NREMT Airway Management and Ventilation – Flashcards

Unlock all answers in this set

Unlock answers
question
Airway management and ventilation are...
answer
FIRST and MOST critical steps in assessment of every patient you encounter.
question
Lower airway anatomy
answer
trachea (C-shaped rings) bronchi (main stems) bronchioles (bronchiole rings)-have unique property: stimulated by drugs alveoli (perfusion takes place)-surfactant keeps them open lung parenchyma pleura (parietal and visceral)
question
Upper airway anatomy
answer
nose nasal cavity para-nasal sinus nasopharynx oropharynx laryngopharynx larynx
question
Pediatric airway is different because...
answer
smaller jaw larger tongue cricoid cartilage is narrowest part of airway epiglottis is rounder and floppier
question
respiration is...
answer
the exchange of gases between organisms and it's environment
question
ventilation is....
answer
the mechanical process of moving air IN and OUT of the lungs
question
Pulmonary Circulation is...
answer
the perfusion of O2 and CO2
question
Diffusion...
answer
movement of gas from an area of HIGHER CONCENTRATION to area of lower concentration
question
Diffusion transfers gases between???
answer
LUNGS and BLOOD and BLOOD and PERIPHERAL TISSUES
question
Normal arterial pressures
answer
oxygen(PaO2)=100 torr Carbon dioxide(PaCO2)=35-45 avg.=40
question
SPO2 and ETCO2
answer
SPO2=94-100 ETCO2=40
question
Factors affecting O2 concentration in Blood...
answer
decreased hemoglobin concentration inadequate alveolar ventilation decreased diffusion across pulmonary membrane, when diffusion distance increases, or pulmonary membrane changes Ventilation/perfusion mismatch occurs when portion of alveoli collapses
question
Factors affecting CO2 concentrations in Blood...
answer
Lowers CO2 levels are due to increased respiratory rates or deeper respiration or hyperventilation and Higher CO2 levels are caused by: fever, muscle exertion, shivering, or metabolic processes resulting in the formation of metabolic acids
question
So, a pt. w/ a PaCO2 of 30 will be...
answer
ALKALOTIC thus decreasing respiratory rate...
question
Respiratory Rate
answer
is INVOLUNTARY however can be VOLUNTARILY controlled. chemical and physical mechanisms provide involuntary impulses to correct breathing irregularities
question
chemoreceptors are located in...
answer
carotid bodies arch of the aorta and medulla
question
baroreceptors in carotid artery
answer
regulate BP stimulated by decreased PaCO2, increased PaCO2, and decreased PH
question
Cerebrospinal fluid (CSF)pH
answer
primary control of respiratory center
question
main respiratory center
answer
medulla (neurons in medulla initiate impulses that produce respiration)
question
apneustic center
answer
assumes respiratory control if the medulla fails to initiate impluse
question
pneumotaxic center
answer
controls respiration
question
Stretch receptors (HERING BREUER REFLEX)
answer
prevents over expansion of the lungs
question
Normal respiratory rates:
answer
adults: 12-20 pedi: 18-24 infant: 40-60
question
airway obstruction caused by:
answer
foreign bodies trauma laryngeal spasm edema aspiration MOST COMMON OBSTRUCTION: YOUR TONGUE...
question
Respiratory system assessment:
answer
is airway patent? is breathing adequate? look, listen, feel
question
respiratory physical exam:
answer
inspection (mouth, nose) skin color (flush, pale, blue) pt. position dyspnea modified form of respiration rate, pattern, mentation, auscultation listen at mouth and nose for adequate air movement stethoscope for normal or abnormal air movement auscultation anterior and posterior
question
kussmaul's respirations
answer
deep slow or rapid gasping (common in DKA)
question
cheyne-stokes respirations
answer
progressively deeper, faster, breathing and alternating gradually with shallow, slower, breathing (indication of brain stem injury)
question
agonal respirations
answer
shallow slow or infrequent (indicating brain anoxia)
question
disruption in ventilation caused by
answer
nervous system trauma poison over dose disease
question
airway sounds:
answer
stridor wheezing rales rhonchi snoring crackles
question
palpate chest wall for:
answer
tenderness symmetry abnormal motion crepitus subcutaneous emphysema
question
monitoring devices for airway
answer
ETCO2 electronic and colormetric SPO2 esophageal detector device EDD (bulb refills easily upon release indicates correct placement of ET tube)
question
manual airway maneuvers
answer
head tilt/chin lift modified jaw thrust (used in trauma b/c C-collar) jaw-thrust maneuver sellick's maneuver (cricoid pressure) jaw lift maneuver
question
basic mechanical airways
answer
nasopharyngeal airway (NPA) or oropharyngeal airway (OPA)-tip facing palate & rotate 180 degrees into position
question
advanced airway management
answer
Endotracheal intubation is performed if basic airway management is NOT effective
question
Laryngoscope blades:
answer
Macintosh blade (vallecula) or Miller blade (lifts up the epiglottis)
question
ET intubation indicators:
answer
cardiac arrest, respiratory arrest, unconsciousness risk aspiration or obstruction from foreign bodies trauma, burns, anaphylaxis, respiratory extremis due to disease pneumothorax, hemo-thorax, hemo-pneumothorax w/ respiratory difficulty
question
complications ET intubation:
answer
equipment malfunction teeth breakage or soft tissue lacerations hypoxia-esophageal intubation, endo-bronchial intubation, or due to TIME tension pneumothorax
question
advantages of ET intubation:
answer
isolates trachea and permits complete control of airway impedes gastric distention eliminates need to maintain mask seal offers direct route suctioning administration of medications
question
disadvantages of ET intubation:
answer
considerable training and experience requires special equipment requires direct visual of vocal cords bypasses upper airway functions of warming, filtering and humidifying the air
question
after ETT intubation:
answer
Check, Check, Check and check again... don't be a D.O.P.E. DISLODGE Obstruction Pneumo Equipment
question
Foreign body removal with direct visualization...
answer
Magill forceps
question
Nasotracheal intubation useful when?
answer
possible spinal injury clenched teeth fractured jaw oral injuries or recent oral surgery facial or airway swelling obesity arthritis
question
other advanced airways:
answer
esophageal CombiTube laryngeal mask airway pharyngo-tracheal lumen airway exophageal gastric tube esophageal obturator airway (EOA)
question
surgical airway when:
answer
inability to establish airway any other way... Jet ventilation w/ cricothrotomy-14G w/ positive pressure air delivery anatomical landmarks for cricothrotomy: between cricoid cartilage and thyroid cartilage make a 1cm horizontal incision through the cricothyroid membrane
question
O2 delivery devices % O2 delivery:
answer
N/C- 40% simple face mask- 40%-60% NRB-80%-95% BVM w/ reservoir- 100% BVM w/o reservoir- 21%
question
ventilation methods:
answer
mouth to mouth mouth to nose bag valve devise demand valve devise automatic transport ventilator
question
Ventilating a patient proper tidal volume
answer
5-10 cc/kg
question
adult respiratory distress syndrome is what type of lung injury...
answer
CHRONIC. CHRONIC. CHRONIC... a lung injury
question
ARDS causes:
answer
sepsis, aspiration, pneumonia, pulmonary injury, burns/inhalation injury, drugs, high altitude, hypothermia...
question
pathophysiology of ARDS:
answer
affects interstitial fluid, causes INCREASE of fluid in interstitial space, and disrupts diffusion and perfusion.. (high mortality, by multiple organ failure)
question
ARDS assessment:
answer
abnormal breath sounds & CRACKLES and RALES
question
Management of ARDS:
answer
manage underlying condition, provide O2, support respiratory effort, provide PPV if respiratory failure is imminent. monitor cardiac rhythm, V/S MEDS: corticosteroids
question
Obstructive Lung Disease:
answer
emphysema chronic bronchitis asthma (causes: genetic disposition, smoking, allergies, and other risk factors)
question
atelectasis
answer
destruction of alveolar wall causing poor perfusion
question
emphysema pathophysiology:
answer
exposure to noxious substances, exposure results in destruction of alveoli walls(atelectasis) causing poor perfusion weakens walls of small bronchioles and results in INCREASE RESIDUAL VOLUME loss of elasticity causes increased pressure right sided heart failure RHF failure-Cor Pulmonale Polycythemia Increased infection & Dysrhythmia
question
emphysema assessment:
answer
Barrel chest prolonged expiration and rapid rest phase thin, pink, skin due to extra red cell production hypertrophy of accessory muscles
question
EMPHYSEMA
answer
PINK PUFFER PUFFER SMOKERS PINK PUFFER PUFF PUFF PUFF
question
Chronic bronchitis pathophysiology
answer
result from increase in mucus-secreting cells in respiratory tree alveoli relatively unaffected decreased alveolar ventilation
question
Chronic bronchitis history:
answer
frequent infections productive cough smoker HAS BEEN GOING ON FOR YEARS...
question
chronic bronchitis exam:
answer
often overweight rhonchi present on auscultation JVD, JVD, JVD ankle edema hepatic congestion "BLUE BLOATER"
question
Bronchitis & Emphysema management:
answer
maintain airway, support breathing, monitor SpO2 position of comfort be prepared to ventilate or intubate monitor cardiac rhythm, IV access, MEDS: bronchodilators & corticosteroids
question
asthma pathophysiology
answer
chronic inflammatory disorder results in widespread but variable air flow obstruction. airway becomes hyper responsive induced by a trigger, varies by individual trigger causes histamine release causing: bronchoconstriction and bronchial edema 6-8 hours later immune system cells invade bronchial mucosa and cause additional edema...
question
asthma exam:
answer
dyspnea wheezing (in some NOT ALL) cough speech 1-2 consecutive words hyperinflation of chest and accessory muscle use. auscultate breath sounds and measure peak expiratory flow rate. may stop breathing b/c decreased lung capacity
question
asthma management:
answer
correct hypoxia, reverse bronchospasm, reduce inflammation maintain airway, support breathing, high flow O2, assist ventilations, monitor cardiac rhythm, IV MEDS: BETA-AGONISTS, IPRATROPIUM BROMIDE, CORTICOSTEROIDS
question
status asthmaticus
answer
severe prolonged asthma attack that can NOT be broken by bronchodilators, greatly diminished breath sounds, RECOGNIZE IMMINENT RESPIRATORY ARREST. AGGRESSIVELY MANAGE AIRWAY/BREATHING. transport immediately MEDS: need albuterol continuously
question
Upper respiratory infection
answer
URI above the GLOTTIC OPENING
question
URI
answer
frequent pt. complaint common pediatric complaint rarely life threatening
question
Worst URI
answer
EPIGOLOTITIS
question
Pneumonia pathophysiology
answer
infection in lungs, problem in immune suppressed pt. bacterial and viral hospital acquired vs. community acquired infection spread throughout the lungs alveoli may collapse resulting in ventilation disorder
question
pneumonia management
answer
maintain airway, support breathing, high flow O2, assist ventilation, monitor V/S, IV access MEDS: AVOID FLUID OVERLOAD, ANTIPYRETICS, BETA-AGONISTS
question
Toxic inhalation pathophysiology
answer
heated air, chemical irritants, steam airway obstruction due to edema and laryngospasm due to thermal and chemical burns
question
toxic inhalation assessment:
answer
focused history and physical exam SAMPLE/OPQRST determine nature of substance, length of exposure, and LOC
question
toxic inhalation management:
answer
SCENE SAFE FIRST... SCENE SAFE... only enter with proper training and equipment. remove pt. from toxic environment. maintain airway, early aggressive management indicated, support breathing, IV access, TRANSPORT PROMPTLY.
question
Carbon Monoxide Inhalation
answer
Carbon Monoxide is odorless, colorless gas, results from combustion of carbon-containing compounds. Often builds up to dangerous level in confined spaces.
question
Carbon Monoxide Inhalation pathophysiology:
answer
binds to Hemoglobin 200-300 times affinity of oxygen (way sticker) prevents O2 from binding and creates hypoxia on cellular level.
question
Carbon Monoxide Inhalation assessment:
answer
focused history and physical exam SAMPLE/OPQRST, length of exposure presence of headache, confusion, agitation, lack of coordination, loss of consciousness, and seizures
question
Carbon Monoxide Inhalation management:
answer
SCENE SAFE...SCENE SAFE... only enter if properly trained and with proper equipment, remove pt. from toxic environment, maintain airway, support breathing, high flow O2, assist ventilation, IV access, transport. (hyperbaric chamber)
question
Pulmonary Embolism
answer
SpO2 in tank ETCO2 in tank
question
pulmonary Embolism pathophysiology:
answer
obstruction pulmonary artery (typically occurs in Right Heart) emboli may be air, thrombus, fat, amniotic, foreign bodies may cause an embolus
question
PE risk factors:
answer
recent surgery, long-bone f(x), pregnancy (pregnant or postpartum), oral contraceptive use, tobacco use, IDDM, PE
question
PE assessment:
answer
focused history and physical exam, SAMPLE/OPQRST presence of risk factors, unexplained tachycardia, sudden severe dyspnea & pain, pain w/ inhalation and exhalation, cough, cough is often blood tinged
question
PE exam:
answer
anxiety syncopy diaphoretic JVD hypotension warm swollen extremities
question
PE management:
answer
maintain airway, support breathing, high flow O2, assist ventilations indicated, ETT intubation may be indicated, IV access, monitor V/S, transport to appropriate facility.
question
spontaneous pneumothorax:
answer
occurs in the absence of blunt or penetrating trauma
question
spontaneous pneumothorax risk factors:
answer
young, tall, skinny, lanky, males
question
spontaneous pneumothorax assessment:
answer
focused history and physical exam, SAMPLE/OPQRST presence of risk factors, rapid onset of symptoms, sharp, pleuritic chest or shoulder pain. OFTEN precipitated by COUGH or LIFTING.
question
spontaneous pneumothorax exam:
answer
decreased or absent breath sounds on affected side, tachypnea, diaphoresis, and pallor
question
spontaneous pneumothorax management:
answer
maintain airway, support breathing, monitor for tension pneumothorax, pleural decompression may be indicated if patient is cyanotic, hypoxic, and difficult to ventilate. JVD and tracheal deviation away from affected side.
question
hyperventilation syndrome assessment:
answer
focused history and physical exam, SAMPLE/OPQRST fatigue, nervousness, dizziness, dyspnea, chest pain, numbness and tingling in hands, mouth, and feet. Presence of tachypnea and tachycardia. spasms of the fingers and feet. (you'll see 100% SPO2 w/ Low ETCO2)
question
hyperventilation syndrome management:
answer
maintain airway, support breathing, high flow O2, assist ventilations indicated. DO NOT ALLOW PATIENT TO REBREATHE EXHALED AIR. Reassure the patient.............
question
CNS dysfunction pathophysiology:
answer
causes include traumatic/atraumatic brain injury, tumors, and drugs.
question
CNS assessment:
answer
evaluate potentially treatable causes such as narcotic drug OverDose or CNS trauma. Evaluate breathing pattern.
question
CNS management:
answer
general management principles, maintain airway, support breathing, use C-spine precautions if indicated.
question
Dysfunction Spinal cord, Nerves, or Respiratory muscles pathophysiology:
answer
PNS problems affecting respiratory function may include trauma, polio, myasthenia gravis, viral infections, tumors
question
Dysfunction Spinal cord, Nerves, or Respiratory muscles assessment:
answer
rule out traumatic injury, assess for numbness, pain, or signs PNS dysfunction
question
Dysfunction Spinal cord, Nerves, or Respiratory muscles management:
answer
general management principles. maintain airway, support breathing. use C-spine precautions if indicated.
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New