Airway Management and Ventilation

  1. The Upper airway consist of:
    • Mouth
    • Pharynx
    • Larynx
    • Epiglottis
    • Oropharynx
    • Nasopharynx
    • Nasal air passage
  2. The Lower airway consist of:
    • Trachea
    • Bronchioles
    • Main bronchus
  3. The point considered the division between the upper and lower airway
  4. The major function of the upper airway
    Warm, Filter, and Humidify Air
  5. The function of the lower airway
    Exchange oxygen and carbon dioxide
  6. Structures that help us breath include:
    • Diaphragm
    • Intercostal muscles
    • Accessory muscles
    • Nerves from Brain & Spinal cord
  7. The physical act of moving air into and out of the lungs
  8. The process of loading oxygen molecules  onto hemoglobin molecules in the bloodstream
  9. The actual exchange of oxygen and carbon dioxide in the alveoli and the tissues of the body
  10. What functions does the diaphragm and intercostal muscles do during inhalation
    They both contract
  11. The autonomic regulation of breathing resumes under control of the brainstem when:
    The concentration of carbon dioxide rises in the blood
  12. Drawing of air into the lungs; airflow from a region of higher pressure (outside the body) to a region of lower pressure (the lungs); occurs during normal (unassisted breathing)
    Negative-pressure ventilation
  13. Normal tidal volume for:
    Infants & Chlidren
    • Adults: 5 to 7 mL/kg (500mL)
    • Infants & Children: 6 to 8 mL/kg
  14. The Primary respiratory drive in patients with COPD (emphysema & chronic bronchitis) can be altered because:
    They have difficulty eliminating carbon dioxide through exhalation; causing higher levels of CO2 in their blood
  15. Secondary control of breathing that stimulates breathing based on decreased Pao2 levels
    Hypoxic drive
  16. What is the best sign of adequate ventilation and/or respiration
    Chest rise and fall
  17. Epinephrine 
    • Cardiac arrest 
    • Anaphylaxis
    • Severe bronchospasm
    • Hypotension
    • Bradycardia (under 60 BPM)
    • Croup

    Pulseless arrest: IV 1mg/1:10,000 (3-5 min)

    • Hypotension or Symptomatic Bradycardia:
    • Titrated to desired hemodynamic response
    • Epi drip:2mg in 250mL (2-10 mcg/min)
    • To get radial pulses back
  18. Dopamine
    • Symptomatic Bradycardia
    • Hypotension (cardiogenic & septic shock) 
    • Hemodynamically hypotension (BP 70-100)
    • Hypotension after return of spontaneous circulation following cardiac arrest

    • Bradycardia:
    • Start at 5 μg/kg/min
    • Shock: cardiogenic or septic (non-hypovolemic)
    • BP < 70 systolic: Start drip at 6 μg/kg/min
    • BP > 70 systolic: Start drip at 3 μg/kg/min
    •               *10% in lbs=6mcg/kg/min
    • > titrate to effect

    (dosage range 2-20 μg/kg/min)
  19. The amount of air that moves in and out of the respiratory tract per minute
    Minute volume
  20. Patient's with allergic reactions might have airway obstructions due to:
    • Swelling (angioedema)
    • Decrease in pulmonary ventilation from bronchoconstriction
  21. Occurs when CO2 production exceeds the body's ability to eliminate it by ventilation;
    or CO2 elimination can no longer keep up with normal metabolism

    decreased amount of air enters the alveoli
  22. A condition in which an increased amount of air enters the alveoli; CO2 elimination exceeds CO2 production
  23. Increased carbon dioxide content in arterial blood

    Decreased carbon dioxide content in arterial blood

  24. The amount of gas in air or dissolved in fluid, such as the blood; measured in millimeters of mercury (mmHg) or torr
    Partial pressure
  25. Anytime a patient is in respiratory distress or unable to breathe what can quickly develop
    • Acidosis
    • Acid retention
  26. Alkalosis can develop if:
    The respiratory rate is too high; or the volume is too much
  27. What results in respiratory acidosis or alkalosis:
    Fluctuations in pH due to respiratory disorders
  28. Normal respiratory rate ranges
    • Adult: 12 to 20
    • Children: 15 to 30
    • Infants: 25 to 50
  29. You are assessing breath sounds for:
    • Duration
    • Pitch
    • Intensity
  30. When patients transition from negative-pressure ventilation to positive pressure ventilation; they can lose:
    • Venous return to heart
    • Decreased cardiac output (hypotension)
  31. How do you assess a patient in respiratory distress (gas exchange)
    • Patient position
    • Chest rise & fall
    • Gasping
    • Skin color (diaphoretic)
    • Nostrils
    • Retractions
    • Accessory muscle use
    • Symmetrical chest movement
    • Quick breaths
    • Prolonged exhalation
  32. Signs of inadequate ventilation:
    • <12 breaths/min
    • >20 breaths/min
    • Irregular rhythm
    • Diminished,absent,noisy breath sounds
    • abnormal breathing
    • Reduced exhaled air
    • Unequal or inadequate chest expansion
    • Accessory muscles use
    • Shallow depth
    • Skin: pale, cyanotic, cool, moist
    • Retractions
    • Speech patterns
  33. Gradually increasing rate and depth of reparations followed by a gradual decrease of reparations with intermittent periods of apnea; associated with brainstem insult
    Cheyne-Strokes Respirations
  34. Deep, rapid respirations; seen in patients with diabetic ketoacidosis
    Kussmaul respirations
  35. Irregular pattern, rate, and depth of breathing with intermittent periods of apnea; results from increased intracranial pressure
    Biot (ataxic) respirations
  36. Prolonged, gasping inhalation followed by extremely short, ineffective exhalation; associated with brainstem insult
    Apneustic respirations
  37. Slow, shallow, irregular, or occasional gasping breaths; results from cerebral anoxia. 
    Heart has stopped but brain sends signals to breath
    (not considered respiration)
    Agonal gasps
  38. An Spo2 of less than 95% in a non smoker suggests
  39. A pulse oximeter measures:
    The percentage of hemoglobin (Hb) in the arterial blood that is saturated with oxygen
  40. End-tidal co2 (ETCO2) monitors detect:
    • CO2 in exhaled air
    • (helps determine ventilation adequacy)
  41. Normal range of ETCO2:
    35 & 45 mm Hg

    (approx. 2 to 5 mm Hg lower than arterial Paco2)
  42. Patients with prolonged cardiac arrest will have minimal to no:
    • Exhaled carbon  dioxide
    • Severe acidosis
    • No carbon dioxide return to lungs
    SODIUM SUCCINATE (Solu-Medrol)
    • Indications: 
    • Reactive airway disease
    • Acute exacerbation of emphysema
    • Chronic bronchitis
    • Asthma
    • Anaphylaxis
Burns involving the airway

    • Dosages:
    • 125mg slow IV bolus
    • Indications
    • Torsade de pointes
    • VF/Pulseless
    • VT 
    • Hyperactive Airway - Severe Asthma
    • Pre-term labor
    • Pregnancy-induced hypertension 
    • (pre-eclampsia and/or eclampsia)

    • Dosages
    • VF/Pulseless VT / Torsade de pointes
    • 1-2 Gm IV diluted in 50-100 ml NS or D5W, administered over 1-2 minutes

    • Hypomagnesemia: 1-2 Gm in 50-100 ml NS /
    • D5W administered IV push over 5-60 minutes

    Respiratory/Severe Asthma: 2 Gm - 50 mL NS / D5W IV using microdrip tubing over 5 to 10 minutes.

    • Pre-term labor (PTL): Initial bolus (Field and
    • Interfacility): 4-6 Gm over 15-20 minute
  45. Cerebrospinal fluid that leaks from the nose is called: 

    C) cerebrospinal rhinorrhea.
  46. The phrenic nerves stimulate the:
  47. Internal respiration is the exchange of gases between the ______ and the ______. 

    D) blood cells, tissues
  48. In children, the most common cause of conscious airway obstruction is:
  49. Dysphonia can best be defined as:
    Difficulty speaking
  50. The preferred device to deliver supplemental oxygen to the patient who is brething
    Nonrebreathering mask
  51. What is the MOST definitive way to control the airway in an unconscious patient
    Endotracheal tube
  52. In what position should the patient's head be placed when preparing to intubate with a combitube
    Neutral position
  53. How much sterile saline should you have ready when you are performing a needle cricothyrotomy
    3 mL
  54. How much volume alveolar volume does the typical adult have
    350 mL
  55. The clinical finding in which the systolic BP drop more than 10 mm Hg during inhalation is called
    Pulsus paradoxus
  56. The abnormal respiratory pattern yo see in patients with ketoacidosis
    Kussmaul respirations
Card Set
Airway Management and Ventilation
MEDIC 2013