Respiration and Artificial Respiration Flashcards
(94 cards)
1
Q
Inhalation is;
A
- Active process
* Negative pressure pulls air into lungs
2
Q
Exhalation;
A
- Passive process
- Muscles relax; size of chest decreases
- Positive pressure created; air pushed out
3
Q
• Tidal volume
A
—amount of air moved in one
breath
4
Q
• Dead space air—air moved in ventilation not reaching alveoli
A
—air moved in ventilation not reaching alveoli
5
Q
• Alveolar ventilation
A
—air actually reaching alveoli
6
Q
• Ventilation
A
—both inhaling and exhaling
7
Q
Diffusion
A
—movement of gases from high
concentration to low concentration
8
Q
• External respiration
A
—diffusion of oxygen and carbon dioxide (exchange of gases) between alveoli and circulating blood
9
Q
• Internal respiration
A
—exchange of gases between blood and cells
10
Q
During ventilation what happens in the cells
A
• Oxygen from blood
diffused into cell
• Carbon dioxide diffused from cell into blood
11
Q
What are the Categories of Respiratory System Failure
A
- Mechanics of breathing disrupted
- Gas exchange interrupted
- Circulation problems
12
Q
Hypoxia:
A
low oxygen level in cells
13
Q
Hypercapnea
A
high carbon dioxide level
14
Q
,
A
• Brain and body cells need a steady supply of oxygen
– Hypoxia: low oxygen level in cells
• Carbon dioxide must be continuously removed
– Hypercapnea: high carbon dioxide level
15
Q
What is the goal of evaluating Respiration
A
• Assesses how well cardiopulmonary system is accomplishing oxygenation and carbon dioxide removal
16
Q
What are the signs of Respiratory Compensation
A
• Compensation for hypoxia or hypercapnea
is predictable
• Signs
– Shortness of breath (symptom)
– Increased respiratory rate and depth – Increased heart rate
• Early on, steps of compensation can meet the needs of the body despite respiratory challenge
17
Q
Respiratory Distress
A
• Body compensating for a respiratory challenge and meeting metabolic needs
18
Q
Signs of Respiratory Distress
A
• Relatively normal mental status
• Relatively normal oxygen saturation and
end tidal carbon dioxide
• Relatively normal skin color
• Shortness of breath
• Increased respiratory rate and heart rate
• Accessory muscle use and position changes
19
Q
Respiratory Failure
A
- Occurs when challenge overcomes compensation or compensatory steps can no longer continue
- Also known as inadequate breathing
- Exceptionally important to recognize; often a precursor to respiratory arrest
20
Q
Signs of Respiratory Failure
A
• Signs of respiratory distress
• Evidence that compensation is no longer
effective
• Signs of poor oxygenation and/or poor removal of CO2
• Signs of decompensation
• Signs of failed oxygenation and/or removal of CO2
– Altered mental status – Cyanosis
21
Q
Signs of Decompensation
A
- No or poor air movement
- Diminished or absent breath sounds
- Breathing rate too rapid, too slow, or irregular
- Patient unable to speak
- Unusual noises (wheezing, crowing, stridor, snoring, gurgling, gasping)
22
Q
Signs of Respiratory Failure: Pediatric Note
A
• In addition to other signs, look for retractions and nasal flaring
23
Q
Critical Decisions: When to Intervene
A
• Often respiratory failure patients will be breathing and conscious
• Identify adequacy of breathing
– If breathing is inadequate, immediate intervention is necessary
24
Q
Critical Decisions: When to Intervene
A
.
25
Positive Pressure Ventilation
* Forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing
* Uses force exactly opposite of how the body normally draws air into the lungs
26
Negative Side Effects of Positive Pressure Ventilation
* Decreasing cardiac output/dropping blood pressure
* Gastric distention
* Hyperventilation
27
Key Concerns with PPV
* Do not ventilate patient who is vomiting or has vomitus in airway—PPV will force vomitus into patient’s lungs
* Watch chest rise and fall with each ventilation
* Ensure rate of ventilation is sufficient
28
Ventilating a Breathing Patient
* Explain procedure to patient
| * After sealing mask on patient’s face, squeeze bag with patient’s inhalation
29
Mouth to Mask Ventilation is Performed using
using a pocket face mask
30
Performing Mouth to Mask Ventilation
1. Open airway
2. Connect oxygen and run at 15 Lpm
3. Position mask on patient’s face
– Apex over bridge of nose
– Base between lower lip and prominence of chin
4. Hold mask firmly in place; maintain head tilt
5. Exhale into mask port
6. Allow passive exhalation
31
Achieving Tight Mask Seal
* Position thumbs over top of mask, index fingers over bottom of mask, and remaining fingers under patient’s jaw
* Position thumbs along side of mask and remaining fingers under patient’s jaw
32
Bag-Valve Mask (BVM)
• Handheld
ventilation device
• Used to ventilate nonbreathing patient and/or patient in respiratory failure
33
Standard Features of BVM
• Self-refilling shell that is easily cleaned
and sterilized
• Non-jam valve that allows an oxygen inlet flow of 15 Lpm
• Nonrebreathing valve
34
Mechanics of BVM
• Supply of 15 Lpm O2 attached and enters
reservoir
• When squeezed, air inlet closed and oxygen delivered to patient
• When released, passive expiration by patient occurs
35
Two-Rescuer BVM Ventilation
* Strongly recommended by AHA
* Most difficult part of BVM ventilation is obtaining adequate mask seal
* Hard to maintain seal while squeezing bag
* One rescuer squeezes bag; other rescuer maintains seal
36
Two-Rescuer BVM Ventilation: No Trauma Suspected
1. Open airway with head-tilt, chin-lift maneuver
2. Select correct bag-valve mask size
3. Kneel at patient’s head; position thumbs over top half of mask, index fingers over bottom half
4. Place apex of triangular mask over bridge of nose; lower mask over mouth and upper chin
5. Use middle, ring, and little fingers to bring patient’s jaw up to mask
– Maintain head-tilt, chin-lift maneuver
6. Second rescuer connects and squeezes bag
7. Second rescuer releases bag; patient exhales passively
37
Two-Rescuer BVM Ventilation: Trauma Suspected
1. Open airway using jaw-thrust maneuver
2. Select correct bag-valve mask size
3. Kneel at patient’s head; place thumb sides of your hands along mask to hold it firmly on patient’s face
4. Use remaining fingers to bring jaw upward toward mask, without tilting head or neck
38
One-Rescuer BVM Ventilation
1. Open airway
2. Select correct size mask
3. Position mask on patient’s face
4. Squeeze bag
5. Release pressure on bag and let patient exhale passively
39
If Chest Does Not Rise During BVM Ventilation
1. Reposition head
2. Check for escape of air around mask;
reposition fingers and mask
3. Check for airway obstruction or obstruction in BVM system
4. Use alternative method
40
Artificial Ventilation of a Stoma Breather
1. Clear mucus plugs or secretions from stoma
2. Leave head and neck in neutral position
3. Use pediatric-sized mask to establish seal around stoma
4. Ventilate at appropriate rate for patient’s age
5. If unable to artificially ventilate through stoma, seal stoma and attempt artificial ventilation through mouth and nose
41
Using Flow-Restricted, Oxygen-Powered Ventilation Device
• Use on adults only
• Follow same procedures for mask seal as
for BVM
• Trigger device until chest rises
42
Automatic Transport Ventilator (ATV)
* Provides automated ventilations
* Can adjust ventilation rate and volume
* Provider must assure appropriate respiratory rate and volume for patient’s size and condition
43
• How would you decide which positive pressure delivery method to use for your patient?
.
44
Conditions Requiring Supplemental Oxygen
* Respiratory or cardiac arrest
* Heart attacks and strokes
* Shock
* Respiratory distress and lung diseases • Head injuries
* Other serious injuries
45
Oxygen Systems can be..
• Portable or installed
46
Oxygen Cylinders D contain how much O2
• Come in various sizes
| – D—about 350 L of O2
47
Oxygen Cylinders E contain how much O2
– E—about 625 L of O2
48
Oxygen Cylinders M contain how much O2
– M—about 3,000 L of O2
49
Oxygen Cylinders G contain how much O2
– G—about 5,300 L of O2
50
Oxygen Cylinders H contain how much O2
– H—about 6,900 L of O2
51
Oxygen Safety
• Use pressure gauges, regulators, and
tubing intended for use with oxygen
• Use non-sparking wrenches
• Replace disposable gaskets each time a cylinder is changed
• Properly secure oxygen cylinders in a cool, ventilated space
• Never drop cylinder or move by dragging
Oxygen Safety
52
Delivery Devices: Nonrebreather Mask
• Best way to deliver high concentrations of oxygen to a breathing patient
53
Delivery Devices: Nonrebreather Mask
* Provides oxygen concentrations of 80%–100%
* Minimum flow rate 8 Lpm
* Maximum flow rate 12–15 Lpm
54
Delivery Devices: Nasal Cannula
• Best choice for a patient who refuses to wear an oxygen face mask
55
Delivery Devices: Nasal Cannula
* Provides oxygen concentrations of 24%–44%
| * Should deliver no more than 4–6 liters per minute
56
Delivery Devices: Partial Rebreather Mask
• Very similar to nonrebreather mask
• No one-way valve in opening to reservoir
bag
• Delivers 40%–60% oxygen at 9–10 Lpm
57
Delivery Devices: Venturi Mask
* Delivers specific concentrations of oxygen by mixing oxygen with inhaled air
* Some have set percentage and flow rate; others have adjustable Venturi port
58
Delivery Devices: Tracheostomy Mask
* Placed over stoma or tracheostomy tube to provide supplemental oxygen
* Connected to 8–10 Lpm
59
Humidifier
• Connected to
flowmeter
• Provides moisture to dry oxygen from supply cylinder
60
Facial Injuries
• Bleeding and swelling can disrupt
movement of air
• Aggressive suction and advanced airway maneuvers may be necessary
61
Obstructions
• Foreign bodies can impede ventilation of
patients
• If unable to ventilate always consider the possibility of obstruction
62
Pediatric Notes
• Hypoxia often occurs rapidly
– Children burn oxygen at twice the rate of adults
– Account for many anatomical differences associated with airway
63
Ventilating Pediatric Patients
* Avoid excessive pressure and volume
* Use properly sized face masks
* Flow-restricted, oxygen-powered ventilation devices contraindicated
* Gastric distention may impair adequate ventilations
64
Types of Advanced Airway Devices
* Devices requiring direct visualization
| * Devices inserted “blindly”
65
Assisting with Intubation
* Maximize oxygenation prior to procedure
* Position patient in sniffing position
* Cricoid pressure
* Confirmation
* Securing tube in place
66
Ventilating the Intubated Patient
* Very little movement can displace an endotracheal tube
* Pay attention to resistance to ventilations; report changes
* If patient is defibrillated, carefully remove bag from tube
67
Assisting with a Trauma Intubation
* Provide manual in-line stabilization throughout procedure
| * Position hands to hold stabilization, but allow for movement of jaw
68
Blind Insertion Devices
```
• Examples
– King LT-DTM airway
– Combitube®
– Laryngeal Mask Airway (LMATM)
• Usually do not require head to be placed in sniffing position
```
69
Chapter Review
• Respiratory failure (inadequate breathing):
breathing is insufficient to support life.
• A patient in respiratory failure or respiratory arrest must receive artificial ventilations.
• Oxygen can be delivered to the nonbreathing patient as a supplement to artificial ventilation.
• Oxygen can also be administered as
therapy to the breathing patient.
• Supplemental oxygen is indicated when breathing is inadequate or in patients that have a condition that would benefit from additional oxygen delivery.
70
Remember
• Always use proper personal protective
equipment when managing an airway.
• Assessment of breathing must be an ongoing process. Respiratory status can change over time.
• Inadequate breathing requires immediate action.
• Positive pressure ventilations are very different than normal breathing and can have negative side effects.
• Select the most appropriate method of positive pressure ventilations based upon the needs of the individual.
• Always use appropriate safety measures
when handling oxygen.
• Select the appropriate delivery device to provide supplemental oxygen.
71
• What are the signs of respiratory distress?
.
72
• What are the signs of respiratory failure?
.
73
• For BVM ventilation, what are recommended variations in technique for one or two rescuers?
.
74
• How does the way positive pressure ventilation moves air differ from how the body normally moves air?
.
75
• Describe a patient problem that would benefit from administration of oxygen and explain how to decide what oxygen delivery device should be used.
.
76
* On arrival at the emergency scene, you find an adult female patient who is semiconscious. Her respiratory rate is 7 per minute. She appears pale and slightly blue around her lips
* Is this patient in respiratory failure, and if so what signs and symptoms indicate this? Does this patient require artificial ventilations?
.
77
What is the intervention for a pt with adequate breathing
Non-rebreather or nasal cannula
78
How do you recognize adequate breathing
| Pt is breathing adequately but needs supplemental O2 due to a medical or traumatic condition
. rate and depth of breathing are adequate
. no abnormal breath sounds
. air moves freely in and out of the chest
. skin color is normal
79
What is the intervention for a pt with inadequate breathing (respiratory failure)
Assisted ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD
Note: a non rebreather mask requires adequate breathing as it does not force air into the lungs
80
What is the intervention for a pt who is not breathing
Artificial ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD, or ATV at 10-12 / minute for an adult and 20/minute for an infant or children
Note: DO NOT use oxygen powered ventilation devices o infants or children
81
What are the signs for a pt with inadequate breathing (respiratory failure)
. pt has some breathing but not enough to live
. rate and/or depth outside of normal limits
. shallow ventilation
. Diminished or absent breath sounds
. Noises such as crowing, stridor, snoring, gurgling or gasping
. blue (cyanotic) or gray skin color
. decreased minute volume
82
What are the signs for a pt with no breathing (respiratory arrest)
. no chest rise
. no evidence of air being moved from the mouth or nose
. no breath sounds
83
when do you use a non rebreather or nasal cannula
Adequate breathing - pt is talking in full sentences
84
when do you use a non rebreather
Increasing respiratory distress: visibly short of breath, speaking 3 or 4 work sentences, increasing anxiety
85
when do you use assisted ventilations: PFM, BVM or FROPVD - assist pt own ventilations, adjusting the rate for rapid or slow breathing
Severe respiratory distress, speaking only 1-2 word sentences very diaphoretic (sweaty), severe anxiety
continues to deteriorate: sleepy with head bobbing, becomes unarousable
86
What device do you use when a pt is in respiratory arrest: no breathing
Artificial ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD, or ATV at 10-12 / minute for an adult and 20/minute for an infant or children
Note: DO NOT use oxygen powered ventilation devices o infants or children
87
What is the normal respiratory rate and quality for an adult
12-20, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
88
What is the normal respiratory rate and quality for an child
12-30, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
89
What is the normal respiratory rate and quality for an infant
25-30, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
90
Signs of Inadequate Breathing
. Chest movements are absent, minimal, or uneven
. Movement associate with breathing is limited to the abdomen (abdominal breathing)
. No air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal
. Breath sounds are diminished or absent
. Noises such as cheesing crowing, sirdor, snoring, gurgling, or gasping are heard during breathing
. rate of breathing is too rapid or too slow
. breathing is very shallow, very deep, or appears labored
. The pt skin, lips, tongue, ear lobes or nail beds are blue or gray - cyanotic
. Inspirations are prolonged Indicating a possible upper airway obstruction, or expirations are prolonged (indicating a possible lower airway obstruction)
. Patient is unable to speak, or the patin cannot speak full sentences because of shortness or breath
. In children there may be reiterations (a pulling in of the muscles) above the clavicles and below the ribs
. Nasal flaring (widening of the nostrils of the nose with respiration) may be present, especially in infants and children
91
cyanotic
a blue or gray color resulting from a lack go oxygen in the blood
92
what can cause hypoxia
a pt is trapped in a fie
a patient has emphysema
a pt overdoes on a drug that has a depressing effect on the respiratory system
a pt has a heart attack
93
artificial ventilation
forcing air into the lungs when a pt has stopped breathing or has inadequate breathing. Also called positive pressure ventilation
94
pocket face mask
a device, usually with a one way valve to aid in artificial ventilation. A rescuer breathes through the valve with the mask is placed over the patient face. It also acts as a barrier to prevent contact with a patients body fluids. It can be used with supplemental oxygen when fitted with an oxygen mask.
