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58 Cards in this Set

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What is the primary objective of airway maintenance?
To establish and then maintain a patent airway to ensure proper ventilation (adequate exchange of O2 and CO2) for all patients. Early detection and intervention of airway and breathing problems are, including bystander action, are vital.
Modified Respiration Form
(Coughing)
Forceful exhalation of a large volume of air from the lungs. This is a protective function that expels foreign material from the lungs.
Modified Respiration Form
(Sneezing)
Sudden, forceful exhalation from the nose. It is usually caused by nasal irritation.
Modified Respiration Form
(Hiccoughing)
Sudden inspiration caused by spasmodic contractions of the diaphragm with spastic closure of the glottis. It serves no known physiologic purpose. It has occasionally been associated with acute MI on the inferior surface of the heart.
Modified Respiration Form
(Sighing)
Slow, deep, involuntary inspirations followed by a prolonged expiration. It hyperinflates the lungs and re-expands atelectatic alveoli. This normally occurs once a minute.
What is the primary objective of airway maintenance?
To establish and maintain a patent airway. This facilitates effective respiration (the proper exchange of O2 and CO2). Early detection and intervention of breathing problems, including bystanders action is vital to patient survival.
Modified Respiration Form
(Coughing)
Forceful exhalation of a large volume of air from the lungs. This performs a a protective function in expelling foreign material from the lungs.
Modified Respiration Form
(Sneezing)
Sudden, forceful exhalation from the nose. It is usually caused by nasal irritation.
Modified Respiration Form
(Hiccoughing)
Sudden inspiration caused by spasmodic contractions of the diaphragm with spastic closure of the glottis. It serve no known physiologic purpose. It has occasionally been associated with acute MI on the inferior surface of the heart.
Modified Respiration Form
(Grunting)
A forceful expiration that occurs against a partially closed epiglottis. It is usually an indication of respiratory distress.
Functions of the respiratory system:
(Mechanics of Ventilation)
Ventilation consists of inspiration (active) and expiration (passive): Inspiration takes place when the diaphragm and intercostal muscles contract and expand the lungs; thus creating a pressure vacuum that draws atmospheric air into the lungs. At the end of inspiration, the respiratory muscles relax, shrinking the thoracic cavity and expelling air from the lungs. This is expiration.
Functions of the respiratory system:
(Pulmonary Circulation)
Deoxygenated blood leaves the right ventricle through the pulmonary artery which divides to the right and left lung where the arteries fan into smaller arteries and end in the capillaries. Gases are exchanged and then the oxygenated blood travels back to the heart through the pulmonary veins, emptying into the left atrium. Perfusion of the lungs themselves is provided through the bronchial arteries and veins.
Methods for measuring O2 and CO2 in the blood and their prehospital use:
(Pulse Oximetry)
It is noninvasive, rapidly applied, easy to operate and provides a continual and dynamic reading of peripheral oxygen delivery. Using infrared (deoxygenated) and near red (oxygenated) emitting diodes the pulse oximetry provides a very accurate reading of the oxygen saturation percentage (SpO2) of hemoglobin. This is a fast and mostly accurate way to measure the level of perfusion in the patient. Above 95% is normal, 85% and lower is sever hypoxia. This is a rapid way of seeing if airway interventions are effective or not.
Methods for measuring O2 and CO2 in the blood and their prehospital use:
(Capnography)
Noninvasive method of monitoring exhaled CO2. End Tidal CO2 (ETCO2) is a noninvasive method of measuring ventilation, metabolism, and circulation. Although initially used in prehospital settings to verify proper ETT placement in the trachea, it is now being used as continual proof of proper placement for documentation, for observing response to medications and showing the effectiveness of CPR. Continuous Waveform Capnography has made this possible.
Basic Capnography Rules:
(Sudden Drop of ETCO2 to zero)
•Esophageal Intubation
•Ventilator Disconnection or defect
•Defect in CO2 analyzer
Basic Capnography Rules:
(Sudden decrease of ETCO2 (not to zero))
•Leak in ventilator system; obstruction
•Partial disconnect in ventilator circuit.
•Partial airway obstruction (secretions)
Basic Capnography Rules:
(Exponential decrease of ETCO2)
•Pulmonary embolism
•cardiac arrest
•hypotension (sudden)
•Severe Hyperventilation
Basic Capnography Rules:
(Change in CO2 Baseline)
•Calibration error
•Water droplet in analyzer
•mechanical failure (ventilator)
Basic Capnography Rules:
(Sudden increase in ETCO2)
•Accessing an area of lung previously obstructed
•Release if tourniquet
•Sudden increase in blood pressure
Basic Capnography Rules:
(Gradual Lowering of ETCO2)
•Hypovolemia
•Decreasing cardiac output
•Decreasing body temperature; hypothermia; drop in metabolism
Basic Capnography Rules:
(Gradual Increase in ETCO2)
•Rising Body Temperature
•CO2 absorption
•Partial airway obstruction (foreign body); reactive airway disease.
SpO2 Reading: 95-100
•Normal
•Change FiO2 to maintain saturation
SpO2 Reading: 91-94
•Mild Hypoxemia
•Increase FiO2 to increase saturation
SpO2 Reading: 86-90
•Moderate Hypoxemia
•Increase FiO2 to increase saturation
•Assess and increase ventilation
SpO2 Reading: <85
•Sever Hypoxemia
•Increase FiO2 to increase saturation
•Increase Ventilation
Causes for Upper Air Obstruction:
(Foreign Body Aspiration)
Often involving alcohol, dentures or young children. An object like a large, poorly chewed piece of food becomes lodged in the hypopharynx. Often mistaken for heart attacks.
Causes for Upper Air Obstruction:
(Laryngeal Spasm)
A spasmodic closure of the vocal cords that can be potentially lethal. Potential causes are trauma, anaphylaxis, epiglottitis, and inhalation of superheated air, smoke, or toxins. The most common cause of Laryngeal Spasm however is overly aggressive intubation. This especially takes place immediately after extubation, and when the patient is semiconscious.
Causes for Upper Air Obstruction:
(Laryngeal Edema)
A swelling of the vocal cords that can be potentially lethal. Just below the mucous membrane of the vocal cords is a layer of loose tissue where blood or other fluids can accumulate. The swelling that may take place in this area tends to be slow to subside. Potential causes are trauma, anaphylaxis, epiglottitis, and inhalation of superheated air, smoke, or toxins.
Complete airway obstruction maneuvers:
(Heimlich Maneuver)
This is the basic life support maneuver that should be conducted for airway obstruction. If the patient is conscious and choking use your fist in a forceful upward thrust in the patients abdomen between the umbilicus and the xiphoid process. If the patient is unconscious use CPR with visualized finger sweeps. Use suction is indicated.
Complete airway obstruction maneuvers:
(Removal with Magill Forceps)
If the obstruction cannot be removed with the Heimlich maneuvers or CPR, finger sweeps and suction, then using a laryngoscope to visualize the airway in an identical manner as used for orotracheal intubation. Then using the Magill Forceps, carefully remove the obstruction.
Causes of Respiratory Distress:
(Inadequate Ventilation)
This is inadequate minute volume which negatively effects oxygen intake and carbon dioxide removal. This can come from either a decreased ventilation rate, a depressed respiratory function such as impairment of respiratory muscles; and a decreased oxygen content in the atmosphere itself such as being in a high altitude setting. Other causes of respiratory impairment are, bronchiospasm, intrinsic disease, pneumothorax, hemothorax, and drug overdose. Sepsis can increase the metabolic rate beyond the bodies ability keep up.
Causes of Respiratory Distress:
(Impairment of Respiratory Muscles)
The muscles primarily impacted in this situation would be the intercostal and the diaphragm. A cause for this impairment would be trauma, thus physically inhibiting the muscles themselves. A flail chest would create paradoxical motion. A possible pneumothorax impairing compliance and so on. A second cause would come from nervous system injury, thus inhibiting or blocking electrical stimulus to the respiratory muscles.
Causes of Respiratory Distress:
(Impairment of the nervous system)
If the nervous system is impaired the brain’s ability to respond to shifting metabolic needs will be limited. Example would be unable to receive input from stretch receptors, or impaired ability to receive input from chemoreceptors that trigger the ventilation process according to PaCO2 levels, or PaO2 levels in the COPD patient. If the nervous system in impaired, there is a good chance the respiratory muscles will be impaired as well.
Diffusion
The movement of a gas from and area of high concentration to an area of lower concentration; seeking equilibrium.
Osmosis
The movement of solvent in a solution from and area of lower solute concentration to an area of higher solute concentration.
Stages of hypoxia
Normal SAO2: 95-100
Mild Hypoxia: 91-95
Moderate Hypoxia: 86-90
Severe Hypoxia: <85
Causes of increased CO2 production
•Fever
•Muscle Exertion
•Shivering
Origins of Breath Sounds:
(Snoring)
Partial obstruction of the upper airway by the tongue.
Origins of Breath Sounds:
(Gurgling)
Accumulation of blood, vomitus, aspiration, or other secretions in the upper airway.
Origins of Breath Sounds:
(Stridor)
Laryngeal edema or Constriction
(usually on inspiration)
Origins of Breath Sounds:
(Wheezing)
Inspiration and/or expiration; bronchial constriction.
Reasons for using Cricoid Pressure
•Prevent regurgitation/ vomitus/ aspiration
•Gastric Distention
•Facilitate intubation by bringing larynx into view.
Signs and Symptoms of Tension Pneumothorax
•Progressively worsening compliance
•Diminished unilateral breath sounds
•Hypoxia with hypotension
•Distended neck veins
•Trachea will deviate away from side with tension pneumothorax
What is atelectasis
Alveolar Collapse
Lungs receive their blood supply from which arteries?
Bronchial arteries branching off from the aorta.
What does CO2 combine with in the blood stream?
Hemoglobin
What does CO2 becoming in the blood stream?
Biocarbonate ion (HCO3)
The 4 gases in the atmosphere and their concentrations:
•Nitrogen: 78.62%
•Oxygen: 20.84%
•Carbon Dioxide: 0.4%
•Water: 0.50%
Endotracheal Intubation Advantages:
•Isolates trachea and permits complete control of the airway
•Impedes gastric distension
•Eliminates need to maintain a mask seal
•Offers direct route for suctioning the respiratory passages
•Although not recommended, permits medication administration
Complications of Endotracheal Intubation and precautions (1)
•Equipment malfunction: Pre-assembled airway kit that is checked regularly
•Tooth breakage and soft tissue lacerations: The Laryngoscope is an instrument to be used carefully, not a tool.
Complications of Endotracheal Intubation and precautions (2)
•Hypoxia: Use the 30 sec rule. or hold your breath, when you need to breath, the patient needs to breath.
•Esphogeal Intubation: Be careful on initial attempt, make sure to visualize the glottis, auscultate lungs and epigastrium.
Complications of Endotracheal Intubation and precautions (3)
•Tension Pneumothroax: Be careful to not be rushed or forced. Be ready with decompression needle if a tear or injury does in fact take place.
Which patients need RSI?
Patients that are awake and have significant AMS, they may combative. If they are hypoxic, with agitation, gag-reflex, clenched teeth, and/or too much muscle tone.
Sedative Agents used for RSI: (1)
•Midazolan (Versed): Dose: 0.1-0.3mg/kg
•Diazepan (Valium): Dose: 0.2-0.5mg/kg
•Etomdiate (Amidate): Dose: 0.3mg/kg
•Ketamine (ketalar): Dose: 1-2mg/kg
Sedative Agents used for RSI: (2)
•Sodium Thiopental: Dose: 3-5mg/kg
•Propofol (diprivan): Dose: 1-1.5mg/kg
•Fentanyl: Dose: 3-5mg/kg
Adjunct Drugs to RSI and Dosages
•Atropine: Dose: 0.01-0.02mg/kg
(min-max. 0.1-0.4)
•Lidocaine: Dose: 1mg/kg
Indications for nasotracheal intubation:
•Possible spinal injury
•Clenched teeth
•Fractured jaw, oral injuries, or recent oral surgery
•Significant angioedema (facial/airway swelling)
•Obesity
•Arthritis, preventing placement in the sniffing position
Contraindications of nasotracheal intubation:
•Suspected nasal fracture
•Suspected basilar skull fracture
•significantly deviated nasal septum or other nasal obstruction
•Cardiac or respiratory arrest
•Unresponsive patient: they usually need to help by swallowing.