward pressure using one finger tip in infants and thumb and index finger and children

255
Q

Head tilt chin lift manouver

A

The preferred technique for opening the airway of a patient who has not sustained trauma

256
Q

Head tilt chin lift manouver indications and contra

A

Indications: non-responsive patient, no mechanism for cervical spine injury or patient who is unable to protect his or her own airway Contra indications: a responsive patient or patient with a possible cervical spine injury

257
Q

Head tilt chin lift manouver advantages and disadvantages

A

adVadantages: no equipment is required and the technique is simple safe and non-invasive disadvantages: hey is the thought to be a hazardous to patients with spinal injury does not protect from aspiration

258
Q

jaw thrust manoeuvre

A

If you suspect that the patient has experienced a cervical spine injury open his or her airway with the jaw thrust maneuver’ Place fingers behind the angle of the jar and left the job forward

259
Q

jaw thrust manoeuvre indications and contra

A

Indications: unresponsive patient, a patient with possible cervical spine injury or patient who is unable to protect his or her own airway Contraindications: responsive patient with resistance to opening the mouth the jar thrust maneuver may be needed in the responsive patient who has sustained a jar fracture

260
Q

jaw thrust manoeuvre advantages and disadvantages

A

Advantages: maybe used in patients with cervical spine injury Disadvantages: cannot maintain if patient becomes responsive or combative difficult to maintain for an extended period of time

261
Q

Jaw thrust manouver with head tilt indications and contra

A

Indications: an unresponsive patient or a patient unable to protect his or her own airway Contraindications: responsive patient or patient with a possible cervical spine injury

262
Q

Jaw thrust manouver with head tilt advantages and disadvantages

A

Advantages: it is a non-invasive and does not require special equipment Disadvantages: it is difficult to maintain requires a second paramedic for a bag mask ventilation and does not protect against aspiration

263
Q

Tongue jaw lift manouver

A

Used more commonly to open a patient’s airway for the purpose of suctioning or setting an OPA airway It cannot be used to ventilate a patient because it will not allow for adequate mask seal on patient’s face

264
Q

The king LT Airway

A

single use single lumen airway device that is blindly inserted to provide positive pressure ventilation to apnoeic patients and to maintain a patent airway and unresponsive patients The king LTSD is more commonly used device it is available in seven sizes that are based on the patient’s height and or weight

265
Q

Indications for King LT airway

A

Alternative to bag mask ventilation when a rescue device is required for a failed intubation attempt Indicated for airway management of deeply unresponsive apnoeic patient with no gag reflex and whom tracheal intubation is not possible or has failed

266
Q

Contraindications for the king LT airway

A

Does not eliminate the risk of vomiting or aspiration Do not use the king LT airway in patients with an intact gag reflex patients with known oesophageal disease or patients who have ingested a caustic substance

267
Q

Complications of the king LT airway

A

Laryngeal spasm, vomiting and possible hyperventilation may occur

268
Q

The laryngeal mask airway

A

It’s around the opening of the larynx with an inflatable silicone positioned in the hypopharynx

269
Q

The laryngeal mask airway Indications and contraindications

A

Alternative to bag mask ventilation when the patient cannot be intubated ineffective in patients with obesity and should not be used in morbidly obese Ineffective for ventilation of patients requiring high pulmonary pressures

270
Q

The laryngeal mask airway dvantages and disadvantages

A

May provide better ventilation than a bag mask and does not require continual maintenance of mask seal Easier and does not require laryngoscopy Provides protection from upper airway secretions Main disadvantage is that it does not provide protection against aspiration but increases the risk of aspiration

271
Q

Complications of the LMA

A

The most significant complications associated with use of the LMA involve regurgitation and subsequent aspiration Should only be used in patients who are fasting —Meaning it cannot be used in emergency situations

272
Q

The I-Gel

A

Supraglottic airway specifically designed to create non-inflatable anatomical seal of the pharyngeal and laryngeal anatomical structures while avoiding trauma Allows passage of an NG tube to decompress the stomach and prevent regurgitation

273
Q

Combitube

A

Multilumen airway device with a long tube that is inserted blindly into the airway it is an alternative to tracheal intubation allows for better ventilation than a bag mask device and simple airway adjunct It can function as a tracheal tube if inserted into the trachea

274
Q

Combitube Indications and contraindications

A

Indicated for every management of deeply unresponsive, apnoeic patients with no gag reflex in whom tracheal intubation is not possible or has failed Cannot be used in children younger than 16 years Contraindicated in patients with oesophageal trauma, patients with known pathological conditions of the esophagus, patients who have ingested a caustic substance or patients who have a history of alcoholism

275
Q

Combitube Advantages and disadvantages

A

It cannot be improperly placed No mask seals required to ventilate Provides patency to the airway No upper airway positioning is required Does not completely illuminate the risk of aspiration

276
Q

Combitube complications

A

Significant complication is unrecognized displacement of the tube into the esophagus Laryngeal spasm, vomiting, impossible hyperventilation may occur

277
Q

Combitube consist of

A

a single tube with two lemons, two balloons and two ventilation ports one lumen is open at its distal and the other is closed

278
Q

Combitube Insertion technique

A

Forwardly displace the jawinsert deviceInflate the cuff:ventilate the longer blue tube first if there are no breath sounds are epigastric sounds present the chest is not rise and fall during ventilation then switch immediately to the shorter clear tube

279
Q

Suction Pressures:Premature infants Term infantsChildrenAdults

A

Premature infants – 60-80 mmHg • Term infants – 80-100 mmHg • Children – 100-220 mmHg • Adults – 120-550 mmHg

280
Q

Yankauer catherter

A

(tonsil tip catherter): a good option for suctioning the pharynx in adults and the preferred device for infants and children They have a diameter and a rigid so they do not collapse and are capable of suctioning large volumes of fluid rapidly

281
Q

Whistler tip catherter

A

soft plastic, non-rigid catheters can be placed in the oral pharynx or nasal pharynx or down a tracheal tube

282
Q

adults should be suctioned for a max of — seconds

A

15 seconds

283
Q

Mechanical ventilation

A

Refers to the application of device that provides patience varying degrees of ventilatory support

284
Q

Negative effects on body

A

Positive pressure ventilation increases intrathoracic and intraocular pressure which can result in barotrauma (pneumothorax) or volutrauma ( injured alveoli/impaired surfactant function) An increase in interest or acid pressure can result in reduced venous return to the right side of the heart which may result in poor cardiac output and hypertension

285
Q

Negative pressure ventilation

A

A negative pressure ventilator operates by a drop in trans airway pressure gradient created by contraction of the diaphragm

286
Q

Monitoring Tubing

A

assists in the measurement of flow and pressures by taking information to the ventilator for interpretation and display.

287
Q

Y–connection

A

brings the inspiratory limb, expiratory limb, and endotracheal tube together to form a closed circuit.

288
Q

End-Tidal Carbon Dioxide

A

The measurement of carbon dioxide in exhaled breath.

289
Q

Manometer

A

A sensor within the ventilator permits several respiratory parameters to be measured, such as: Peak pressure, Mean airway pressure, Plateau pressure and lung volumes.

290
Q

Respirometer:

A

Measurements of gas exchange can be made with a respirometer located within the ventilator. This is done by measuring the change in the volume of gas surrounding the probe during breathing. A respirometer will measure the rate of oxygen consumption and then calculate the rate of production of carbon dioxide by comparison.

291
Q

Capnography

A

measures the concentration of CO2in expired gas

292
Q

The peak CO2 concentration

A

occurs at end-exhalation and is regarded as the patient’s “end-tidal CO2” (ET CO2), which approximates the alveolar gas concentration.

293
Q

D cylinderM cylinder E cylinder

A

You will often use the D cylinder which contains 350 L of oxygen and is typically carried from the ambulance to the patient The M cylinder which contains 3450 L of oxygen remains on board the ambulance The E cylinder holds 625 L of oxygen

294
Q

Therapy regulator

A

attaches to stem of the oxygen cylinder and reduces the high pressure of gas to a safe range approximately 50 psi

295
Q

Cylander constants

A

D 0.16 E 0.28 M 1.56 G 2.41 H 3.14 K 3.14

296
Q

why do we put end tidal on everyone

A
  1. Want to see whats going on in the lungs (bronchoconstriction) 2. Want to see the effects of treatments
297
Q
  • Capnography (capnometry)
A

The measurement of carbon dioxide in exhaled breath

298
Q
  • Capnometer
A

The numeric measure of CO2

299
Q
  • Capnogram
A

The wave form produced with inspiration & expiration

300
Q
  • ETCO2 define
A

the level of partial pressure of carbon

301
Q

-PaCO2

A

Partial pressure of CO2 in arterial blood

302
Q

3 things needed for 02

A
  • Cardiac output - Ventilation: gas exchange at the alveoli wall - Metabolism: what the cells need to use oxygen
303
Q
  • CO2
A

is the “Gas of Life” produced from “The fire of life” metabolism

304
Q

ETCO2

A
  • Provides an immediate, real time, picture of the pt.’s condition- Capnography will show immediate apnea- Directly related to the ventilatory status of the pt.
305
Q

SPO2

A
  • Delayed, SpO2 can show high saturations for several minutes- SPO2 will not show immediate apnea- Directly related to oxygenation of the pt.
306
Q

What else can ETCO2 tell us?

A

Not only can ETCO2 measure ventilation but . . . . - It also indirectly measures metabolism & circulation

307
Q
  • An increased metabolism will
A

increase the production of carbon dioxide & increasing levels on the monitor

308
Q
  • A decreased metabolism will
A

decrease the amount of CO2 delivered to the lungs & decreases levels on the monitor

309
Q

Intubated Capnography Patients

A
  • EtCO2 is directly related to the ventilation status & can be used in intubated as well as non-intubated pt.’s
310
Q
  • Capnography in Intubated pt.’s can be used to:
A

o Verify ETT placement o Monitor ETT position o Assess ventilation and treatments o Evaluate resuscitative efforts during CPR

311
Q

Non-Intubated Capnography Patients

A
  • Asthma & COPD - CHF/Pulmonary Edema - CPAP pt.’s - Pulmonary Embolus - Head Injury
312
Q

Capnography Values Hyperventilation / Hypocapnia

A
  • > 45mmHg - Respiratory Acidosis
313
Q

In-accurate readings may be due to;

A
  • Poor positioning of NC capnofilters - Obstructed nares - Mouth breathers - O2 by mask may lower reading by 10% or more
314
Q

Increased ETCO2

A

Due to Increased CO2 Production - Fever - Burns - Hyperthyroidism - Seizure - Bicarbonate Tx - Return Of Spontaneous Circulation - (ROSC) - Release of Tourniquet / Reperfusion - Decreased ETCO2 - Increased CO2 Clearanceo Hyperventilation - Exercise- Sick

315
Q

Decreased ETCO2

A

Decreased CO2 production- Hypothermia- Sedation- Paralysis Decreased delivery to the lungs - Decreased cardiac output

316
Q

Normal Waveform

A
  • Straight boxes are good- Length of wave = Time- Height of wave = CO2 Level
317
Q
  • CO2 is a result of
A

Metabolism

318
Q

Hyperventilation Waveform

A

CO2 goes down - Wave forms start getting lower- Anxiety- Bronchospasm- PE- Increased ventilation - Remember to look at the trend not just the number

319
Q

Causes for CO2 going down

A
  • Hypothermia- Decreased Metabolism- Decreased Pulmonary perfusion
320
Q

Hypoventilation Causes

A

Hypoventilation Causes – CO2 goes up, wave form slows - Wave forms start getting bigger- Decreased ventilation- OD/Intoxication/Sedation - CNS Dysfunction- Tiring respiratory pt. Remember to look at the trend not just the number

321
Q

High CO2 Waveform

A

Causes for CO2 going up - Decrease in respiratory rate - Decrease in tidal volume - Increase in metabolic rate - Rapid rise in body temperature (hyperthermia)

322
Q

Bronchospasm Waveform

A
  • This wave form can occur in Asthma, COPD, Incomplete Airway Obstruction, Tube kinked or obstructed o CO2 that is transferred to the alveoli from the bloodstream may take longer to exhale because of the narrowed bronchi. o This delayed emptying of the alveoli varies in different parts of the lungs. o This results in the sloping plateau on the capnograph trace, CO2 from parts of the lungs with more severe bronchial narrowing is exhaled later than those parts with less severe narrowing.
323
Q

what type of shape is bronchospasm

A

o This represents struggling to exhale & un- even emptying of alveoli o The pt. hyperventilates to compensate, CO2 drops to below 35 o Asthma worsens, the C02 levels will rise to normal

324
Q

Emphysema Waveform

A
  • The slope of phase III can be reversed in patients with emphysema where there is marked destruction of alveolar- capillary membranes and reduced gas exchange
325
Q

Cardiac Asthma & ETCO2

A

Decrease in airway diameter caused by pulmonary congestion, not bronchoconstriction. - If the wave form is upright, there is no constriction, the wheezing is caused by the CHF, not the COPD, you might want to withhold the neb treatment.

326
Q

Pulmonary Embolus

A
  • PE will cause an increase in dead space in the lungs decreasing the alveoli available to off load CO2 - The ETCO2will go down.
327
Q
  • A zero reading from intubated pt
A

may indicate the ETT is in the esophagus, prolonged down time prior to CPR, or massive PE

328
Q

Ventilating Pt.’s With ICP

A
  • Finding a Balance - Hyperventilation = Hypocapnea =  Cerebral Ischemia - Hypoventilation = Hypercapnia = Dialation  bleed & pressure - Keep C02 value of aprox 30 (>35 & not <25 mmHg)
329
Q

“Bucking” the Tube - “Curare Cleft”

A

Sedated Intubated Pt.’s - A notch in the wave form indicates the pt. is starting to arouse from sedation, breathing on their own & may need additional medication

330
Q

Capnography & Cardiac Output

A
  • Increased Cardiac Output = Increased CO2 - Decreased Cardiac Output = Decreased CO2
331
Q
  • CPAP
A

is a respiratory modality which can assist patients in their breathingdistends alveoli preventing collapse on expirationallows for greater surface area, which improves gas exchangeincreases medication distribution when used for COPD is very effective in reducing the amount of fluid in the alveoli and increase the FiO2 (Fraction of Inspired Oxygen) of the inhaled air up to 100%

332
Q
  • The overall goal of CPAP
A

CPAP is to increase Functional Residual Capacity(FRC)

333
Q
  • Functional Residual Capacity(FRC
A

is the volume of air present in the lungs at the end of passive expiration.

334
Q

How does CPAP work?

A
  • CPAP mask forms a tight seal around patients mouth and nose. - CPAP system pressurizes the patients airway while still allowing them to spontaneously inhale and exhale on their own
335
Q

What is CPAP?

A
  • CPAP increases pressure in the lungs and holds open collapsed alveoli, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary vasculature. - This improves oxygenation, ventilation and ease of breathing. - The increased intrathoracic pressure decreases venous return to the heart and reduces the overwhelming preload (pressure in the ventricles at the end of diastole). - This lowers the pressure that the heart must pump against (afterload), both of which improve left ventricular function. - CPAP alters the pressure gradient
336
Q

protocol criteria for CPAP

A
  • Patient must be alert and able to follow commands (GCS >13) - Be able to maintain an open and patent airway on their own - Patient is over 12 years of age and must be able to fit the CPAP mask - PCP’s may apply CPAP to adult patients with severe respiratory distress - Severe Respiratory distress as per Paramedic Clinical Practice protocols is RR greater than 25,SPO2 less than 92%, use of accessory muscle use. - If the CPAP is on, try to keep it on. Alveoli can collapse again within seconds. - It may take hours to reopen alveoli again
337
Q

Indications for CPAP

A
  • Hypoxemia secondary to congestive heart failure - Acute cardiogenic shock - Pulmonary edema - Asthma/COPD - Respiratory distress (A respiratory rate >25bpm, SpO2 <92%, accessory muscle use during
338
Q

CPAP Contraindications

A
  • Pneumothorax or chest trauma - Hemodynamically unstable patients - Altered mental state- Patient has a tracheotomy- Patient is actively vomiting- Patient has an upper GI bleed

PRIMARY CARE PARAMEDIC 2021/22 (12 decks)

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