Module 3 - Airway Flashcards
1
Q
What causes a patient to breathe?
A
primary driver of breathing is the level of carbon dioxide in the blood
2
Q
Adequate breathing requires BOTH adequate __________
and adequate __________.
A
tidal volume and respiration rate
3
Q
Patient scenario (what action to do):
PT unresponsive
No Pulse
No breathing
A
Start CPR and AED
4
Q
Patient scenario (what action to do):
PT unresponsive
Pulse but
NO breathing
A
- Start Positive pressure ventilations (PPV) with High flow O2
- at a rate of 1 breathing every 5-6 seconds
5
Q
Patient scenario (what action to do):
- PT unresponsive
- pulse and
- breathing present
A
Perform Sternum rub to check PT response to painful stimuli
6
Q
Patient scenario (what action to do):
- PT unresponsive/decreased level of responsiveness
- Snoring sound present
A
- Perform Manual airway maneuver
- followed by placement of mechanical airway
7
Q
Patient scenario (what action to do):
- PT unresponsive
- decreased level of responsiveness
- Gurgling sound present
A
Perform suctioning on patient on the way out of the mouth for not more then 10-15 seconds at a time
8
Q
Patient scenario (what action to do):
- PT unresponsive/decreased level of responsiveness
- Stridor sound present
A
- Perform simple maneuvers
- airway adjuncts
- assess for adequate breathing
9
Q
Patient scenario (what action to do):
- PT unresponsive
- Has adequate breathing
A
Insert appropriate airway adjunct and apply Oxygen via non-rebreather mask (NBM)
10
Q
Patient scenario (what action to do):
- PT unresponsive
- Has Inadequate breathing
A
Insert Appropriate airway adjunct and and positive pressure ventilation (PPV) with High flow flow supplemental O2
11
Q
Patient scenario (what action to do):
- PT Responsive
- Has Inadequate breathing
A
- Perform PPV (positive pressure ventilations) with Supplemental O2 to a rate of :
10-12 breaths per minute in adult
12-20 breaths per minute in child/infant
12
Q
Patient scenario (what action to do):
- PT Responsive
- Has adequate breathing and oxygenation
A
No airway adjunct or supplemental O2
Do not meet criteria for Supplemental O2
13
Q
Patient Scenario:
Unresponsive 24 year old male with shallow breathing 4 BPM:
A
Positive Pressure Ventilation with Supplemental O2
14
Q
Define Snoring :
A
Hoarse or harsh sound from nose or mouth that occurs when breathing is partially obstructed by tongue while sleeping
15
Q
Define Gurgling:
A
characterized by a hollow bubbling sound caused by air passing over pooled oral and respiratory secretions the patient is no longer able to swallow or cough up
16
Q
Define Stridor:
A
a high-pitched, abnormal breathing sound that occurs when there is a partial or complete blockage in the upper airway
17
Q
Patient scenario:
42 year old female complaining of difficulty breathing and can only speak 1-2 words at a time. Breathing is 30 bpm and pulse ox is 92%:
A
Positive pressure ventilation with 15 liters of O2
18
Q
Patient Scenario:
Responsive 83 Y.O. female comaplaining of abdominal pain. Denies difficulty breathing or history of respiratory problems. She is breathing 20 bpm with normal rise and fall of chest. Pulse ox is 93%
A
Nasal cannula at 2 lpm
19
Q
Patient Scenario:
Responsive 64 year old female who fell while walking her dog. No obvious distress and skin is warm to touch
A
No supplemental oxygen needed
20
Q
Define hypoxia
A
low levels of oxygen in your body tissues
21
Q
What are signs of inadequate breathing?
A
rate issues
irregularities in pattern
inadequate depth
use of accessory muscles
nasal flaring
seesaw breathing
head bobbing
abnormal noises
tripod position
22
Q
What are signs of Mild hypoxia?
(PHERD)
A
- Pale, cool, clammy skin
- Headache
- Elevation of BP
- Restlessness and agitation
- Disorientation and confusion
23
Q
What are signs of Severe hypoxia?
(CLASSSH)
A
- cyanosis
- Loss of coordination
- AMS
- Severe confusion
- Seizure
- Sleepy appearance
- Head bobbing
24
Q
Define Cyanosis:
A
blueish or purplish discoloration of the skin when lack of oxygen is present
25
What are signs and symptoms associated with all severities of hypoxia?
- Tachycardia
- Dyspnea
- Tachypnea
26
Define the following terms:
Tachycardia
Tachypnea
Dyspnea
- Tachycardia: Elevated heart rate above 100 bpm
- Tachypnea: rapid, shallow breathing
- Dyspnea: feeling of shortness of breath
27
What are the average respiratory rates of Adults, Elderly, children, infants?
Adults : 12-20 Breaths/ minute
Elderly: 20-22 Breaths/minute
Children: 18-37 Breaths/minute
Infants: 30-60 Breaths/minute
28
1. adequate rise and fall of chest (1 inch)
2. General a
29
Describe the relationship between the neurological system and the respiratory system.
Respiratory system depends on neurological system because
- nervous system has receptors that monitor CO2 and O2 levels (chemoreceptors)
- Nervous system controls and stimulates diaphragm and external intercostal muscles
- CNS is needed to transmit signals
And adjust breathing as necessary
30
What are some of the steps an EMT can take to gain the cooperation of a child or adult patient with respiratory problems?
Gain their trust, coaching and reassurance
31
What are the reasons to suction a patient?
Reasons to suction: To remove any blood, vomitus, secretions and any other liquids, food particles or objects from the mouth and airway
32
What makes up the upper and lower airway?
- Upper airway: extends from the nose and mouth to the cricoid cartilage (the most inferior portion of the larynx)
- Lower airway: extends from the cricoid cartilage at the lower edge of the larynx to the alveoli of the lungs
33
What are the steps of managing a patient with vomitus or secretions in the mouth?
1. If vomitus or secretions are small enough, suctioning will be performed.
- Use rigid catheter when mouth or oropharynx
- Use soft (french) catheter for nasal
2. If vomitus or objects are big enough (teeth, foreign bodies, or food). Can place PT on side and perform finger sweep if objects can be visualized.
34
What are the indications, contraindications, advantages, disadvantages, and processes necessary to place a King LT?
35
How you would manage a patient with a stoma?
- If the patient has a Trach tube, then place BVM directly to the Trach tube
- If the patient has no Trach tube, place Pediatric mask to BVM and place BVM over Stoma
36
Describe the four indications of effective ventilation via BVM:
1. Adequate & consistent Rate of ventilation
- Infants & children : breath every 2-3 seconds (12-20 per minute)
- Adults : breath every 6 seconds (10-12 per minute)
- each ventilation delivered over 1 second
2. Adequate & Consistent Tidal volume
- Bilateral rise and fall of chest
3. PT heart rate returns to normal
4. Color improves
- gray, cyanotic, or pale color lessens and disappears.
37
Describe the pathophysiology associated with fluid build-up in the lungs:
- Pulmonary edema :
Fluid buildup in the lungs caused by heart attack, high blood pressure that cause fluid to build up in kidneys b/c of narrowing kidneys arteries or kidney disease
- Pleural effusion:
collection of fluid around your lungs
38
What is the difference between partial and total airway occlusion:
partial airway obstruction allows some air to pass through, while total airway obstruction does not
39
Define the following:
Tidal volume
Ventilation
Respiration
- Tidal volume: The amount of air inhaled and exhaled during one breath
- Ventilation: the movement of air into the lungs
- Respiration: The movement of gases from one area of the body into another
40
What makes managing a COPD patient breathing different?
COPD patients run on a Hypoxic (low oxygen drive)
- Breathing receptors relay on the amount of O2 instead of CO2 to determine breathing
- Must use caution with supplemental oxygen b/c if O2 goes above PT's normal range
the body can signal to slow or stop respirations
- can result in respiratory distress or respiratory arrest
41
define Hypoxemia:
is a low oxygen content in arterial blood
42
What can cause Hypoxia? List some good examples
Inadequate delivery of O2 to the cells
Ex:
- blocked airway
- Inadequate breathing
- shock
- Inhalation of toxic substances
- Lung and airway disease
- Drug overdose
- Stroke
- Injury to chest, respiratory structures or head
43
What are the different Manuel maneuvers to open an airway and when/why are they are appropriate?
- head tilt-chin lift and the jaw thrust maneuver
- appropriate for when needing to clear airways except
on trauma patients when neck injuries are suspected
44
What are some of the changes that go on in Geriatric patients that can affect airway?
Cognitive, Physiology, and cognition changes such as :
- Tooth decay
- Significant decrease in the flexibility of the neck
- Oropharyngeal tumors
- Loss of muscle mass around the lips and mouth in the dentulous mouth make creating a mask seal for BVM difficult
- Higher incidence of chronic obstructive pulmonary disease (COPD)—increases incidence of a faster onset of hypoxia
- Obstructive sleep apnea—increases incidence of a faster onset of hypoxia
- Increase in gastroesophageal reflux disease—increases the risk of aspiration of gastric contents
- Dementia and confusion—reduction in cooperation of the patient
- Lower functional residual volume in the lungs
45
Hypoxia causes Restless and agitation in the patient, whereas the buildup of carbon dioxide in the blood will cause the patient to become _________
confused or sleepy
46
What are the signs of Adequate breathing:
- Adequate rate
- Clear and equal breath sounds bilaterally
- Adequate air movement heard and felt from nose and mouth (tidal volume)
- Good chest rise and fall with each ventilation (tidal volume)
47
What are the steps to assess for adequate breathing?
1. Look
- (inspect) for rise and fall of chest (1 inch)
- Observe Patients appearance: do they look like their in distress or anxious
- Decide whether the breathing pattern is regular or irregular
- Look at nostrils to see if they flaring during breathing
2. Listen
- Listen to the patient as they are talking and breathing
3. Feel
- Feel with your cheek
4. Auscultate with stethoscope
48
What are the steps to suction a patient?
1. Position yourself at head of patient
2. Turn on suction unit
3. Select appropriate type of catheter and pressure
- Nasal : 80-120 mmHg
- Adult: 100-120 mmHG
- Child: 80-100 mmHg
- Infant : 60-80 mmHg
4. Measure catheter and insert it into oral cavity without suction (NO further down that base of tongue)
5. Apply suction on the way out of airway
- no more then 15 seconds in adults
- no more then 5 seconds for children/Infants
6. If necessary, rinse the catheter with water to prevent obstruction of the tubing from dried or thick material . Use bottle of water to rinse off
49
Describe the use of an ATV?
- an automatic transport ventilator (ATV) device used for positive pressure ventilation
- They help provide and maintain a constant rate and tidal volume during ventilation
50
Describe the use of ATP in reference to inspiration and expiration.
- we inhale oxygen which is needed for cellular respiration (aerobic metabolism) to make a lot of ATP
- the cellular respiration process creates a lot of ATP and then releases carbon dioxide and water as a by-product.
- the CO2 created enters the blood as "bicarb" to be breathed out through exhalation
51
Indications of inadequate ventilation:
1. Chest does not rise and fall with ventilation
2. Heart rate does not return to normal with ventilation
3. Color does not improve
52
What are some troubleshooting steps to BVM when inadequate ventilation is occurring?
1. Check the position of the head and chin. Reposition the airway and repeat your attempt at ventilation.
2. Check mask seal to ensure not excessive air is escaping
- reposition fingers
- check for appropriate mask size
3. Assess for obstruction
4. Check BVM parts to make sure all is connected properly
5. If the chest still does not rise and fall, use an alternative method for positive pressure ventilation, for example, mouth-to-mask
6. If issues with maintaining open airway, use OPA or NPA
7. If PT stomach is rising or distended, check Manuel airway maneuver, Ventilation rate and tidal volume
53
If you need to assist ventilations, what two mechanical airways can you use?
oropharyngeal (OPA) or nasopharyngeal airway or (NPA)
54
What are signs of a open (Patent) Airway?
- Air can be felt and heard moving in and out of the mouth and nose.
- The patient is speaking in full sentences or with little difficulty.
- The sound of the voice is normal for the patient.
- Airway is open, free of any debris or any problems
55
What are 3 ways to open an airway?
1. Manual airway maneuvers:
- Head-tilt, chin-lift maneuver
- Jaw-thrust maneuver
2. Mechanical airways
- OPA
- NPA
3. Suction
56
What are some Abnormal upper airway sounds?
- Snoring
- Crowing
- Gurgling
- Stridor
57
What are some ways to help patients with Lung compliance issues?
- Supplemental O2
- CPAP
- Mechanical ventilation
- Position changes
- Corticosteroids
58
Define Crowing:
is a sound like a crow cawing that occurs when the muscles around the larynx spasm and narrow the opening into the trachea
59
Compare Tidal volume and minute volume:
- Tidal volume is the amount of air you breath in on breath
- Minute volume is the amount of air you breath in one minute
60
Which disease process causes a person to change from one respiratory drive to the other?
Chronic obstructive pulmonary disease (COPD)
61
Explain the process of how a persons respiratory drive changes with COPD:
- With COPD, Lungs become progressively obstructed making it hard to breath out CO2 which leads to chronic Hypercapnia (High CO2) levels
- Over time body becomes less sensitive to CO2 levels and starts monitoring more on low O2 levels (Hypoxia) to trigger breathing
- creates the "Hypoxic drive"
62
Which of the following drives does a normal healthy person use to breathe?
Hypercapnic drive
63
Define Hypercapnic drive:
a respiratory drive that occurs when the body uses carbon dioxide receptors to regulate breathing
64
Define Hypoxic drive:
a respiratory drive that occurs when the body uses oxygen chemoreceptors to regulate breathing instead of carbon dioxide receptors
65
Is cyanosis an early or late sign of distress in your patient?
Late sign
66
Describe a situation where it would be contraindicated to use the head tilt chin lift?
In trauma patient suspected of spinal injury
67
What is the proper way to measure an OPA?
from the corner of their mouth to the angle of their jaw
68
What is the proper way to measure an NPA?
1. Select an NPA with a diameter slightly smaller than the patient's largest nostril
2. Measure from the tip of the patient's nose to the tip of their earlobe or the angle of their jaw
69
What are chemoreceptors and what do they measure?
They are specialized receptors that monitor the , carbon dioxide, and oxygen levels in arterial blood
70
What are chemoreceptors located?
- central : are located near the respiratory center in the medulla
- peripheral: are located in the aortic arch and the carotid bodies in the neck
71
Why are chemoreceptors important?
- Respiration is controlled by the autonomic nervous system.
- chemoreceptors within the body measure oxygen, carbon dioxide, and hydrogen ions
- They send signals to the brain to adjust the rate and depth of respiration
72
Explain why inhalation is an active process?
Because it requires the contraction of the Diaphragm muscle
73
What is the difference between respiration and ventilation?
Ventilation is the movement of air into the lungs
Respiration is the movement of gases from one area of the body into another
74
Describe the process by which you take a breath?
Two steps: inspiration and expiration
-Inspiration:
Air enters the lungs when the diaphragm and external intercostal muscles contract. This increases the volume of the thoracic cavity, which decreases the pressure inside the lungs and creates a pressure gradient that pulls air in.
-Expiration:
Air leaves the lungs when the muscles used for inspiration relax.
75
Why is inhalation known as “negative pressure ventilation”?
because when we breathe in, the pressure inside our chest cavity decreases compared to atmospheric pressure, creating a negative pressure that draws air into the lungs;
76
During positive pressure ventilation by BVM, how do you know when you have adequately inflated your patient’s lungs?
- Bilateral rise and fall
- Breath sounds
- Oxygen saturation
77
How do you know if it is appropriate or not to remove your patience dentures?
- If the patient has dentures that are secure in the mouth, leave them in place (easier to establish a tight mask seal with the dentures in place)
- If the dentures are extremely loose, remove them so they do not dislodge and occlude the airway
78
What are some early signs that your patient is having difficulty breathing?
- Tachypnea
- Dyspnea
- pale, cool, clammy skin
- Elevation in BP
- Restless and agitation
- Headache
- Disorientation and confusion
79
What are some late signs that your patient is having difficulty breathing
- Cyanosis : of the conjuctiva (eyes), Mucosa (Mouth), Fingernail beds, and Circumoral area (around the mouth)
- Tachycardia
- Dyspnea
- Altered mental status
- Seizure
- Slow reaction time
- Tachypnea
80
What are signs of Hypercarbia (High CO2 in blood)?
- Sleepy appearance
- Head bobbing
81
When is the oral pharyngeal airway (OPA) contraindicated?
on a conscious patient with an intact gag reflex
82
What complication results from placing the rigid suction catheter too deep in the patient's mouth?
- If the tip of the catheter goes to far it can stimulate the gag reflex and cause vomiting if it touches back of the oropharynx
- If vague nerve is stimulated, can cause PT to become Bradycardic
- Rigid catheter can cause soft tissue trauma and stimulate bradycardia in children & Infants
83
What is the purpose of the airway adjuncts?
To keep the airway open in the PT
84
What is the difference between internal respiration and external respiration?
- External respiration refers to the Gas exchange that happens between the alveoli and surrounding capillaries
- Internal respiration refers to the gas exchange between the cells and capillaries
85
Explain the difference between the airway anatomy in a child and an adult?
- Head: In the supine position, a young child's head will cause a natural flexion of the neck due to its large size. This neck flexion can create a potential airway obstruction.
- tongue is proportionally larger in the mouth then adults
- Larynx: a child larynx is higher up than in an adult, creating a more anterior location
- Epiglottis: The adult epiglottis is flat and flexible, while a child's is U-shaped, shorter and stiffer
- Vocal cords: The anterior attachment of a pediatric patient's vocal cords is lower than the posterior attachment, which creates an upward slant, whereas in adults, the vocal cords are horizontal
- Trachea: The trachea is shorter in pediatric patients, which increases the likelihood of right mainstem intubation.
-Airway diameter: A child's airway is narrowest at the cricoid ring.
-Residual lung capacity: Smaller lung capacity in pediatric patients means that a child c
86
Is cyanosis an early or late sign of distress in your patient?
Late
87
What are the indications and contraindications of the King tube:
Indications:
- Cardiac arrest
- Inability to ventilate with BVM
- Hypoxia or hypoventilation: When a patient has hypoxia or hypoventilation that is resistant to non-invasive airway management
Contraindications:
- Intact Gag reflex
- Esophageal disease (cancers, etc)
- Laryngectomy with stoma
- Height: The patient is less than 4 feet tall
- Foreign body airway obstruction:
88
What are the indications and contraindications of CPAP?
Indications:
- PT is awake, alert and oriented
- Able to maintain their airway
- Can breath and maintain proper respiratory rate
- Is exhibiting signs and symptoms of moderate to severe respiratory distress or early respiratory failure (use of accessory muscles or )
- Is presenting with increased end tidal values
- Is able to wear the face mask or interface chosen
- Doesn’t require frequent suctioning
- Doesn’t have facial deformities that interfere with the mask fit and seal
Contraindications:
- Apnea, Respiratory arrest, or agonal respirations
- Inability to understand commands
- Inability to maintain airway
- Upper gastrointestinal bleeding or history of recent gastric surgery
- Pneumothorax or trauma to the chest, especially penetrating trauma
- Tracheotomy
- Facial trauma, especially midface fractures, or facial anomalies
- Increased intrathoracic pressure causing hypotension
- Shock associated with cardiac insufficiency
- Active vomiting
89
What are the indications and contraindications of the Combitube:
Indications:
- Apnea, severe respiratory failure, or impending respiratory arrest
- Need for ventilation and oxygenation in an unconscious, unresponsive, or paralyzed patient
- Rescue airway needed after failed intubation
- Patients with significant maxillofacial trauma and cervical spine injuries
Contraindications:
- Awake, responsive patient
- Intact gag reflex
- Known esophageal disease
- Ingestion of caustic substances
- Child (no Combitubes are made for children)
- Restricted mouth opening
- Impassable upper airway obstruction
- Hypopharyngeal or esophageal abnormalities or trauma
90
What is pulmonary edema ?
Pulmonary edema is a condition caused by too much fluid in the lungs
Fluid collects in the many air sacs in the lungs
91
What are the positions to listen for lungs sounds
2 inches below clavicle
midclavicular line
92
Rhonchi vs Rales:
Rhonchi:
- Low pitched breathing sounds resembling snoring or gurgling
• Heard when you breathe out
• Caused by the obstruction of the larger airways
Rales:
- Either high-pitched or low-pitched
• Crackles, small clicking, bubbling, or rattling sounds
• Heard when you breathe in
• Caused by lung secretions that involve the alveoli
