AIRWAY FINAL CARDS

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medic11
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80034
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AIRWAY FINAL CARDS
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2011-04-16 16:27:42
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AIRWAY CARDS
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Airway Cards for Class final 4/15/11
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  1. 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
  2. What is diffusion?
    Movement of a gas fr an area of higher concentration to one of lower concentration
  3. 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
  4. What is total lung capacity?
    • Total vol of air @ max inhalation
    • Avg adult male = 6 liters
  5. What is tidal vol?
    • Avg vol of gas inhaled or exhaled in 1 resp cycle
    • Approx 500 cc
  6. What is dead space?
    Amt of gasses in tidal vol that remains in the airway
  7. What is alveolar vol?
    Amt of gas in tidal vol that reaches alveoli for gas exchange
  8. 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
  9. Inspiratory reserve Vol (IRV) is?
    Amt of air that can be maximally inhaled after normal inspiration
  10. Expiratory Reserve Vol (ERV) is?
    Amt of air that can be exhaled aft normal expiration
  11. What is residual vol?
    Amt of remaining in lungs @ end of maximal resp
  12. What is functional residual vol?
    Vol of gas remaining @ end of normal expiration
  13. What is atelectasis?
    Alveolar collapse
  14. What is a pneumothorax?
    Accumulation of air or gas in the pleural cavity
  15. What is a hemothorax?
    Accumulation of blood or fluid in the pleural cavity
  16. What is hypoxemia?
    Decreased partial pressure of O2 in blood
  17. What are the 4 types of hypoxia?
    • Hypemic
    • Stagnant
    • Histotoxic
    • Hypoxic
  18. What is Hypemic Hypoxia?
    • Adequate O2 available
    • Obstruction prevents O2 fr diffusing across alveolar membrane
    • Causes= COPD, Pneumonia, PE, Pulmonary Embolism
  19. What is Stagnant Hypoxia?
    • Adequate O2 Available.
    • Blood moving slowly & not reaching cells
    • Causes = AMI, Cardiomyopathy, Cardiogenic Shock, Crush Inj's
  20. What is Histotoxic Hypoxia?
    • Adequate O2 Available
    • RBCs cant use O2 due to tissue pathology or poisoning
    • Causes = Cyanide Toxicity, CO poisoning, Anaphylaxis
  21. What is Hypoxic Hypoxia?
    • Inadequate Availability of O2
    • Reduces pO2 in lungs due to lower avail of O2
    • Causes = Altitude, Scuba Diving Accidents
  22. What is the 5 airway mgmt techniques triangle?
    • Basic Maneuvers
    • Basic Adjuncts
    • Intubation
    • Bail Outs
    • Surgical
  23. Effective ventilatory support requires tidal vol of @ least ____ of O2 @ ____ to ____ breaths/min.
    • 800 mL
    • 10 to 12
  24. What 3 things are required for effective artificial ventilation?
    • Patent Airway
    • Effective Mask/Face seal
    • Delivery of adequate vol
  25. What are 3 forms of suctioning equip?
    • Yankauer
    • Soft Tip Catheters
    • Gastric Tubes
  26. How long & when should you suction?
    • No longer than 10 secs
    • Only while retracting the catheter
  27. What should always be done b/f suctioning?
    Preoxygenation
  28. What is anoxia?
    Absence or near absence of O2
  29. What are Kussmaul's respirations?
    • Deep, slow or rapid, gasping breathing
    • Common in diabetic ketoacidosis
  30. Describe Cheyne-Stokes Respirations.
    • Progressively deeper, faster breathing alternating w/shallow, slower breathing
    • Indicative of brain stem inj
  31. Describe Biot's respirations.
    • Irregular pattern of rate & depth w/sudden, periodic episodes of apnea
    • Indicates ^ ICP
  32. Describe Central Neurogenic Hyperventilation.
    • Deep, rapid resp,
    • Indicates ^ ICP
  33. What are agonal Respiration?
    • Shallow, slow or infrequent breathing
    • Indicates brain anoxia
  34. What causes snoring respirations?
    partial obstruction of upper airway by tongue
  35. What causes gurgling?
    An accumulation of blood, vomitus or other secretions in upper airway
  36. Describe Stridor.
    • Harsh, high pitched sound heard on inhalation,
    • assoc w/ laryngeal edema or constriction
  37. Describe Wheezing.
    • Musical, squeaking or whistling sound heard in inspiration &/or expiration.
    • Indicates bronchiolar constriction
  38. What are quiet respirations?
    Diminished or absent breath sounds are an ominous finding & indicate a serious prob w/airway breathing or both
  39. What are 2 sounds that may indicate compromise of gas exchange?
    • Crackles (rales)
    • Rhonchi
  40. Describe Crackles (rales).
    • Fine, bubbling sound heard on inspiration.
    • Associated w/ fluid in lower bronchioles
  41. Describe Rhonchi.
    • Course, rattling noise heard on inspiration
    • Associated w/ inflammation, mucus or fluid in the bronchioles
  42. What is compliance?
    Stiffness or flexibility of lung tissue
  43. A sudden drop of ETCO2 to 0 could indicate?
    • Esophageal intubation
    • Vent disconnection or defect
    • Defect in CO2 analyzer
  44. Sudden decrease in CO2 NOT to 0 could indicate?
    • Leak in vent sys or obstruction
    • Partial disconnect of vent circuit
    • Partial airway obstruction
  45. Exponential decrease in ETCO2 could indicate?
    • Pulmonary Embolism
    • Cardiac Arrest
    • Hypotension (sudden)
    • Severe Hyperventilation
  46. Change in CO2 baseline could indicate?
    • Calibration Error
    • H2O drop in analyzer
    • Mechanical failure (ventilator)
  47. Sudden ^ ETCO2 could indicate?
    • Accessing area of lung previously obstructed
    • Release of tourniquet
    • Sudden ^ BP
  48. Gradual lowering of ETCO2 could indicate?
    • Hypovolemia
    • Decreased cardiac output
    • Hypothermia; drop in metabolism
  49. Gradual ^ in ETCO2 could indicate?
    • ^ body temp
    • Hpoventilation
    • CO2 absorption
    • Partial airway obstruction
  50. What does Phase I on a capnogram indicate?
    • Respiratory baseline
    • Corresponds to late inspiration & early experation
  51. What does Phase II on a capnogram indicate?
    • Resp upstroke
    • Reflects CO2 in the alveoli
  52. 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
  53. What does Phase IV on a capnogram indicate?
    • Resp inspiration
    • Sudden downstroke & returns to baseline during inspiration
  54. Arterial blood gas is PaCO2 in the rang of ____ mmHg.
    35-40
  55. Mixed venous blood gas is PeCO2 in the range of ____ mmHg.
    46-48
  56. Exhaled CO2 is EtCO2 in the range of ____ mmHg.
    35-45
  57. What does LEMON in the Lemon Law mean?
    • L Look externally
    • E Evaluate 3-3-2 rule
    • M Mallampati
    • O Obstruction
    • N Neck Mobility
  58. What should you look for when looking externally?
    • Obesity or Very small
    • Short muscular neck
    • Lg breasts
    • Buck teeth
    • Receding Jaw or dentures
    • Burns
    • Facial Trauma
    • S/S of anaphylaxis
    • Stridor
    • FBAO
  59. 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
  60. Describe Class 1 Mallampati.
    Visualization of soft palate, fauces, uvula & anterior & posterior pillars
  61. Describe Class 2 Mallampati.
    Visualization of soft palate, fauces & uvula
  62. Describe Class 3 Mallampati.
    Visualization of soft palate & base of uvula
  63. Describe Class 4 Mallampati.
    Soft palate is not visible @ all
  64. 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
  65. What is a quick test to chk neck mobility?
    Put chin to chest then move toward ceiling
  66. Name 4 contraindications to ET intubation.....
    • Penetrating neck trauma w/rapidly expanding hematoma
    • Tracheal inj or Laryngeal Fx
    • Epiglotitis
    • Pt doesnt want to be intubated
  67. What is avg size tube for an adult male? Female?
    • 7.5 - 8 male
    • 7 female
  68. How do you adjust ur tube size for nasal intubation?
    Go down 1/2 to a full size
  69. What is the formula for determining the size of a pedi tube?
    Age +16 divided by 4
  70. What the eye of Murphy?
    Dot on an ET tube marking the place where a stylet is never to pass
  71. What is the vocal card marker?
    Black line on an ET tube that shows where to stop insertion. Once this passes the cords STOP!
  72. What is ELM maneuver?
    Moving the thyroid cartilage & vocal cords in order to attempt to get a better view.
  73. Do we ever move the laryngiscope blade to get a better view?
    NEVER!!!! Causes trauma
  74. Give 2 contraindications for nasal intubation.
    • Basil Skull Fx
    • Coumadin pt (blood thinners)
  75. 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
  76. 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
  77. Give 6 indications for nasotracheal intubation.
    • Spinal Inj
    • Clenched teeth
    • Jaw Fx, oral inj or recent oral surgery
    • Significant angioedema
    • Obesity
    • Arthritis preventing head placement
  78. 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
  79. Give 4 advantages of nasal intubation.
    • Head & neck remains in neutral position
    • Less gag response
    • More easily secured
    • Pt cant bite tube
  80. 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
  81. What is the purpose of lung surfactant?
    Keeps surface tension of alveoli
  82. What is the avg vol of tidal vol?
    500
  83. A capnogram shaped like a shark tooth is indicative of what 3 resp problems?
    COPD, Bronchospasm, Asthma
  84. Define partial pressure of a gas. . .
    In a mix of gases, portion of pressure exerted by each component in the mix
  85. What is pulmonary ventilation dependent upon?
    Pressure changes in the thoracic cavity
  86. What is hypoxic drive?
    Mechanism the increases resp stim when PaO2 falls & inhibits resp stim when PaO2 climbs
  87. Describe the Hering-Breuer reflex.
    As lung stretch decreases, the stretch receptors cease firing preventing overexpansion of the lungs
  88. Minute volume is defines as:
    Amt of gas moved in and out of the resp tract in 1 min.

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