-
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?
Alveolar collapse
-
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?
- Hypemic
- Stagnant
- Histotoxic
- Hypoxic
-
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
- Intubation
- Bail Outs
- Surgical
-
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?
- Yankauer
- 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?
Preoxygenation
-
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
-
Describe Stridor.
- Harsh, high pitched sound heard on inhalation,
- assoc w/ laryngeal edema or constriction
-
Describe Wheezing.
- 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
-
Describe Rhonchi.
- 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?
- Hypovolemia
- Decreased cardiac output
- Hypothermia; drop in metabolism
-
Gradual ^ in ETCO2 could indicate?
- ^ body temp
- Hpoventilation
- 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.
35-40
-
Mixed venous blood gas is PeCO2 in the range of ____ mmHg.
46-48
-
Exhaled CO2 is EtCO2 in the range of ____ mmHg.
35-45
-
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
- Burns
- Facial Trauma
- S/S of anaphylaxis
- Stridor
- FBAO
-
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
- Epiglotitis
- 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
- Obesity
- 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?
500
-
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.
|
|
