Chapter 13 NC

respiratory

abdominal thrusts preformed to relieve a foreign body airway obstruction- also known as the Heimlich manoeuver

Abdominal Thrust Maneuver

Muscles not normally used during normal breathing, including the sternocleidomastoid muscles of the neck

Accessory muscles

A chemical mediator of the parasympathetic nervous system

Acetylcholine

Lymphatic tissues located on the posterior nasopharyngeal wall that filter bacteria

Adenoids

A type of abnormal breath sounds that occurs in addition to the normal breath sounds- examples are crackles and wheezes

Adventitious noises

Slow shallow irregular respirations or occasional gasping breaths- results from cerebral anoxia

Agonal Respirations

volume of inhaled air that reaches the alveoli and participates in gas exchange, equal to tidal volume (Vt) - dead space volume. is approximately 350 ml in the average adult

Alveolar Volume

Balloon like clusters of single layer air sacs that are the functional site for the exchange of oxygen and carbon dioxide in the lungs (single is an alveolus) can also refer to small pits or cavities such as the sockets for the teeth

Alveoli

The portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange. It includes the trachea and the larger bronchi the air remaining in these areas is the result of residual gas in the upper airway at the end of ventilation

Anatomic dead space

An absence of oxygen

anoxia

The inability to create new memories

Antegrade amnesia

inability to speak

aponia

portion of the brainstem that influences the respiratory rate by increasing the number of inspirations per minute

Apneustic center

Prolonged gasping inspirations followed by extremely short, ineffective expirations, associated with brainstem insult

apneustic respirations

Pyramid-like cartilaginous structures that form the posterior attachment of the vocal cords

arytenoid cartilages

Entry of fluids or solids into the trachea, bronchi and lungs

aspiration

When one side of the chest moves less than the other, indicates decreased airflow into one lung

asymmetric chest wall movement

Alveolar collapse that prevents use of that portion of the lung for ventilation and oxygenation

atelectasis

the joint formed at the articulation of the atlas of the vertebral column and the occipital bone of the skull

The atlanto-occipital joint allows nodding and lateral movements of the head.

manual ventilation device that consists of a bag, mask, reservoir, and oxygen inlet. Capable of delivering up to 100% oxygen, removal of the mask for bag ventilation is used when attached directly to a tracheal tube

Bag-mask device

injury resulting from excessive pressure disequilibrium across the body surfaces

Barotrauma

any medications of a group of psychotropic agents that provide relaxation and mild sedation, used as antianxiety drugs, muscle relaxants, sedatives or hypnotics. Examples include midazolam, and diazepam.

benzodiazepines

An effective technique to improve the laryngoscopic view of the vocal cords by external manipulation of the larynx

Bimanual laryngoscopy

respirations characterized by an irregular rate, pattern and volume of breathing with intermittent periods of apnea, results from intracranial pressure also known as ataxic respirations.

Biot respirations

Also known as the Eschmann stylet, a flexible device that is inserted in between the glottis under direct laryngoscopy the tracheal tube is then threaded over the device to facilitate its entry into the trachea

Bougie

an oxygen flowmeter that is commonly used because it is not affected by gravity and can be placed in any position

Bourdon-gauge flowmeter

Subdivision of the smaller bronchi in the lungs, made of smooth muscle and dilate or constrict in response to various stimuli

Bronchioles

Acronym as it relates to laryngoscopy for backwards, upward, rightward pressure

BURP maneuver

Device that attaches in between the tracheal tube and bag-mask device, contains colorimetric paper which should turn yellow during exhalation indicating proper tube placement

Capnographer

Device that attaches in the same way as a capnographer but provides a light emitting diode readout of the patients exhaled carbon dioxide

Capnometer

A device that measures absorption at several wavelengths to distinguish oxyhemoglobin from carboxyhemoglobin

Carbon monoxide oximeter

Abnormal hemoglobin that is formed by the attachment of carbon monoxide to the hemoglobin molecule

carboxyhemoglobin

point at which the trachea bifuricates into the left and right mainstem bronchi

Carina

Cerebrospinal fluid drainage from the ears

Cerebrospinal otorrhea

Cerebrospinal fluid drainage from the nose

Cerebrospinal rhinorrhea

Monitor the levels of O2 and CO2 in the blood, and the pH of the cerebrospinal fluid, and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time

Chemoreceptors

Gradually increasing rate and depth followed by a gradual decrease with intermittent periods of apnea, associated with a brainstem injury

Cheyne-stokes respirations

A device that attaches between the tracheal tube and ventilation device, uses special paper that should turn from purple to yellow during exhalation, indicating the presence of exhaled carbon dioxide

Colorimetric carbon dioxide detector

Millilumen airway device that consists of a single tube with two lumens two balloons, and two ventilation ports, and alternative device if tracheal intubation is not possible or has failed

Combitube

a noninvasive means of raising the breathing baseline above ambient pressure via a tight fitting face mask. The increased pressure across the entire breathing cycle achieves two benefits, stents the airway and increase the functional residual capacity, thereby improving oxygenation and lung compliance in a hypoinflated lung pathology

CPAP

A system used to predict intubation difficulty based on the airway structures observed during laryngoscopy

Cormack-Lehane Classification

From the lowest portion of the larynx, also referred to as the cricoid ring, the first ring of the trachea, and is the only upper airway structure that forms a complete ring

cricoid cartilage

The application of posterior pressure to the cricoid cartilage to reduce the risk of gastric distention and regurgitation during positive pressure ventilation also called the Sellick maneuver

Cricoid pressure

A thin superficial membrane located between the thyroid and cricoid cartilages that is relatively avascular and contains few nerves, the site for emergency surgical and non surgical access to the airway

Cricothyroid membrane

Also called the Macintosh blade, designed to fit into the vallecula indirectly lifting the epiglottis and exposing the vocal cords

Curved laryngoscope blade

a blue gray skin colour that is caused by reduced levels of oxygen in the blood

Cyanosis

Any portion of the airway that does not contain air and cannot participate in gas exchange

Dead space

Medications that bind to the acetylcholine receptor sites and keep muscles in a contracted state, including meds like succinylcholine

depolarizing neuromuscular blocking agents

Large skeletal muscle that plays a major role in breathing and separates the chest cavity from the abdominal cavity

Diaphragm

A process in which molecules move from an area of higher concentration to an area of lower concentration

Diffusion

Method of intubation that involves directly palpating the glottic structures and elevating the epiglottis with the middle finger while guiding the tracheal tube into the trachea by feel

Digital intubation

Visualization of the airway with a laryngoscope

Direct Laryngoscopy

Difficulty speaking

dysphonia

Any difficulty in respiratory rate, regularity or effort

Dyspnea

Device that detects the presence of carbon dioxide in exhaled air

end-tidal carbon dioxide detectors

Leaf shaped cartilaginous structure thar closes over the trachea during swallowing

Epiglottis

Blub or syringe that is attached to the proximal end of the tracheal tube, a device that is used to confirm proper tracheal tube placement

Esophageal detector device

a nonnarcotic, nonbarbiturate hypnotic sedative drug also called amidate

Etomidate

Passive movement out of the lungs, also called expiration

Exhalation

Passive movement out of the lungs, also called exhalation

expiration

The amount of air that you can exhale following a normal exhalation, average volume is approximately 1200 mL

Expiratory reserve volume

The exchange of gasses between the lungs and the blood cells in the pulmonary capillaries also called pulmonary respiration

External respiration

The process of removing the tube from an intubated patient

extubation

Characterized by brief uncoordinated twitching of small muscle groups in the face, neck, trunk, and extremities. Caused by the administration of depolarizing neuromuscular blocking agents like succinylcholine

Fasciculations

The % of oxygen in inhaled air

Fraction of inspired oxygen

The amount of air remaining in the lungs after normal passive exhalation, the sum of residual volume and expiratory reserve volume

is known as functional residual capacity.

Automatic reaction when something touches an area deep in the oral cavity, helps protect the lower airway from aspiration

Gag reflex

Inflation of the patients stomach with air

Gastric distention

A tube that is commonly inserted in a patients stomach to decompress the stomach by removing its contents, can also be used administer certain enteral medications

Gastric tube

The space in between the vocal cords that is the narrowest portion of the adults airway, also known as the glottic opening

glottis

Manual airway maneuver that involves tilting the head back while lifting up the chin, used to open the airway of an unresponsive patient

Head tilt chin lift maneuver

an iron rich protein and oxygen carrying pigment of the red blood cells, when it has absorbed oxygen in the lungs it is bight red and called oxyhemoglobin, after it has given up its oxygen in the tissues it is purple and is called reduced hemoglobin

Hemoglobin

A protective mechanism that terminates inhalation thus preventing overexpansion of the lungs

Hering-Breuer reflex.

In the context of the kidney a cleft where the ureters, renal blood vessels, lymphatic vessels and nerves enter and leave the kidney. In the context of the lungs it is the point of entry of all the blood vessels and the bronchi into each lung

Hilum

A mask that allows the patient to inhale oxygen from a reservoir bag via a one-way valve and exhale breath through another one way valve through a high efficiency filter before exiting the mask

Hi-Ox mask

A small horseshoe shaped bone to which the jaw, tongue, epiglottis and thyroid cartilage attach

hyoid bone

Increased co2 content in arterial blood

Hypercapnia

Occurs when co2 elimination exceeds co2 production

hyperventilation

Decreased carbon dioxide content in arterial blood

Hypocapnia

Occurs when carbon dioxide production exceeds the body’s ability to eliminate it by ventilation

hypoventilation

A decrease in arterial oxygen levels

Hypoxemia

a lack of oxygen to the body’s cells and tissues

Hypoxia

a situation in which a persons stimulus to breath comes from a decrease in PaO2 levels rather than the normal stimulus a rise in PaCo2 levels

Hypoxic drive

a supraglottic airway device that uses a noninflatable gel like mask to isolate the larynx and facilitate ventilation

iGel

The active process of moving air into the lungs, also called inhalation

inspiration

The amount of air that can be inflated after a normal inhalation, the amount of air that can be inhaled in addition to the normal tidal volume

inspiratory reserve volume

Nerves that innervate the external intercostal muscles- the muscles between the ribs

intercostal nerves

The exchange of gases between the blood cells and the tissues, also known as cellular respiration

internal respiration

Bypassing of oxygen poor blood past nonfunctional alveoli

intrapulmonary shunting

Manual airway maneuver that involves stabilization of the patients head and thrusting the jaw forward, the preferred method of opening the airway of an unresponsive trauma patient

Jaw thrust maneuver

Manual airway maneuver that involves thrusting the jaw forward while tilting back on the head

Jaw thrust maneuver with head tilt

a drug with sedative, analgesic and hypnotic properties created in a laboratory from phencyclidine

Ketamine

A single lumen airway device that is blindly inserted into the esophagus, when properly placed in the esophagus one cuff seals the esophagus and the other seals the oropharynx

King Lt airway

Deep Gasping respirations characteristic of the person with diabetes who is in ketoacidosis with marker hypernea and tachypnea

Kussmaul respirations

Device that surrounds the opening of the larynx with an inflatable silicone cuff positioned in the hypopharynx and alternative device to bag mask ventilation

laryngeal mask airway

A surgical procedure in which the larynx is removed

Laryngectomy

Device that is used in conjunction with a laryngoscope blade in order to preform direct laryngoscopy

laryngoscope

Severe constriction of the larynx in response to allergy, noxious stimuli or illness

laryngospasm

A complex structure formed by many independent cartilaginous structures that all work together to produce voice, located where the upper airway ends and the lower airway begins

larynx

The ability of the alveoli to expand when air is drawn into the lungs, either during negative pressure ventilation or positive pressure ventilation

lung compliance