Chapter 11: Airway and Ventilation Management

How long can brain tissue go without oxygen?

4-6 minutes

Action of swallowing

Larynx is elevated and epiglottis folds over glottis to prevent aspiration

Larynx

Voice box

How long is the trachea?

4-5 inches

What is pleura?

Definition: Lube to prevent friction

• Visceral: Outer lung

• Parietal: Inside thoracic

Phrenic nerve

Originate from the third, fourth, and fifth cervical nerves

Allow diaphragm to contract

Partial pressure

Describe amount of gas in air / dissolved in fluid

Hypoxia

Tissues and cells of the body do not get enough oxygen

Hypoxic drive

Backup system to control breathing

Dyspnea

Shortness of breath

What is surfectant?

Reduces surface tension within alveoli to keep them expanded

Hypercapnia

Increased amount of carbon dioxide in the blood stream

Hemothorax

Blood in chest cavity

Intrapulmonary shunting

Blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the right side unoxygenated

Apnea

Lack of spontaneous breathing

Cheyne-Stokes Respirations

“Crescendo-deconscendo” followed by apnea

End-tidal carbon dioxide ETCO2

Max concentration of carbon dioxide at the end of each exhaled breath

35-45 mm Hg

Phases of capnographic waveform

Phase 1: Gas sample is in dead space, free of CO2

Phase 2: Alveolar gas (lg amount of CO2) mixes with dead space gas

Phase 3: All alveolar

Phase 0: Patient inhales and fresh gas is breathed into the lungs

How powerful should a vacuum do the thing a vacuum does?

300 mm Hg

What are the different types of catheters used to suction a patients airway

Yankauer tonsil-tip: Useful for removing thin secretions

DuCanto catheter: Larger distal bore capable of removing copious thick secretions, large debris, clotted blood

Warning for using suction

Don’t suction for more than 15 seconds

Don’t suction on the way in

What is oxygen toxicity?

Damage of cellular tissue due to excessive oxygen levels in the blood

Oxygen delivery devices compared

Nonrebreather

• Flow rate: 10-15 L/min

• Oxygen delivered: Up to 95%

Nasal cannula

• Flow rate: 1-6 L/min

• Oxygen delivered: 24-44%

Bag-mask device w/ reservoir

• 15 L/min

• Up to 95%

Blow-by

• 6 L/min

• More than 21%

Simple face mask

• 6-10 L/min

• 35-60 % oxygen

What is compliance in relation to breathing system?

Ability of alveoli to expand when air is drawn in at inhalation

CPAP contraindications

• Patient is in respiratory distress or has agonal breathing

• Patient is hypo ventilating

• Patient cannot speak/follow verbal commands

• Patient cannot protect own airway

• Patient has hypotension

• Signs of pneumothorax or chest trauma

• Has tracheostomy

• Bleeding, nausea, or vomiting

DOPE when dealing w/ trach

D: Displaced, dislodged, or damaged tube

O: Obstructed tube

P: Pneumothorax (collapsed lung)

E: Equipment failure

Wheezing

Mild lower airway obstruction

Stridor

Upper airway obstruction

A nasopharyngeal airway is inserted:

Into the larger nostril with the bevel facing toward the septum

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:

Nonrebreathing mask

Admin of humidified oxygen would be most appropriate in which of the following conditions?

Croup

Airway obstruction occurs in children more than adults in part due to the child’s proportionally smaller … and proportionately larger …

Mandible, tongue

An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:

500 psi

During the preoxygenation phase of patient prep for intubation, the EMT should:

Apply a nasal cannular to the patient and set the flow rate at 15 to 25 L/min

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

It forces the alveoli open and inc the conc of oxygen in the alveoli

In which of the following patients would the head tilt-chin lift maneuver be the most appropriate method of opening the airway?

A 37-year-old female who is found unconscious in her bed

Irregular respirations characterized by an inc rate and depth of breathing followed by periods of apnea are called?

Cheyne-Stokes respirations

The diaphragm is innervated by the … nerve which allows it to contract

Phrenic

The nasal cannula is most appropriately used in the prehospital setting:

When the patient cannot tolerate a nonrebreathing mask

To select the proper size oropharyngeal airway: you should measure from the:

Corner of the mouth to the earlobe

When testing a mechanical suctioning unit, you should turn on the device, clamp tubing, and ensure that it generates a vacuum generates pressure of more than:

300 mm Hg

Which of the following factors will cause a reduction in minute volume in an adult?

Shallow breathing

Which of the following is useful mnemonic to use if you think that a patient has an obstructed trach?

DOPE

Which of the following is not a sign that indicates a complication with an intubated patient?

The patient’s blood pressure dec

Which of the following is the most reliable indicator of adequately performed bag-mask ventilations in an apneic adult with a pulse?

Adequate rise of the chest when squeezing the bag

Which of the following is not found in the upper airway?

Bronchus