Emergency Transportation of the Sick and Injured - Twelfth Edition: Chapter 11, Airway Management

diffusion

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

nasopharynx

lined with a ciliated mucous membrane that keeps contaminants such as dust and other small particles out of the reparatory tract.

oropharynx

the posterior portion of the oral cavity, which is bordered by the cheeks, and inferiorly by the tongue

aspiration

contents enter the trachea

larynx

marks where the upper airway ends and the lower airway begins,

complex structure formed by many independent cartilaginous structures

glottis

the space between the vocal cords,

the narrowest portion of the adult's airway

vocal cords

white bands of thin muscle tissue that are partially separated at rest and serve as the primary center for speech.

carina

Where the trachea splits in two bronchi

visceral pleura

inner layer of pleura lying closer to the lung tissue

parietal pleura

outer layer of pleura lying closer to the ribs and chest wall

bronchioles

thin, hollow tubes made of smooth muscle

pulmonary capillaries

surround the thin tissue membranes of the alveoli; site of gas exchange in blood

mediastinum

space between the lungs. It contains the heart, esophagus, trachea, great blood vessels, and other structures.

phrenic nerves

originate from the third, fourth, and fifth, cervical nerves, innervate the diaphragm, allowing it to contract

inhalation

muscular part of breathing

partial pressure

the amount of gas in air or dissolved in fluid, such as blood

tidal volume

amount of air that is moved into or out of the lungs during one breath

residual volume

The air that remains in the lungs after maximal expiration.

alveolar ventilation

the volume of air that reaches the alveoli

minute volume

volume of air moved through the lungs in one minute

alveolar minute volume

the volume of air moved through the lungs in 1 minute,

minus dead space

vital capacity

the amount of air that can be forcibly expelled from the lungs as possible

dead space

the portion of the tidal volume that does not reach alveoli and thus does not participate in gas exchange

exhalation

does not normally require muscular effort; passive process

hypoxia

the tissues and cells of the body do not get enough oxygen

hypoxic drive

theory of secondary control of breathing

dyspnea

shortness of breath

oxygenation

The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

external respiration

breathing fresh air into the reparatory system and exchanging oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries

surfactant

reduces surface tension within the alveoli and keeps them expanded making it easier for the gas exchange between oxygen and carbon dioxid

internal respiration

Exchange of gases between cells of the body and the blood

chemoreceptors

Monitor the levels of O2, CO2, 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.

hypercarbia

the amount of oxygen in the blood decreases and the amount of carbon dioxide in the bloodstream increases

extrinsic factors

trauma or foreign body airway obstruction

external factors

-atmospheric pressure

-partial pressure of oxygen

intrapulmonary shunting

blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state

hemothorax

blood in the pleural cavity

pneumothorax

air in the pleural cavity

tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping

open pneumothorax

sucking chest wound

Hemopneuomothorax

Accumulation of air and blood in the pleural cavity

hypovolemic shock

abnormal decrease in circulating volume that causes inadequate oxygen delivery to the body

vasodilatory shock

determined by the size of the blood vessels

Cheyne-Stokes respiration

pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea

apnea

lack of spontaneous breathing

ataxic respirations

Irregular, ineffective respirations that may or may not have an identifiable pattern.

pulse oximetry

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds.

1. clean the patients finger and remove nail polish as needed. place the index or middle finger into the probe. turn on the pulse oximeter and note the LED reading of the Spo2,

,

,

2. Palpate the radial pulse to ensure that correlates with the LED display on the pulse oximeter

performing pulse oximetry

end-tidal CO2

The amount of carbon dioxide present in exhaled breath.

carbon monoxide poisoning

What serious condition allows the Spo2 to appear normal during hypoxia?

tall capnographic waveform

sign of to much co2

if you hear gurgling

when does the patient needs suctioning?

suction catheter

hollow, cylindrical device that is used to remove fluids from the patients airway

stoma

opening through the skin that goes into an organ or other structure

only as far as you can visualize

How far to put the suction catheter?

If it is visible and the catheter is not strong enough,

First, log the patient to the side.

When to remove an object with your finger?

1. keep the tongue from blocking the upper airway,

,

2. make it easier to suction the oropharynx if necessary

purposes of the oropharyngeal airway:

gag reflex

a protective reflex mechanism that prevents food and other particles from entering the airway

it should reach from the angle of the earlobe, to the corner of the mouth

how long should an oropharyngeal airway be?

nasopharyngeal airway

-Used with an unresponsive patient or a patient with an altered LOC who has an intact gag reflex and isn't able to maintain his or her own airway

from the tip of the patients nose to the earlobe

how long should the nasopharyngeal be?

recovery position

maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own with a normal respiratory rate and adequate tidal volume

never

When should you withhold oxygen from a patient who might benefit from it?

pin-indexing system

prevent an oxygen regulator from being connected to a carbon dioxide cylinder, a carbon dioxide regulator from being connected to an oxygen cylinder, and son on

American Standard Safety System

A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas.

Pressure-compensated flowmeter

An oxygen flowmeter that incorporates a float ball in a tapered calibrated tube; the float rises or falls according to the gas flow in the tube; is affected by gravity and must remain in an upright position for an accurate reading.

Bourdon-gauge flowmeter

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

oxygen toxicity

A condition of excessive oxygen consumption resulting in cellular and tissue damage.

nonrebreathing mask

used to administer high concentrations of oxygen to significantly hypoxic patients who are otherwise breathing adequately,

flow rate - 15L/min

nasal cannula

- delivers between 24-44% of oxygen between two small, tubelike prongs that go into the nostrils

Partial rebreather mask

a face mask and reservoir oxygen bag with no one-way valve to the reservoir bag so some exhaled air mixes with the oxygen; used in some patients to help preserve carbon dioxide levels in the blood to stimulate breathing

venturi mask

A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air.

tracheostomy mask

a small oxygen-delivery apparatus that fits over a tracheostomy site and is held in place by an adjustable elastic strap that fits around the patient's neck; also called a tracheostomy collar,

use a pediatric tip on the BBM

humidification

humidified oxygen to patients during extended transport or for certain conditions such as croup.

gastric distention

inflation of the stomach with air

1. ensure that the patient's airway is appropriately positioned,

2. ventilate the patient at the appropriate rate,

3. ventilate the patient with the appropriate volume ,

how to alleviate gastric distention?

passive ventilation

air movement in and out of the chest cavity occurs passively as a result of compressing the chest

automotive transport ventilator

ventilation device attached to a control box that allows the variables of ventilation to be set

continuous positive airway pressure (CPAP)

noninvasive means of providing ventilatory support for patients experiencing respiratory distress

7.0 to 10.0 cm H2O

Acceptable therapeutic pressure range for a patient on CPAP?

tracheostomy

permanent tracheal stoma

endotracheal intubation

insertion of a tube inside the trachea

preoxygenation

oxygenation before endotracheal intubation

apneic oxygenation

allows for continuous oxygen delivery down the airways during all phases of the intubation procedure

direct laryngoscopy

Visualization of the airway with a laryngoscope.

video laryngoscopy

Visualization of the epiglottis and vocal cords through a video monitor that is attached to a laryngoscope

B - Perform bag-mask preoxygenation,

E - Evaluate for Airway difficulties,

M - Manipulate the patient,

A - Attempt first-pass intubation,

GI - use a supraGlottic airway if unable to intubate,

C - confirm success and Correct issues,

BEMAGIC

esophageal intubation

advanced airway device has been placed into the esophagus rather than into the trachea