Volume 1 Chapter 13

Gas necessary for energy production

Waste product of the body's metabolism

The exchange of gases between a living organism and it environment

• NASAL CAVITY
• -Superior, middle and inferior turbinates
• -Hard and soft palates

• NASOPHARYNX
• -Tonsils/adenoids
• -Uvula

• OROPHARYNX
• -Tongue

• LARYNGOPHARYNX
• -Vallecula
• -Epiglottis

• LARYNX
• -Esophagus
• -Trachea
• -Glottic opening
• -Vocal cords
• -Thyroid cartilage
• -Cricothyroid membrane
• -Cricoid cartilage
• -Thyroid gland

• Nasal cavity
• Oral cavity
• Pharynx

Cartilage that seperates the right and left nasal cavities

Air cavity that conducts fluids from the eustacian tuves and tear ducts to and from the nasopharynx

A tube that connects the ear with the nasal cavity

Tubular vessels that drain tears and debris from the eyes into the nasal cavity

Nostril

Lining in body cavities that handle air transport. Usually contains small, mucus secreting cells

Slippery secretion that lubricates and protects airway surfaces

A muscular tube that extends verticalls from the back of the soft palate to the superior aspect of the esophagus

• Nasopharynx
• Oropharynx
• Laryngopharynx

Mechanism that stimulates retching or striving to vomit when the soft palate is touched

Depression between the epiglottis and the base of the tongue

Passing a tube into a body opening

The complex structure that joins the pharynx with the trachea

Liplike opening between the vocal cords

Pressure applied in a posterior direction to the anterior cricoid cartilage. Occludes the esophagus

Inhaling foreign material such as vomitus into the lungs

Membrane between the cricoid and thyroid cartilages of the larynx

• Trachea
• Bronchi
• Alveoli
• Lung parenchyma
• Pleura

10-12 cm long tube that connects the larynx to the mainstem bronchi

Tubes from the trachea into the lungs

Microscopic air sacs where lost oxygen and carbon dioxide gas exchanges take place

Alveolar collapse

Principal or essential parts of an organ

Membranous connective tissue covering the lung

• 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

The mechanical process that moves air into and out of the lungs

500 mL

150 mL

• 20.94% Oxygen
• 79.01 % Nitrogen
• 0.04% Carbon Dioxide

The pressure exerted by each component of a gas mixture

Alveolar partial pressure

Arterial partial pressure

Movement of a gas from an area of higher concentration to an area of lower concentration

• Decrease hemoglobin
• Inadequate alveolar ventilation
• Decreased diffusion across the pulmonary membrane (COPD, Pneumonia, Edema)

Reduction in breathing rate and depth

Accumulation of air or gas in the pleural cavity

Accumulation of blood or fluid containing blood in the pleural cavity

Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood

Concentration of oxygen in inspired air

Hypercarbia/Hypocarbia

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

• Respiratory depression by drugs
• Airway obstruction
• Impairment of respiratory muscles
• COPD, etc.

Excessive CO2 in the blood

Number of times a person breaths in 1 minute

Medulla

Stretch receptors in the lung which prevent overinflation when inhaling

• 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

Decreased partial pressure of oxygen in the blood

Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs

• Fever, Emotion, Pain, Hypoxia, Acidosis, Simulant drugs- increase rate
• Sleep, depressant drugs- decrease rate

Maximum lung capacity- approx 6 liters for adult male

Average volume of gas inhaled or exhaled in one cycle- approx 500 mL in adult male

Amount of gas inhaled and exhaled in 1 minute

An interference with air movement through the upper airway

• Tongue- #1 cause
• Foreign bodies
• Trauma
• Laryngeal spasm and edema
• Aspiration

Removing a tube from a body

Airway, breathing, circulation

Asymmetrical chest wall movement that lessens repiratory efficiency

Defect in the chest wall that allows a segment to move freely, causing paradoxical chest motion

Bluish discoloration

An abnormalitity of breathing rate, pattern or effort

Oxygen defficiency

The absence or near-absence of oxygen

Drop in blood pressure greater than 10 torr during inspiration

Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis

Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indication brainstem injury

Irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure

Deep, rapid respirations, indicating increased intracranial pressure

Shallow, slow, or infrequent breathing, indicating brain anoxia

• 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

The stiffness or flexibility of the lung tissue

A measurement of hemoglobin oxygen saturation in th eperipheral tissues

The saturation of arterial blood with oxygen as measured by pulse oximetry expressed as a percentage

• 95-100%- normal
• 91-94%- mild hypoxemia
• 86-90%- moderate hypoxemia
• <85%- severe hypoxemia

• 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

• 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.

Bulb placed on end of ET tube to confirm placement. Squeeze then apply. If it returns to normal indicates correct placement.

Uncuffed tube that follows the natural curvature of the nasopharynx

Unit of measurement approximately equal to one-third millimeter

Semicircular device that follows the palate's curvature

Used for blind nasotracheal intubations to confirm tube placement. Whistles when patient exhales

• Laryngoscope (Handle and blade)
• Endotracheal tube
• 10 mL syringe
• Stylet
• Bag-valve mask
• Suction device
• Bite block
• Magill forceps
• Tape or tube-holding device

Hearing device used to confirm tube placement in blind nasotracheal intubation

Device used for lifting the tongue and epiglottis in order to see the vocal cords

Straight blade

Curved blade

Tube passed into the trachea to protect and maintain the airway and to permit medication administration and deep suctioning

Plastic covered metal wire used to bend the ETT in order to guide it easier into the trachea

Scissor style clamps with circular tips

• 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

• Isolates trachea
• Impedes gastric distention
• Eliminates mask seal
• Offers direct route for suctioning
• Permits medication administration

• 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

• Equipment malfunction
• Teeth breakage and soft-tissue lacerations
• Hypoxia
• Esophegeal intubation
• Endobronchial intubation
• Tension pneumothorax

Giving medications to sedate (induce) and temporarily paralyze a patient to perform ET intubation

• Succinylcholine
• Vecuronium
• Atracurim
• Pancuronium

Through the nose and into the trachea. PATIENT MUST BE BREATHING

• 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

• Nasal fractures
• Basilar skull fractures
• Deviated septum or nasal obstruction
• Cardiac or respiratory arrest
• Unresponsive patient

• 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

• 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

• Endotracheal Tube (ETT)
• Esophogeal Tracheal Combitube (ETC)
• Laryngeal Mask Airway (LMA)
• Pharyngeal Lumen Airway (PtL)
• Esophegeal Gastric Tube (EGTA)
• Esophageal Obturator Airway (EOA)

Surgical airway technique that inserts a 14-gauge needle into the trachea at the thyroid membrane

Surgical airway technique that places and ET or tracheostomy tube directly into the trachea through a surgical incision made at the crichothyroid membrane

Narrowing or constriction

Injury caused by pressure within a closed space

Clinical situation where a paramedic has difficulty with mask and/or ET intubation

• 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

• 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

Airway assessment used by some EMS personnel to rate the percentage of glottic opening (POGO) one can visualize from 0% to 100%

Regulator used to transfer oxgen at high pressures from tank to tank

Pressure regulator used for delivering oxygen to patients

Catheter placed at the nares

High-flow face mask that uses a Venturi system to deliver relatively precise oxygen concentrations

• Mouth-to-mouth/mouth-to-nose
• Mouth-to-mask
• Bag-valve mask
• Demand valve device
• Automatic transport ventilator