Chapter 9 & 10

the glottic opening is the start to which part of the airway

lower airway

all the air passages are supported with _________

cartilage

all the air passages are lined with what kind of muscle

smooth muscle

in infants and children their airway structures are ?

shorter, narrower and less rigid

in children the mouth and nose are ____ compared to adults

smaller

because children have smaller mouths and noses then adults this means that they??

are more easily obstructed

in children what muscle takes up more space in their mouths then adults

the tongue

what type of breathers are newborns and infants

nose breathers

what part in pediatric patients is softer and more flexible

the trachea

in infants their ______ wall is smaller and they depend more on their ________

chest, diaphragms

this is when all 14 muscle groups are intact and keeping the airway patent

intact muscle tone

the most common obstruction for patients with an altered mental status is their

their tongue

because the airway is made up of smooth muscle even the smallest change in diameter can lead to problems in pt airflow this is known as ?

bronchoconstricion

a bronchoconstriction is also known as a

bronchospasm

bronchospasms and bronchoconstrictions are the most common in pts with

asthma

this sound is characterized by a whistling sound and implies a severley narrowed/constricted airway

stirdor

stridor is a common effect of what type of injury

swelling in upper airway i.e. anaphylaxis

this is an almost dry or raspy sound and can be a sign of a swelling or burnt airway

hoarseness

this is a sound that can be loud or quiet and is almost a grumbly like sound

snoring

snoring is an indicator that not only is the pt unconscious but has a partially obstructed airway, what thing is causing the obstruction

the patients tongue

this is a sound which implies that a patient has a partially obstructed airway and their may be blood, vomitus, or other bodily fluids in the pts airway

gurgling

the position that the patient is in reveals a lot about ______?

any possibly respiratory stress the pt may be in

for most conscious patients the airway can be assessed by whether or not the patient is ?

talking to you

airway and breathing have priority over what ?

C-Spine precaution

often conscious patients are best managed by moving them into a position that _____?

facilitates the constant movement of air

what position can often be helpful for conscious patients so they can recieve adequate oxygen

the sniffing or head-elevated position

how much padding should you place behind a patients head

1.5-2inches

for adults where do you place padding to elevate their head

behind their head

for children where do you place the padding so that their head is elevated

behind their shoulders

however not all patients will require padding based on what two things

weight and age

optimal head elevation is achieved when ?

the patients ear is at the same level as the supersternal notch

when do you not use the head-tilt-chin lift maneuver

when there is a suspected spinal injury in a pt

when do you use the jaw thrust maneuver

when the patient has a suspected spinal injury

choking patients are categorized into what two categories

severe and nonsevere

what does the category of choking depend on

how obstructed the pts airway is

what can a partially blocked airway be recognized by what?

change in patient voice

if a conscious patient has a partially obstructed airway what can you ask them to do

cough aggresively

if any choking patient becomes unconscious what should you immediately do

start CPR

what are the two most common kinds of airway

OPA and NPA

when is the only time you use an OPA

when a patient does not have an intact gag reflex

what does an OPA do

it keeps the patients tongue back to prevent it form blocking the airway

NPA’s are different because you can use them in patients with?

an intact gag reflex

NPA’s should be used in

patients with clenched teeth, oral injuries and an intact gag reflex

what should you have ready prior to inserting any kind of airway adjunct

suction

what PPE should be used before suctioning

mask, gloves, goggles

remember if the OPA is too big it will touch the patients ?

back of the pts esophagus

for an OPA you should remember what when removing it

you do not need to rotate it

in pediatric patients the larynx is higher up and closer because of this you should remember what when inserting an OPA

you do not need to rotate it upon insertion

the typical sizes for this device are under the name of French

NPA

in an NPA what are the 4 french sizes

28,30,32,34

a supraglottic airway is used when what ?

when all other airway measures have failed

what three times are an I-Gel used besides when OPA & NPA insertion fail

long transport, as a bridge between simple maneuver, and between ET intubation

what is the first thing to remember when inserting an I-Gel

a pt should be oxygenated at high flow O2 through a BVM before the insertion

after I-Gel insertion you should have what sort of detection available

end-tidal detection

when suctioning a patient you should remember to let what do some of the work for you?

let gravity do some of the work for you

materials left in the airway may force themselves down the pts what?

the pts trachea

after a foreign object makes it’s way to the trachea it can move to the pts what ?

the pts lungs

if a foreign material makes it’s way to the pts lungs it can cause what

pnuemonia

mounted suction systems are usually installed where

near the head of the stretcher

a mounted suction system must furnish an air intake of?

30L/min

at the end of a mounted suction system the end of the tube has to furnish what amount

300mmHg

this type of suction device may be oxygen, air, or battery powered

portable suction device

what is the best part about a portable suction device

they have the ability to suction anywhere

what is the first thing you must have before suctioning

tubing

what is the second thing you must have before suctioning

suctioning tips

what is the third thing you must have before suctioning

suction catheters

what is the fourth thing you must have before suctioning

a collection container

what is the fifth thing you must have before suctioning

container of clean or sterile water

the tubing attached to the unit must be ?

thick-walled, non-kinking, and wide bore

this type of tip can be recognized by it’s wide and rigid opening and is most helpful for unconsious patients because of how much fluid it can suck up

yankeur tip

this is a flexible plastic tube that come in various sizes and are indentified by number french as well

suction catheter

what is sterile water used for when suctioning a pt

to clean out the tubing (if any chunks get stuck in it)

when suctioning a patient you are at risk to hit which nerve on the esophagus

the vagus nerve

what happens when you hit the vagus nerve when suctioning a patient

it can cause patient heart rate to go down

remember in pediatric pts the ___________ nerve is much more senstive

vagus n

what is a common suctioning device to use in pediatric patients

a bulb syringe

a bulb syringe is not only helpful to use in pediatric pts but as well as in cases of

emergency child birth

how long do you want to suction a pt for

limit to less then 10s (cap says 15s)

you should take EXTRA care of suctioning the airway when the pt has what kind of injuries

facial

as the intercostals and diaphragm contract and move in a downward motion this creates what kind of pressure

negative pressure

the negative pressure created by the diaphragm and intercostals pulls air through what

the glottic opening to which the air then inflates the lungs

in pts with ________ and __________ the narrowing of airways can cause exhalation to become much more of an active process

asthma and COPD

asthma and COPD pts can often be recognized by their what?

excessive amount effort and their expiratory phrase of breathing

what does the expiratory phase of breathing refer to

amount of time it takes for a patient to exhale

the average pt has a normal tidal volume of ?

500 mL

although patients have a normal tidal volume of 500mL only about how much actually reaches the pts alveoli

350mL

the 150mL that does not reach the alveoli is known as what?

dead space

the air that becomes dead space instead of being delivered to the alveoli usually goes to which parts of the body

the trachea and bronchioles

this term refers to how much air actually reaches the alveoli

alveolar ventialation

alveolar ventilation depends very much on what two things

tidal volume and RR (minute vL)

the alveolis contain air on the inside and what on the outside surface

pulmonary capillaries

this is the diffusion of oxygen and carbon dioxide

pulmonary respiration

after CO2 is offloaded from the blood in the alveoli what happens

oxygen attaches to the hemoglobin

this is the diffusion of oxygen and carbon dioxide that takes place between the cells and the circulating blood

cellular respiration

what happens when the chest can not create the necessary needed pressure

the pts breathing will be altered

what can interupt gas exchange

low oxygen levels in the outside air

what two conditions can limit the alveoli’s ability to exchange properly with oxygen and carbon dioxide

CHF and COPD

the body will tolerate longer periods of _________ over hypoxia

hypercapnia

as soon as the body starts to increase RR what will happen with the pt

the pt will start to complain of SOB

this is when the body is in compensation, changing position, coughing, chest pain, gasping, (the body is somewhat keeping up with the problem)

respiratory distress