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Describe Respiration Vs Ventilation
Respiration is the exchange of gasses where as Ventilation is the physical act of moving air into & out of the lungs
What is diffusion?
Movement of a gas fr an area of higher concentration to one of lower concentration
What factors affect O2 concen in blood?
- Lowered hemoglobin Concen
- Inadequate Alveolar Vent
- Lowered diffusion across pulmonary membrane
- Vent/perfusion mismatch when portion of alveoli collapse
What is total lung capacity?
- Total vol of air @ max inhalation
- Avg adult male = 6 liters
What is tidal vol?
- Avg vol of gas inhaled or exhaled in 1 resp cycle
- Approx 500 cc
What is dead space?
Amt of gasses in tidal vol that remains in the airway
What is alveolar vol?
Amt of gas in tidal vol that reaches alveoli for gas exchange
Minute vol is & its formula is?
- Amt of gas moved in & out of resp tract in 1 min
- Minute Vol = Tidal Vol x Breathes/Min
Inspiratory reserve Vol (IRV) is?
Amt of air that can be maximally inhaled after normal inspiration
Expiratory Reserve Vol (ERV) is?
Amt of air that can be exhaled aft normal expiration
What is residual vol?
Amt of remaining in lungs @ end of maximal resp
What is functional residual vol?
Vol of gas remaining @ end of normal expiration
What is atelectasis?
What is a pneumothorax?
Accumulation of air or gas in the pleural cavity
What is a hemothorax?
Accumulation of blood or fluid in the pleural cavity
What is hypoxemia?
Decreased partial pressure of O2 in blood
What are the 4 types of hypoxia?
What is Hypemic Hypoxia?
- Adequate O2 available
- Obstruction prevents O2 fr diffusing across alveolar membrane
- Causes= COPD, Pneumonia, PE, Pulmonary Embolism
What is Stagnant Hypoxia?
- Adequate O2 Available.
- Blood moving slowly & not reaching cells
- Causes = AMI, Cardiomyopathy, Cardiogenic Shock, Crush Inj's
What is Histotoxic Hypoxia?
- Adequate O2 Available
- RBCs cant use O2 due to tissue pathology or poisoning
- Causes = Cyanide Toxicity, CO poisoning, Anaphylaxis
What is Hypoxic Hypoxia?
- Inadequate Availability of O2
- Reduces pO2 in lungs due to lower avail of O2
- Causes = Altitude, Scuba Diving Accidents
What is the 5 airway mgmt techniques triangle?
- Basic Maneuvers
- Basic Adjuncts
- Bail Outs
Effective ventilatory support requires tidal vol of @ least ____ of O2 @ ____ to ____ breaths/min.
What 3 things are required for effective artificial ventilation?
- Patent Airway
- Effective Mask/Face seal
- Delivery of adequate vol
What are 3 forms of suctioning equip?
- Soft Tip Catheters
- Gastric Tubes
How long & when should you suction?
- No longer than 10 secs
- Only while retracting the catheter
What should always be done b/f suctioning?
What is anoxia?
Absence or near absence of O2
What are Kussmaul's respirations?
- Deep, slow or rapid, gasping breathing
- Common in diabetic ketoacidosis
Describe Cheyne-Stokes Respirations.
- Progressively deeper, faster breathing alternating w/shallow, slower breathing
- Indicative of brain stem inj
Describe Biot's respirations.
- Irregular pattern of rate & depth w/sudden, periodic episodes of apnea
- Indicates ^ ICP
Describe Central Neurogenic Hyperventilation.
- Deep, rapid resp,
- Indicates ^ ICP
What are agonal Respiration?
- Shallow, slow or infrequent breathing
- Indicates brain anoxia
What causes snoring respirations?
partial obstruction of upper airway by tongue
What causes gurgling?
An accumulation of blood, vomitus or other secretions in upper airway
- Harsh, high pitched sound heard on inhalation,
- assoc w/ laryngeal edema or constriction
- Musical, squeaking or whistling sound heard in inspiration &/or expiration.
- Indicates bronchiolar constriction
What are quiet respirations?
Diminished or absent breath sounds are an ominous finding & indicate a serious prob w/airway breathing or both
What are 2 sounds that may indicate compromise of gas exchange?
Describe Crackles (rales).
- Fine, bubbling sound heard on inspiration.
- Associated w/ fluid in lower bronchioles
- Course, rattling noise heard on inspiration
- Associated w/ inflammation, mucus or fluid in the bronchioles
What is compliance?
Stiffness or flexibility of lung tissue
A sudden drop of ETCO2 to 0 could indicate?
- Esophageal intubation
- Vent disconnection or defect
- Defect in CO2 analyzer
Sudden decrease in CO2 NOT to 0 could indicate?
- Leak in vent sys or obstruction
- Partial disconnect of vent circuit
- Partial airway obstruction
Exponential decrease in ETCO2 could indicate?
- Pulmonary Embolism
- Cardiac Arrest
- Hypotension (sudden)
- Severe Hyperventilation
Change in CO2 baseline could indicate?
- Calibration Error
- H2O drop in analyzer
- Mechanical failure (ventilator)
Sudden ^ ETCO2 could indicate?
- Accessing area of lung previously obstructed
- Release of tourniquet
- Sudden ^ BP
Gradual lowering of ETCO2 could indicate?
- Decreased cardiac output
- Hypothermia; drop in metabolism
Gradual ^ in ETCO2 could indicate?
- ^ body temp
- CO2 absorption
- Partial airway obstruction
What does Phase I on a capnogram indicate?
- Respiratory baseline
- Corresponds to late inspiration & early experation
What does Phase II on a capnogram indicate?
- Resp upstroke
- Reflects CO2 in the alveoli
What does Phase III on a capnogram indicate?
- Resp Plateau
- Reflects airflow thru vented alveoli w/ constant CO2 level
- Highest level is called ETCO2 & is recorded as such
What does Phase IV on a capnogram indicate?
- Resp inspiration
- Sudden downstroke & returns to baseline during inspiration
Arterial blood gas is PaCO2 in the rang of ____ mmHg.
Mixed venous blood gas is PeCO2 in the range of ____ mmHg.
Exhaled CO2 is EtCO2 in the range of ____ mmHg.
What does LEMON in the Lemon Law mean?
- L Look externally
- E Evaluate 3-3-2 rule
- M Mallampati
- O Obstruction
- N Neck Mobility
What should you look for when looking externally?
- Obesity or Very small
- Short muscular neck
- Lg breasts
- Buck teeth
- Receding Jaw or dentures
- Facial Trauma
- S/S of anaphylaxis
What Does 3-3-2 stand for?
- 3 = 3 fingers fit vertically in mouth
- 3 = 3 fingers between mentum & hyoid bone
- 2 = 2 fingers fr floor of mouth to hyoid cartilage
Describe Class 1 Mallampati.
Visualization of soft palate, fauces, uvula & anterior & posterior pillars
Describe Class 2 Mallampati.
Visualization of soft palate, fauces & uvula
Describe Class 3 Mallampati.
Visualization of soft palate & base of uvula
Describe Class 4 Mallampati.
Soft palate is not visible @ all
Describe Cormack & Lehane Grading of trachea opening.
- Grade 1: Full aperture visible
- Grade 2: Lower part of cords are visible
- Grade 3: Only epiglottis is visible
- Grade 4: Epiglottis not visible
What is a quick test to chk neck mobility?
Put chin to chest then move toward ceiling
Name 4 contraindications to ET intubation.....
- Penetrating neck trauma w/rapidly expanding hematoma
- Tracheal inj or Laryngeal Fx
- Pt doesnt want to be intubated
What is avg size tube for an adult male? Female?
How do you adjust ur tube size for nasal intubation?
Go down 1/2 to a full size
What is the formula for determining the size of a pedi tube?
Age +16 divided by 4
What the eye of Murphy?
Dot on an ET tube marking the place where a stylet is never to pass
What is the vocal card marker?
Black line on an ET tube that shows where to stop insertion. Once this passes the cords STOP!
What is ELM maneuver?
Moving the thyroid cartilage & vocal cords in order to attempt to get a better view.
Do we ever move the laryngiscope blade to get a better view?
NEVER!!!! Causes trauma
Give 2 contraindications for nasal intubation.
- Basil Skull Fx
- Coumadin pt (blood thinners)
Give 5 tricks for nasal intubation.
- Dont rush!
- Viscous/Hurricane/Neosynephrine are your friends
- Maximally deflate cuff
- Bevel AWAY fr septum
- Dont start too deep
Give 6 verifications of proper tube placement.
- Direct visualization
- Chest rise
- Lack of epigastric sounds
- ETCO2 detection
- Esophageal detector devices
- Tube contents: condensation Vs vomitus
Give 6 indications for nasotracheal intubation.
- Spinal Inj
- Clenched teeth
- Jaw Fx, oral inj or recent oral surgery
- Significant angioedema
- Arthritis preventing head placement
What are 5 contraindications for nasal intubation?
- Suspected nasal Fx
- Suspected basilar skull Fx
- Deviated septum or other obstruction
- Cardiac or resp arrest
- Unresponsive pt
Give 4 advantages of nasal intubation.
- Head & neck remains in neutral position
- Less gag response
- More easily secured
- Pt cant bite tube
Give 6 disadvantages of nasal intubation.
- More difficult & time consuming than oro
- May cause nasal trauma
- Tube may kink or clog more easily
- ^ risk of infection
- ^ possibility of improper placement
- Pt must be breathing
What is the purpose of lung surfactant?
Keeps surface tension of alveoli
What is the avg vol of tidal vol?
A capnogram shaped like a shark tooth is indicative of what 3 resp problems?
COPD, Bronchospasm, Asthma
Define partial pressure of a gas. . .
In a mix of gases, portion of pressure exerted by each component in the mix
What is pulmonary ventilation dependent upon?
Pressure changes in the thoracic cavity
What is hypoxic drive?
Mechanism the increases resp stim when PaO2 falls & inhibits resp stim when PaO2 climbs
Describe the Hering-Breuer reflex.
As lung stretch decreases, the stretch receptors cease firing preventing overexpansion of the lungs
Minute volume is defines as:
Amt of gas moved in and out of the resp tract in 1 min.