Volume 1 Chapter 13

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Volume 1 Chapter 13
2010-04-27 12:02:23
Volume Chapter

Volume 1 Chapter 13
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  1. Oxygen
    Gas necessary for energy production
  2. Carbon Dioxide
    Waste product of the body's metabolism
  3. Respiration
    The exchange of gases between a living organism and it environment
  4. Important Airway Anatomy
    • -Superior, middle and inferior turbinates
    • -Hard and soft palates

    • -Tonsils/adenoids
    • -Uvula

    • -Tongue

    • -Vallecula
    • -Epiglottis

    • LARYNX
    • -Esophagus
    • -Trachea
    • -Glottic opening
    • -Vocal cords
    • -Thyroid cartilage
    • -Cricothyroid membrane
    • -Cricoid cartilage
    • -Thyroid gland
  5. Upper Airway Components
    • Nasal cavity
    • Oral cavity
    • Pharynx
  6. Septum
    Cartilage that seperates the right and left nasal cavities
  7. Sinus
    Air cavity that conducts fluids from the eustacian tuves and tear ducts to and from the nasopharynx
  8. Eustacian Tubes
    A tube that connects the ear with the nasal cavity
  9. Nasolacrimal Ducts
    Tubular vessels that drain tears and debris from the eyes into the nasal cavity
  10. Nare
  11. Muscous Membrane
    Lining in body cavities that handle air transport. Usually contains small, mucus secreting cells
  12. Mucus
    Slippery secretion that lubricates and protects airway surfaces
  13. Pharynx
    A muscular tube that extends verticalls from the back of the soft palate to the superior aspect of the esophagus
  14. Regions of the Pharynx
    • Nasopharynx
    • Oropharynx
    • Laryngopharynx
  15. Gag Reflex
    Mechanism that stimulates retching or striving to vomit when the soft palate is touched
  16. Vallecula
    Depression between the epiglottis and the base of the tongue
  17. Intubation
    Passing a tube into a body opening
  18. Larynx
    The complex structure that joins the pharynx with the trachea
  19. Glottis
    Liplike opening between the vocal cords
  20. Cricoid Pressure
    Pressure applied in a posterior direction to the anterior cricoid cartilage. Occludes the esophagus
  21. Aspiration
    Inhaling foreign material such as vomitus into the lungs
  22. Cricothyroid Membrane
    Membrane between the cricoid and thyroid cartilages of the larynx
  23. Lower Airway Components
    • Trachea
    • Bronchi
    • Alveoli
    • Lung parenchyma
    • Pleura
  24. Trachea
    10-12 cm long tube that connects the larynx to the mainstem bronchi
  25. Bronchi
    Tubes from the trachea into the lungs
  26. Alveoli
    Microscopic air sacs where lost oxygen and carbon dioxide gas exchanges take place
  27. Atelectasis
    Alveolar collapse
  28. Parenchyma
    Principal or essential parts of an organ
  29. Pleura
    Membranous connective tissue covering the lung
  30. Pediatric Airway
    • Narowest point is the cricoid cartilage
    • Greater proportion of soft tissue
    • Larynx more superior and anterior
    • Epiglottis rounder and floppier
    • Smaller jaw
    • Loosely attached mucous membranes
  31. Ventilation
    The mechanical process that moves air into and out of the lungs
  32. Normal Adult Tidal Volume
    500 mL
  33. Dead Space Air
    150 mL
  34. Air Contains
    • 20.94% Oxygen
    • 79.01 % Nitrogen
    • 0.04% Carbon Dioxide
  35. Partial Pressure
    The pressure exerted by each component of a gas mixture
  36. PA
    Alveolar partial pressure
  37. Pa
    Arterial partial pressure
  38. Diffusion
    Movement of a gas from an area of higher concentration to an area of lower concentration
  39. Factors Effecting SpO2
    • Decrease hemoglobin
    • Inadequate alveolar ventilation
    • Decreased diffusion across the pulmonary membrane (COPD, Pneumonia, Edema)
  40. Hypoventilation
    Reduction in breathing rate and depth
  41. Pneumothorax
    Accumulation of air or gas in the pleural cavity
  42. Hemothorax
    Accumulation of blood or fluid containing blood in the pleural cavity
  43. Pulmonary Embolism
    Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood
  44. FiO2
    Concentration of oxygen in inspired air
  45. Factors Effecting CO2 in the Blood

    • Hyperventilation lowers
    • Fever raises
    • Muscle exertion raises
    • Shivering raises
    • Metabolic processes raise

    • Respiratory depression by drugs
    • Airway obstruction
    • Impairment of respiratory muscles
    • COPD, etc.
  46. Hypercarbia
    Excessive CO2 in the blood
  47. Respiratory Rate
    Number of times a person breaths in 1 minute
  48. Main Respiratory Center
  49. Hering-Breuer Reflex
    Stretch receptors in the lung which prevent overinflation when inhaling
  50. Chemoreceptors
    • Located in medulla and other periphal locations
    • Stimulated by decreased PaO2, increased PaO2 and decreased pH
    • Cerebral spinal fluid pH is the primary control of respiratory center simulation
  51. Hypoxemia
    Decreased partial pressure of oxygen in the blood
  52. Hypoxic Drive
    Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs
  53. Respiratory Rate Factors
    • Fever, Emotion, Pain, Hypoxia, Acidosis, Simulant drugs- increase rate
    • Sleep, depressant drugs- decrease rate
  54. Total Lung Capacity (TLC)
    Maximum lung capacity- approx 6 liters for adult male
  55. Tidal Volume (Vt)
    Average volume of gas inhaled or exhaled in one cycle- approx 500 mL in adult male
  56. Minute Volume (Vmin)
    Amount of gas inhaled and exhaled in 1 minute
  57. Upper Airway Obstruction
    An interference with air movement through the upper airway
  58. Causes of Airway Obstruction
    • Tongue- #1 cause
    • Foreign bodies
    • Trauma
    • Laryngeal spasm and edema
    • Aspiration
  59. Extubation
    Removing a tube from a body
  60. ABCs
    Airway, breathing, circulation
  61. Paradoxical Breathing
    Asymmetrical chest wall movement that lessens repiratory efficiency
  62. Flail Chest
    Defect in the chest wall that allows a segment to move freely, causing paradoxical chest motion
  63. Cyanosis
    Bluish discoloration
  64. Dyspnea
    An abnormalitity of breathing rate, pattern or effort
  65. Hypoxia
    Oxygen defficiency
  66. Anoxia
    The absence or near-absence of oxygen
  67. Pulsus Paradoxus
    Drop in blood pressure greater than 10 torr during inspiration
  68. Kussmaul's Respirations
    Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis
  69. Cheyne-Stokes Respirations
    Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indication brainstem injury
  70. Biot's Respirations
    Irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure
  71. Central Neurogenic Hyperventilation
    Deep, rapid respirations, indicating increased intracranial pressure
  72. Agonal Respirations
    Shallow, slow, or infrequent breathing, indicating brain anoxia
  73. Respiratory Distress Sounds
    • Snoring-results from partial obstruction of upper aiway by tongue
    • Gurgling- results from the accumlation of blood, vomitus or other secretions in the upper airway
    • Stridor- a harsh, high-pitched sound heard on inhalation, associated with laryngeal edema or constriction
    • Wheezing- a musical, squeaking, or whistling sound heard in inspiration and/or expiration, associated with bronchiolar constriction
    • Crackles (Rhales)- a fine, bubbling sound heard on inspiration, associated with fluid in the smaller bronchioles
    • Rhonchi- a coarse, rattling noise heard on inspiration, associated with inflammation, mucus, or fluid in the bronchioles
    • Quiet- diminished or absent breath sounds
  74. Compliance
    The stiffness or flexibility of the lung tissue
  75. Pulse Oximetry
    A measurement of hemoglobin oxygen saturation in th eperipheral tissues
  76. Oxygen Saturation Percentage
    The saturation of arterial blood with oxygen as measured by pulse oximetry expressed as a percentage
  77. SpO2 Findings
    • 95-100%- normal
    • 91-94%- mild hypoxemia
    • 86-90%- moderate hypoxemia
    • <85%- severe hypoxemia
  78. Capnography Terms
    • Capnometry- Measurement of expired CO2. Provides numerical display of the partial pressure of CO2 in torr or %
    • Capnography- Capnography is a graphic recording or display of the capnometry reading over time
    • Capnograph- Device that measures expired CO2 levels
    • Capnogram- Visual representation of expired CO2 waveform
    • End-tidal CO2- Measurement of the CO2 concentration at the end of expiration
    • PETCO2- Partial pressure of the end-tidal CO2 in mixed gas solution
    • PaCO2- Represents the partial pressure of CO2 in the arterial blood
  79. Capnogram Phases
    • Phase I- Baseline. Flat when no CO2 is present and corresponds to the late phase of inspiration and early part of expiration
    • Phase II- Respiratory upstroke. Reflects appearance of CO2 in alveoli
    • Phase III- Respiratory plateau. reflects airflow through uniformly ventilated alveoli with nearly constant CO2 level
    • Phase IV- Inspiratory phase. Downstroke and returns to baseline.
  80. Esophageal Detector Device (EDD)
    Bulb placed on end of ET tube to confirm placement. Squeeze then apply. If it returns to normal indicates correct placement.
  81. Nasopaharyngeal Airway
    Uncuffed tube that follows the natural curvature of the nasopharynx
  82. French
    Unit of measurement approximately equal to one-third millimeter
  83. Oropharyngeal Airway
    Semicircular device that follows the palate's curvature
  84. Beck Airway-Airflow Monitor (BAAM)
    Used for blind nasotracheal intubations to confirm tube placement. Whistles when patient exhales
  85. ET Intubation Equipment
    • Laryngoscope (Handle and blade)
    • Endotracheal tube
    • 10 mL syringe
    • Stylet
    • Bag-valve mask
    • Suction device
    • Bite block
    • Magill forceps
    • Tape or tube-holding device
  86. Burden Nasoscope
    Hearing device used to confirm tube placement in blind nasotracheal intubation
  87. Laryngoscope
    Device used for lifting the tongue and epiglottis in order to see the vocal cords
  88. Miller Blade
    Straight blade
  89. Mac blade
    Curved blade
  90. Endotracheal Tube (ETT)
    Tube passed into the trachea to protect and maintain the airway and to permit medication administration and deep suctioning
  91. Stylet
    Plastic covered metal wire used to bend the ETT in order to guide it easier into the trachea
  92. Magill Forceps
    Scissor style clamps with circular tips
  93. Indications for ET Intubation
    • Respiratory or cardiac arrest
    • Unconciousness or obtusion without gag reflex
    • Risk of aspiration
    • Obstruction due to foreign bodies, trauma, burns or anaphylaxis
    • Respiratory extremis due to disease
    • Pneumothorax, hemopneumothorax with respiratory difficulty
  94. Advantages of ET Intubation
    • Isolates trachea
    • Impedes gastric distention
    • Eliminates mask seal
    • Offers direct route for suctioning
    • Permits medication administration
  95. Disadvantages of ET Intubation
    • Required considerable experience and training
    • Requires specialized equipment
    • Requires direct visualization of vocal cords
    • Bypasses upper airway's functions of warming, filtering and humidifying inhaled air
    • Can lead to disease transmission
  96. Complications of ET Intubation
    • Equipment malfunction
    • Teeth breakage and soft-tissue lacerations
    • Hypoxia
    • Esophegeal intubation
    • Endobronchial intubation
    • Tension pneumothorax
  97. Rapid Sequence Intubation (RSI)
    Giving medications to sedate (induce) and temporarily paralyze a patient to perform ET intubation
  98. Common Paralytic Agents
    • Succinylcholine
    • Vecuronium
    • Atracurim
    • Pancuronium
  99. Nasotracheal Intubation
    Through the nose and into the trachea. PATIENT MUST BE BREATHING
  100. Indications for Nasotracheal Intubation
    • Possible spinal injury
    • Clenched teeth preventing opening of the mouth
    • Fractured jaw, oral injuries or recent oral sugery
    • Significant angioedema (facial and airway swelling)
    • Obesity
    • Arthiritis preventing placement in sniffing position
  101. Contraindications for NT Intubation
    • Nasal fractures
    • Basilar skull fractures
    • Deviated septum or nasal obstruction
    • Cardiac or respiratory arrest
    • Unresponsive patient
  102. Advantages of NT Intubation
    • Patient head can remain in position
    • Does not produce as much gag reflex
    • Can be secured more easily than oral tube
    • Patient cannot bite the tube
  103. Disadvantages of NT Intubation
    • More difficult and time consuming
    • Potentially more traumatic
    • Tube may kink or clog more easily
    • Greater risk of infection
    • Improper placement is more likely
    • Requires patient be breathing
  104. Intubation Devices
    • Endotracheal Tube (ETT)
    • Esophogeal Tracheal Combitube (ETC)
    • Laryngeal Mask Airway (LMA)
    • Pharyngeal Lumen Airway (PtL)
    • Esophegeal Gastric Tube (EGTA)
    • Esophageal Obturator Airway (EOA)
  105. Needle Crichothyrotomy
    Surgical airway technique that inserts a 14-gauge needle into the trachea at the thyroid membrane
  106. Open Crichothyrotomy
    Surgical airway technique that places and ET or tracheostomy tube directly into the trachea through a surgical incision made at the crichothyroid membrane
  107. Stenosis
    Narrowing or constriction
  108. Barotrauma
    Injury caused by pressure within a closed space
  109. Difficult Airway
    Clinical situation where a paramedic has difficulty with mask and/or ET intubation
  110. Mallampati Classification
    • Four class level airway assessment for use in conscious patients defined by the ability to visualize all, part or none of the tonsillar pillars and/or the uvula
    • Class 1: Entire tonsil clearly visible
    • Class 2: Upper half of tonsil fossa visible
    • Class 3: Soft and hard palate clearly visible
    • Class 4: Only hard palate visible
  111. Cormack and LeHane Classification System
    • Four grade level airway assessment for use in unconscious patients, defined by the ability to visualize all, part, or none of the glottic opening and/or the vocal cords.
    • Grade 1: Entire glottic opening and vocal cords can be seen
    • Grade 2: Epiglottis and posterior portion of glottic opening may be seen with only partial view of vocal cords
    • Grade 3: Only epiglottis and (sometimes) posterior cartilages seen
    • Grade 4: Neither epiglottis nor glottis seen
  112. POGO Classification System
    Airway assessment used by some EMS personnel to rate the percentage of glottic opening (POGO) one can visualize from 0% to 100%
  113. High-Pressure Regulator
    Regulator used to transfer oxgen at high pressures from tank to tank
  114. Therapy Regulator
    Pressure regulator used for delivering oxygen to patients
  115. Nasal Cannula
    Catheter placed at the nares
  116. Venturi Mask
    High-flow face mask that uses a Venturi system to deliver relatively precise oxygen concentrations
  117. Ventilation Methods
    • Mouth-to-mouth/mouth-to-nose
    • Mouth-to-mask
    • Bag-valve mask
    • Demand valve device
    • Automatic transport ventilator