Airway

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Author:
dallas.dawn
ID:
174613
Filename:
Airway
Updated:
2012-09-30 23:36:41
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Emt
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Description:
Airway management
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  1. diffusion
    -a process in which molecules move from an area of higher concentration to an area of lower concentration 
  2. upper airway functions: 
    upper airway functions: warm filter and humidify air 
  3. aspiration-
    the introduction to vomitus or other foreign material into the lungs 
  4. epigolottis-
     leaf shaped cartilaginous structure that helps separate the digestive system from the respiratory system. To help prevent food and liquid from entering th larynx during swallowing 
  5. visceral pleura
    - lung tissue is covered with a thing, slippery outer membrane
  6. parietal pleura-
     lines the inside of the thoracic cavity 
  7. bronchioles-
     thin, hollow tubes made of smooth muscle 
  8. alveoli-
  9. millions of thin walled balloon like sacs that serve as the functional site for the exchange of oxygen and co2 
  10. ventilation
    the physical act of moving air into and out of the lungs 
  11. oxygenation
     the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream 
  12. respiration-
     the actual exchange of oxygen and co2 in the alvoli as well as the tissues of the body 
  13. inhalation
    • --the active, muscular part of breathing that draws air into the airway and lungs ---diaphragm and intercostal muscles contract 
    • --when the diaphragm contracts, it moves down slightly and enlarges the thoracic cage from top to bottom and when the intercostal muscles contract, they lift the ribs up and out 
  14. diaphragm
    --voluntary muscle--> when taking a deep breath coughing or holding your breath ---> automatic ; during sleep and other times 
  15. accessory muscles are secondary muscles of respiration 
  16. partial pressure-
    -term used to describe the amount of fas in air or dissolved in fluid, such as blood 
  17. alveolar ventilation
    - “the volume of air that reaches the aveloi” determined by subtracting the amount of dead space air from the tidal volume 
  18. tidal volume=
      the amount of air ml that is moved in or out of the lungs during one breath 
  19. dead space
     the portion of the tidal volume that doesn’t reach the alveoli and thus doesn’t participate in gas exchange. 
  20. minute ventilation
    (minute volume) the amount of air moved through  the lungs in one minute minus the dead space~ calculated by subtracting the dead space from the tidal volume, then multiplying that number by the respiratory rate
  21. varations
    • patient is breathing at a rate of 12 but the tidal volume is reduced(shallow) minute volume will decrease 
    • patient is breathing at a rate of 12 and the tidal volume increase (deep breathing) minute volume will increase 
  22. vital capacity
    amount of air that can be forcibly expelled from the lungs after breathing deeply
  23. residual volume=
    the air that remains in the lungs after maximal expiration 
  24. exhalation 
     doesn’t normal require muscular effort --passive process--diaphragm and intercostal muscles relax
  25. patent-
  26.  open clear of obstruction--air will reach the the lungs only if travels though the trachea 
  27. hypoxia
    =a dangerous condition in which the body tissues and cells do not have enough oxygen 
  28. hypoxic drive
    =a condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive, seen in patients with chronic lung diseases.
  29. *the drive to breathe is based on ph changes related to co2 in the blood and cerbrospinal fulid 
  30. *early sigs of hypoxia include restlessness irritability apprehension, fast heart rate, and anxiety *late signs of hypoxia include mental status change, a weak*thready) pulse and cyanosis. 
  31. dyspnea
    =shortness of breath 
  32. oxygenation---
    • adequate oxygenation is required for internal respiration to take place however it doesn’t guarantee internal respiration is taking place. you generally cannot oxygenate with out ventilation it is possible to ventilate with out oxygenation 
    • ventilation with out adequate oxygenation occurs in clumbers who ascend too quickly to an altitude of lower atmoshperic pressure--at high alt the percentage of 02 remains the same but atmoshperic pressure make it difficult to adequately bring sufficeint amount of o2 into the body 
  33. metabolism(cellular respiration)
    the biochemical processes that result in production of energy from nutrients within the cells 

    respiration is the process of exchaning oxygen and co2 happens by diffusiotn 
  34. external respiration 
    pulmonary respiration--is the process of breathing fresh air into the respiratory system and exchaning o2 and co2 between the alveoli and the blood in the pulmonary capillaries 
  35. fresh air that inspired into the lungs contains 
    • 21%02 
    • 78%N 
    • .3% co2 
  36. surfactant 
    a lipid proten substance that coats teh alveoli in the lungs, decreases alveolar surface tension, an keeps teh alveoli expanded, a low level in a premature infant contributes to respiratory distress syndrome
  37. internal respiration 
    the exchang eof oxygen and co2 between the systemic curculatory system and the cells of teh body 
  38. aerobic metabolism 
    metabolsim that can proceed only with oxygen 
  39. anerobic metabolism 
    metabolism that take place in the absence of oxygen, the principle product i lactic acid 
  40. chemoreceptors 
    monitor the levels of02 co2 and the ph of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the bodys needs at any given time 
  41. hypercarbia 
    increased carbon dioxide level in the bloodstream 
  42. intrapulmonary shunting 
    bypassing of oxygen poor blood past nonfunctional alveoli to th eleft side of the heart 
  43. tension pneumothrorax 
    a life threathing collection of air within the pleural space , the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures to the opposite side 
  44. adequate breathing 
    • normal rate 12-20 
    • a regular pattern of inhalation and exhalation 
    • clear and equal lung sounds on both sides of the chest(bilateral) 
    • regular and equal chest rise and rall 
    • adequate depth or tidal volume 
  45. bag mask devise 
    devise with a one way valve and a face mask attached to a ventilation bag, when attached to a reserbior and connected to o2 delivers more that 90% supplamental oxygen 
  46. respiratory rate ranges 
    • adult 12-20
    • children 15-30
    • infants 25-50
  47. labored breathing 
    breathing that requires greater than normal effort, mau ne slower or faster than normal and usually requires the use of accessory muscles 
  48. accessory muscles 
    neck muscle chest pectoralis major and abs 
  49. signs of inadequate breathing 
    • resp rate fewer than 12 or more than 20 
    • irr rythm 
    • diminished absent or noise ausculated breath sounds 
    • unequal chest expansion, resulting in reduced tidal colume 
    • increaed effort of breathing 
    • shallow depth 
    • skin that is pale, cyanotic , coool or moist 
    • skin pulling in aournd the ribs or aboice the clavicles during insirations 
  50. retractions 
    skin pulling in around the ribs or aboce the clacivles during inspiration 
  51. agonal gasps 
    • occasional, gasping breaths that occur after the heart has stopped 
    • **you will need to procide artifical ventilations and most likely chest compressions 
  52. some patients may have irr resp breath patterns to a certain condition 
    cheyne stokes 
    respirations are often seen in patients with stroke and patients with serious head injuries 
  53. apnea
    lack of spontaneous breathing
  54. ataxic respirations 
    ineffective respirations tha may or may not have a identidiafiable pattern 
  55. pulse oximetry 
    an assessment tool that measure oxygen sturation of hemoglobin in the capillary beds 
  56. innaccurate pulse oximetry reading
    • hypovolemia 
    • anemia 
    • severe peripheral vasoconstriciton 
    • time delay in detecting respiratory insufficeincy 
    • nail polish 
    • dirty fings 
    • carbon monoxide--displaces o2 from the hemoglobin
  57. causes of airway obstruction include 
    •  relaxation of the tongue in an unresponsive patient 
    • foreign objects 
    • blood clots ,broken teeth following tramua 
    • airway tissue swelling infection, allergic reaction 
    • aspirated vomitus 
  58. head tilt-chin lift maneuver 
    • a combination of two movements to open the airway by tilting the forehead back and lifting the chin
    • **not used for trauma patients 
  59. jaw thrust maneuver 
    technique to open the airway by placing the fingers behind thae angle of the jaw and bringing the jaw forward

    used for patients who may have a cervical injury 
  60. oropharyngeal oral airway 
    airway adjunct inserted into the mouth of an unresponsive patient to keep the tongue from blocking the upper airway and to facilitate suctioning the airway
  61. indications for oral airway include 
    • unresponsive patients without a gag reflex 
    • any apneic patient being ventilated with a bag mask device 
  62. contradictions or oral airway 
    • conscious patients 
    • any patient who has an intact gag reflex 
  63. gag reflex
     protective relex mechanism that prevents food and other particles from entering teh airway. 
  64. nasopharyngeal airway 
    used withan unresponsive patient or a patient with an altered elvel of consciousness who has an intact gag relex and is not able to maintain hsi or her airway spontaneuously 
  65. indications for use of nasal airway 
    • semiconscious or unconscious patients with an intact gag relex 
    • patients who otherwise will not tolerate an orpharyngeal airway 
  66. contradictions for nasal airway 
    • severe head injury with blood draining from teh nose 
    • history  of fractured nose s
  67. suction catheter
    time limit -15 sec adults 
    a hollow, cylindrical device that is used to remove fluids from the patients airway 

    a tonsil tip catheter is the best kind of catheter for suctioning the oropharynx in adults 
  68. stoma
    opening through the skin that goes into an organ or other stucture 

    tips with a contour  french or whistle tip
  69. recovery postion
    a side laying postiion used to maintain a clear airway in unconscious patients without injuries who are breathing adequately 
  70. always give supplemental oxygen to patients who are hypoxic because they arenot getting enough oxygen to the tissues and cells of the body 
     
  71. pin indexing system 
     a system established for portable cylinders to ensure taht a regulator is not connected to a cylinder containing the wrong type of gas 
  72. pressure in gas full of oxygen cylinder 
    2,000psi 
  73. oxygen suppotts combustion 
  74. nonrebreathing mask
    • a combination mask and resercior bag system that is the prederred way to give oxygen in the prehoptial settering 
    • delivers up to 90 percent inspired oxygen and prevents inhaling the exhaled gas

    showing signs of hypoxia 
  75. nasal cannula
    • an oxigen delivery device in which oxygen flows through two small, tuvelike prongs that fit into the patients nostrils
    • delivers 24% to 44% supplemtntal oxygen
    • 1-6L
    • can dry out the nose( consider use of humidifier) 
  76. Venturi masks 
    • 24-40 % 
    • the use of its fine adjustment capaabilities in the long term maagement of physiologicall stabel patients 
  77. Tracheostomy masks 
    masks designed to cover the tracheostomy hole 
  78. methods of ventalition (order of preferance )
    • mouth to mask with one way valve 
    • two person bag mask device with reservior and supplemental oxygen
    • manually triggered ventilation device 
    • one person bag mask device with oxygen reservior and sup o2 
  79. purpose of assisted ventalitions 
    • improve the overall oxugenation and ventialatory status of patiens 
    • pat are no longer able to maintain adequate oxygen levels for the body and need assistance to prevent further hypoxia 
  80. ventilation rates 
    • adult one breath per  5 to 6 sec 
    • child one breath per 3 to 5 sec 
    • infant one breath 3 to 5 sec 
  81. barrier device 
    a protective item such as a pocket mask with a valve that limtis exposure to a patients body fluids 
  82. bag mask device 
    • oxygen flow rate at 15 l per min and a adequate seal can deliver nearly 100% o2
    • provides less tidal volume than mouth to mask ventilation, but it delivers a much higher concentration of oxygen. 
    • most common method 
  83. gastric distension 
    a condition in which air fills the stomach  often as a result of high colume and pressure during artifical ventialtion 
  84. maually triggered ventilation device
    • a fixed flow rate ventilation device that delivers a breath every time its button is pushed, also referred to as a flow resticted oxygen powered ventilation device
    • device shouldnt' be used on patients with copd or suspected cervial spine or chest injureis 
  85. compliance
    • the ability of the alveoli to expand when air i drawn in during inhalation, poor lung compliance is the inabliltiy of the alveoli to fully expand during inhilation
    • barotrauma is common complication assc with manually triggered ventilation needs to asses for full chest recoil ATV
  86. continuous positive airway pressure CPAP 
    a method of ventilation used primarily in the treatment of critically ill patients with respiratory distress, can prevent the need for endotracheal intubation 
  87. cpap mechanism 
    increases pressure in the lungs opens collapsed alveoli, pushes more oxygen across teh alveolar membrane and forces interstitial fluid back into the pulmonary circulation 
  88. indication for cpap 
    • patient must be alert and able to follow commands 
    • patient is displaying obcious sighns of moderate to severe respiratory distress from an underlying pathology, such as pulmonary edema or obstuctive pulmonary disease
    •  patient is breathing rapidly such that it affects overall minute volume 
  89. contraindictions of using cpap
    • patient who is in respiratory arrest
    • signs and symptoms of a pneumothrorax or chest trauma  patient who has a tracheostomy 
    • active gastrointestinal bleeding or vomiting 
    • patient is unable to follow verbal commands 
  90. tracheostomy 
    surgical opening in the trachea 
  91. good air exchange you will hear wheezing 
    • the production of whistling sounds during respirations 
    • indicative of a mild lower airway obsturction 
    • as long as teh patient can breath cough forcefull or talk you should not interfere with the patients efforts to expel the foregn object 
  92. with poor air exchange stirdor
    • weak, ineffective cough and may have increased difficutly breathing (stridor--a high pitched noise heard primarily on inspiration ) and cyanosis 
    • an indication of a mild upper airway obstuction

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