Lecture 7: Airway/Respiratory Management

Question 1

Define hypoxia and hypoxemia

Answer 1

• Hypoxia = insufficient O2 within the tissues
• Hypoxemia = low arterial oxygen tension (PaO2)

Question 2

What are the 4 causes of hypoxia in the inpatient setting?

Answer 2

• Hypoventilation
• V/Q mismatch
• R to L shunt
• Diffusion Abnormalities

Reduced inspired o2 tension can occur at high altitudes.

Question 3

What are the 2 main ways to deliver O2?

Answer 3

1. Low-flow: NC, simple mask, NRB
2. High-flow: Venturi mask

Question 4

What are the 2 main causes of inadequate ventilation?

Answer 4

1. Inadequate respiratory effort
2. Airway obstruction

Question 5

Which airway maneuver is preferred when C-spine injury is a concern?

Answer 5

Jaw-thrust

Question 6

Who is an OPA indicated in?

Answer 6

Unconscious patient who cannot maintain their own airway

Question 7

What happens if an NPA is too long?

Answer 7

It will enter the esophagus

Question 8

What 3 things does BVM depend on for proper ventilation?

Answer 8

• Patent airway
• Adequate mask seal
• Proper ventilation rate/volume/cadence

Question 9

One handed BVM Technique

Answer 9

Two handed BVM Technique

Question 10

What 3 things should you be wary about during BVM?

Answer 10

1. Excessive Tidal Volumes
2. Forcing air too quickly
3. Ventilating too quickly

Question 11

What is the primary NIPPV for COPD?

Answer 11

BiPAP

Alveoli cannot contract back down during exhalation. Cannot survive against a continuous airway pressure.

Question 12

What is the overall main contraindication to NIPPV?

Answer 12

They cannot be AMS

Question 13

What are the 3 primary indications for intubation?

Answer 13

1. Failure to maintain a patent airway
2. Failure to oxygenate or ventilate
3. Anticipating a deteriotation in clinical condition

Question 14

What else can an ET tube enter accidentaly besides the esophagus?

Answer 14

Right mainstem bronchus

Higher up and straight

Question 15

What are the 5 main indications for mechnical ventilation?

Answer 15

• Airway protection for an obtunded or dynamic airway
• Hypercapnic respiratory failure due to decrease in minute ventilation
• Hypoxemic respiratory failure due to failure of oxygenation
• CV distress where mechanical ventilation can help offload energy of breathing
• Expectant course

Question 16

What are the 4 primary phases of mechanical ventilation?

Answer 16

• Initiation
• Delivery
• Termination
• Exhalation

Question 17

What are the 3 breath types for mechanical breaths?

Answer 17

• Controlled
• Assisted
• Spontaneous

Question 18

What are the 4 categories we use to evaluate whether someone can undergo a spontaneous breathing trial (SBT)?

Answer 18

1. Disease (can support own respiratory function)
2. Neurological (alert, follow commands, initiate a breath)
3. Respiratory (FiO2 < 40% and PEEP < 8, strong cough + suction no more than q4h.)
4. CV (hemodynamically stable with minimal vasopressor/inotrope support)