Lonestar patient asm
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| What it the most frequent Airway Obstruction in the unconscious Patient? | The Tongue.
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| What is Nasal Cavity's function? | Warm, filter, and humidifies air.
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| What is the Pharynx? | A Muscular tube that extends vertically from the back of the soft palate to the superior aspect of the esophagus. Contains Epiglottis and Vallecula.
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| What is the Larynx? | Joins the Pharnyx with the Trachea. Contains Catilage (Thyroid,Cricoid, and Arytenoid) Glottic Opening (Vocal Cords) Hyoid Bone
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| What structures are in the Lower Airway? | Trachea Bronchi Alveoli Lung Parenchyma Pleura
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| Where does the trachea divide into right and left mainstem bronchi? | At the Corina.
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| What do the secondary and tertiary bronchi ultimately branch into? | Bronchioles.
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| What is the Trachea? | Connects the Larynx to the mainstem bronchi. Contains Catilaginous C-shaped open rings. Lined with epithelium containing cilia and mucous-producing cells.
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| What it the Alveoli? | The key functional unit of the respiratory system. Facilitates diffusion of oxygen and carbon dioxide.
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| What is Ateltectasis? | Alveolar Collapse caused by insufficient surfactant or if the alveolar are not inflated. No gas exhcange takes place in atelectasis alveoli.
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| What is Parenchyma? | Principal or essential parts of an organ.
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| What is the Visceral Pleura? | The visceral pleura envelopes the lungs and does not contain nerve fibers.
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| What is the Parietal Pleura? | The parietal pleura lines the thoracic cavity and does contain nerve fibers.
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| What is Respiration? | Respiration is the exchange of gases between a living organism and its enviroment. Provides Oxygen to the cells and removes Carbon Dioxide.
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| What is Ventilation? | Ventilation is the mechanical process that moves air in and out of the lungs. ( What we see and what we count)
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| What is Inhalation? | Active, muscular part of breathing. Diaphragm and intercostal muscles contract increasing intrathoracic volume and subsequently dropping pressure (a vacuum).
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| What is Exhalation? | Under normal conditions does not require muscular effort; therefore a passive process. Diaphragm and intercostal muscles relax to make thorax smaller thus compresses air out the lungs.
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| What is Diffusion? | Movement of a gas from an are of higher concentration to an area of lower concentration. Transfer gases between the lungs and the blood, and between the blood and the peripheral tissues.
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| What are the four major respiratory gases? | Nitrogen Oxygen Carbon Dioxide Water
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| What is Normal Arterial Partial Pressure? | Abbreviated Pa. Oxygen (PaO2) = 100 torr (average = 80-100)
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| What are Factors that affect oxygen concentration in the blood? | Decreased Hemoglobin concentration. Inadequate alveolar ventilation. Decreased diffusion across the pulmonary membrane. Ventilation/perfusion mismatch occurs when a portion of the alveoli collapses.
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| What are Factors affecting Carbon Dioxide concentrations in the blood? | Hyperventilation. Increased Carbon Dioxide production. Decreased Carbon Dioxide elimination.
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| What causes increased Carbon Dioxide production? | Fever Muscle exertion Shivering Metabolic Processes
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| What is Hyperventialtions effect on concentraions in the blood? | Lowers Carbon Dioxide levels due to increased respiratory rates or deeper respiration.
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| What causes decreased Carbon Dioxide elimination? | Decreased Alveolar Ventialtion.
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| What are respiratory Centers? | Collective group of control centers in the pons and medulla.
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| What groups are in the Medullary Rhythmicity area? | Dorsal Respiratory Group (DRG) and VEntral Respiratory Group (VRG).
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| What does the Dorsal Respiratory Group do? | Integrates information from chemoreceptors for pCO2 and mechanoreceptros. Signals the VRG to alter the breathing rhythm.
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| What does the Ventral Respiratory Group do? | Responsible for basic rhythm control. Normal, quiet breathing rhythm is generated by alternating patterns of stimulation and inhibition of motor neurons that signal the muscles of the diaphragm.
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| What does the Pontine Respiratory Group (PRG; formerly called the pneumotaxic and apneustic center) do? | Limit respiratory duration by sending inhibitroy signals to the medullary rhythmicity area.
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| Where are Chemoreceptors located? | Located in Carotid Bodies, arch of the aorta, and the medulla.
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| How are chemorecptors stimulated? | Stimulated by decreased PaO2, increased PaO2, and decreased pH.
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| What is the primary control of respiratory center stimulation? | Cerebrospinal fluid (CSF) pH
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| What is the Herin-Breuer Reflex? | Prevent over inflation of the lungs in a conscious, spontaneously breathing person.
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| What is total lung capacity? | Total colume of air at maimum inhalation. Average Adult male TLC is 6 liters.
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| What is Tidal Volume? | Average volume of gas inhaled or exhaledin one respiratory cycle. Approximately 500cc.
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| What are factors influencing respiratory rate? | Fever, emotion, pain, hypoxia, acidosis, stimulant drugs, depressant drugs, and sleep.
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| What are the average respiratory rates for infants, children, and adults? | Infants 40-60 Children 18-24 Adult 12-20
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| What is Alveolar Minute Volume? | Amount of gas that reaches the alveolifor gas exchange in one minute.
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| What is Inspiratory Reserve Volume? | The amount of air that can be maximally inhaled after a normal inspiration. Amount of gas that can be forcefully inspired in addition to a normal breath's tidal volume.
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| What is Expiratory Reserve Volume? | The amount of air that can be maximally exhaled after a normal expiration. Amount of gas that can be forcefully expired at the end of a normal expiration.
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| What is Dead Space? | Amount of gases in tidal volume that remains in the airway. Not all the air inspired during a breath participates in gas exchange and can be further classified as anatomic or physiologic dead space.
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| What is Anatomic Dead Space? | In the average adult man this equates to approximately 150 mL. Anatomic dead space includes airway passages such as the trachea and bronchi that are incapable of participating in gas exchange.
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| What is Physiologic Dead Space? | Physiologic dead space includes alveoli that have the potential to participate in gas exchange but do not because of disease or obstruction.
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| What is Alveolar Volume? | The amount of gas in the tidal volume that reaches the alveoli for gas exchange. The Difference between Tidal Volume and Dead Space.
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| How is Alveolar Volume different than Dead Space? | Alveolar Volume is the amount of air that does reach thealveoli for gas exchange (apporximately 350mL in an adult male) It is the difference between Tidal Volume and Dead Space.
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| What is Minute Volume? | The amount of gas moved in and out of tje respiratory tract in 1 minute. Is the true measurement of a patient's ventilatory status and is vital in assessing pulmonary function. Tidal Voume X Ventilatory Rate.
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| What is FiO2? | The percentage of oxygen in inspired air.
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| What is Peak expiratory flow? | The greatest rate of air flow that can be achieved during forced expiration beginning with the lungs fully inflated.
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| What is Residual Volume? | The amount of air remaining in the lungs at the end of maximal expiration. After a maximal forced exhalation, this is the amount of air remaining in the lungs and airway passages not able to be expelled.
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| What is Functional Residual Volume? | The Volume of gas that remains in the lunss at the end of normal expiration.
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| What is Forced Expiratory Volume? | The amount of air that can be maximally expired after maximum inspiration.
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| What are some causes of respiratory problems? | Injury to upper or lower airway structures. Inadequate Ventilation CNS dysfunction
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| What are Airflow Compromise Airway Sounds? | Snoring
Gurgling
Stridor
Wheezing
Quiet
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| What are Gas Exchange Compromise Airway Sounds? | Crackles
Rhonci
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| Pulse oximetry below what percentage is considered hypoxic? | 85% or lower indicates severe hypoxia.
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| What is the best technique for opening an airway on an unconscious patient? | Head-tilt/chin-lift
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| What do airway adjuncts do? | Help to lift the base of the tongue froward and away from the posterior oropharynx.
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| What is the preferred advanced airway management method? | Ednotracheal Intubation
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| What are Endotracheal Intubation Equipment? | Layngoscope
Appropriate size Endotracheal Tube
10 mL syringe
Stylet
Bag-valve mask
Suction device
Bite block
Magill forceps
Tape or commercial securing device
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| What is Direct Laryngoscopy "DL"? | Generally Requires direct visualization of the larynx with a laryngoscope.
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| What is the placement for the Macintosh Blade? | The blade is desgined to fit into the vallecula. When you lift its handle anteriorly, the blade elevates the tongue and, indirectly, the epiglottis, allowing you to see the glottic opening.
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| What sizes are the blades made? | 0 for infants and 4 for large adults.
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| What is the placement for the Miller blade? | The Miller blade is designed to fit under the epiglottis. When you lift its handle anteriorly, the blade directly lifts the epiglottis out of the way.
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| Which Laryngoscope blade is preferred for children? | The Miller blade,because it stabilizes their floppier epiglottises and provides greater displacement of their relatively larger tongues.
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| What are Endotracheal Tubes? | Flexible, translucent tube open at both ends and available in lengths ranging from 12 to 32 cm.
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| What are Endotracheal Tube Components? | Pilot Ballon 15mm adapter Cuff
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| What are Magill Forceps? | Are scissor- style clamps with circular tips. You will use them to remove foreign bodies or to redirect the endotracheal tube during nasotracheal intubation.
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| What are advantages of Endotracheal Intubation? | Isolates Trachea and permits complete control of airway Impedes gastric distention Eliminates need to maintain a mask seal Offers direct route for suctioning Permits administration of some medications.
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| What are some ET Intubation Indications? | Respiratory or cardiac arrest Unconsciousness Risk of aspiration Obstruction due to foreign bodies, trauma, burns, or anaphylaxis Respiratory extremis due to disease Pneumothorax, hemothorax, hemopneumothorax with respiratory difficulty.
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| What are some Complications of ET Intubation? | Equipment Malfunction Teeth breakage and soft tissue lacerations Hypoxia Esphogaeal intubation Endobronchial intubation "Mainstem" Tension Pneumothorax
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| What are some disadvantages of ET Intubation? | Requires considerable training and experience Requires specialized equipment Requires direct visualization of vocal cords Bypasses upper airway's functions of warming, filtering, and humidifying the inhaled air.
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| What is the BURP Maneuver | Backwards Upward Rightward Pressure. Helps displace the glottis posteriorly allowing for a better visualization.
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| What does RSI (Rapid Seuence Induction) do? | Paralyzes the patient to facilitate endotracheal intubation.
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| How do you confirm tube placement? | Direct Laryngoscopy Esophageal Detction Device(EDD) Lack of epigastric sounds Bilateral breath sounds Condensation in the tube Colormetric Capnography ETCO2 capnography Lack of Phaonation No emesis in the tube Chest X-ray
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| What are pediatric anatomical differences? | Airway much smalle in diameter and shorter in length Infants tongue takes up more room Jaw is proportionally smaller Infants are nasal breathers Vocal cords higher ( C 2-3) and more anterior
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| What are pediatric anatomical differences? Continued | Children under 10 narrowest part of airway is cricoid cartilage Tracheal cartilage is softer and more collapsible Epiglottis is floppier and round. (Omega shaped) Vocal cords slant upward and are closer to the base of the tongue.
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| How do you correctly size the Pediatric ET tube? | Use a resucitation tape (Broselow tape) Estimate using the diameter of the little finger Nare Diameter Formulas
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| What is the formula for a pediatric uncuffed tube? | Uncuffed = 4 + (age/4)
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| What is the formula for a pediatric cuffed tube? | Cuffed = 3.5 +(age/4)
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| What is DOPE? | How we trouble shoot resistance/problems. Displacement Obstruction - don't forget about secretions Pneumothorax Equipment
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| What are Nasotracheal Intubation Contraindications? | Suspected nasal fractures Suspected basilar skull fractures Significantly deviated nasal septum or other nasal obstruction Cardiac or Respiratory arrest Apnea
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| What is a "blind" procedure? | Procedures without direct visualization the vocal cords.
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| What are Nasotracheal Intubation Indications? | Possible Spinal Injury Clenched teeth Fractured jaw, oral injuries, or recent oral surgery Facial or airway swelling Obesity Arthritis preventing putting patient in sniffing position.
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| What are Nasotracheal Intubation Disadvantages? | More difficult and time consuming Potentially more traumatic for patients Tube may kink or clog more easily Greater risk of infection Improper placement more likely Requires that patient be breathing
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| What are Nasotracheal Intubation Advantages? | The head and neck can remain in neutral position It does not produce as much gag response and is better tolerate by the awake patient It can be secured more easily than an orotacheal tube The patient cannot bite the ET tube
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| What situations migh warrant Field Extubation? | The Patient is clearly able to maintain and protect his airway. The patient is not under the influence of sedatives. Reassessment indicates the problem that eld to endotracheal intubation is resolved.
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| What are Esophageal Tracheal Combitube Advantages? | PRovide alternate airway control Inseertion is rapid and easy Does not require visualization of the larynx Pharyngeal ballon anchors the airway Patient may be ventilated regardless of tube placement Gastric Content can be Suctioned Has trauma use
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| What are Esophageal Tracheal Combitube disadvantages? | The cuff can caue esophageal, tracheal, and hypopharyngeal ischemia. It does not isolate and completely protect the trachea It cannot be used in patients with esophageal disease or caustic ingestions It cannot be used with pediatric
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| What are Esophageal Tracheal Combitube disadvantages? Continued | Suctioning tracheal secretions is impossible when the airway is in the esophagus Placing an endotracheal tube is very difficult with the ETC in place It cannot be used in conscious patients or in thos with a gag reflex
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| What is an Intubating Laryngeal Mask Airway? | An airway device designed to facilitate endotracheal intubation. HAs an epiglottic elevating bar in the mask aperture that elevates the epiglottis. Tube is directed centrally and anteriorly.
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| What is a Laryngeal Mask Airway? | Used for blind insertion, has an inflatable distal end that is placed in the hypopharynx and then inflated. Does not isolate Trachea however.
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| What is an Ambu Laryngeal Mask? | A supraglottic, single use , disposable airway that features a curve that replicates the natural human airway anatomy.
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| What is a Cobra Perilaryngeal Airway? | A supraglottic airway similar tot the laryngeal mask. "Cobra head" of the airway holds both of the soft tissue and the epiglottis out of the way.
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| What procedures are followed for removing a foreign body from the airway? | Basic life support maneuvers should be attempted first. If these fail direct visualization of the airway for the foreign body removal is indicated.
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| What is a King LT Airway? | Alternative airway that stabilizes the airway at the base of the tongue. LArge silcone cuff that disperses pressure over a large mucousal surface area.
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| What are the two Surgical airways we can perform? | Needle Cricothyrotomy and a Surgical Cricothyrotomy
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| When should Surgical airways be used? | Only after all other airway skills have been tried.
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| What are Surgical Airway indications? | Massive facial or neck trauma Total upper airway obstruction
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| What are contraindications to Surgical Airways? | Inability to identify anatomical landmarks. Crush injury to the larynx Tracheal transection Underlying anatomical abnormalities
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| What is required to ventilate with a Needle Crocothyrotomy? | Transtracheal jet insufflation.
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| What are Complications to Needle Cricothyrotomy? | Barotrauma from overinflation Excessive bleeding due to improper catheter placement Subcutaneous Emphysema Airway obstruction Hypoventilation
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| What are Cricothyrotomy Complications? | Incorrect tube placement into a false passage Cricoid and/or thyroid catrilage damage Thyroid gland damage Severe bleeding Laryngeal nerve damage Subcutaneous emphysema Vocal cord damge Infection
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| What does Dificult Laryngoscopy mean? | Not being able to see any part of the vocal cords with the convetntional laryngoscopy.
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| What does Difficult Intubation mean? | Conventional laryngoscopy requires either A) more than three attempts or B) takes more than 10 minutes
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| What are factors related to difficult airways? | Historical Information, anatomical, and poor technique.
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| What does Difficult Airway mean? | A conventionally trained paramedic experiences difficulty with mask ventillation, endotracheal intubation or both.
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| What does Difficult Mask Ventilation mean? | Inability of unassisted paramedic to maintainan oxygen saturation of at least 90% using 100% oxygen and positive pressure mask ventilation or to not prevent or reveerse signs of inadequate ventilation during positive pressure mask ventilation.
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| What are the main rating systems for Airways? | Revised Cormack and LeHane POGO Mallampati
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| What is the Revised Cormack and LeHane classification? | Similar to the mallampati. Assigns four classes.
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| What is the POGO classification? | The percentage of the glottis that can be visualized is scored.
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| What is Class 1 Mallampati score? | Entire tonsil clearly visible.
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| What is Class 2 Mallampati score? | Upper half of tonsil fossa visible.
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| What is Class 3 Mallampati score? | Soft and Hard palate clearly visible
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| What is Class 4 Mallampati score? | Only hard palate visible.
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| What are other Difficult Airway considerations? | Short neck Thick Neck Restricted range of motion Dentition Small Mouth Short Mandible Anterior Larynx Obesity Anatomical Distortion
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| What is LEMON? | Look...for high risk factors Evaluate the 3-3-2 rule Mallampati Score Obstruction Neck Mobility
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| How do you perform the Mallampati Score? | - have the patient extend his neck, open his mouthfully and protrude his tongue and say "ah". Then Score the Class.
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| In LEMON what high risk factors do we look for? | Obesity Short/thick neck Facial trauma Previous craniofacial burns, including Radiation Abnormal teeth Facial Hair
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| What is the 3-3-2 rule? | Three of the patients fingers in their mouth "Normal mouth opening". Three fingers under the chin "Thyromental distance". Two fingers om the neck, Normal mandible anatomy- floor of the mouth to the thyroid cartilage.
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| What obstructions do we look for in LEMON? | Evaluate for stridor, foreign bodies, and other forms of sub/supra glottic obstruction.
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| What do we assess Neck Mobility for in LEMON? | Not assessed or pertinent in trauma patients. Patients with prior neck injuries, rheumatoid arthritis, severe osteoarthritis will be significantly harder to position.
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| What is a common problem when ventilationg a nonintubated patient? | Gastric Distention
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| What is the procedure for gastric distention and decompression? | Place head in neutral position Measure Tube Use topical anesthetic Lubricate and insert tube Encourage patient to swallow Advance to predetermined mark Verify placement Apply suction Secure in place
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| What are Gastric Distention and Decompression Indications? | The need for decompression because of the risk of aspiration or difficulty ventilating. Gastric Lavage in hypothermia and some overdose emergencies.
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| What are Gastric Distention and Decompression Complications? | Possibility of espohageal bleeding Increased risk of esophageal perforation
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| What does a small volume nebulizer do? | Allows for delivery of medicatiosn in aerosol form.
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| What is classified as effective ventilatory support? | A tidal volume of at least 800mL of oxygen at 10 to 12 breaths per minute.
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| What does an effective artificial ventilation require? | A patent airway An effective seal between the mask and the patients face Delivery of adequate volumes
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| What are the preffered Ventilation Methods in order? | Mouth-to-mouth Mouth-to-nose Mouth-to-mask Bag-valve device Demand Valve device Automatic transport ventilator
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