Airway & Ventilation Management

What is the pathway of respiration

Nose/ mouth → pharynx → larynx → trachea → carina → left and right bronchi → bronchioles → alveoli

What is the upper airway from and to
what is the main purpose

Mouth and nose → larynx

mainly warms, filters, and humidifies incoming air

Uvula

Dangling muscle at the back of throat from the soft palate

Laryngeal prominence / thyroid cartilage

adams apple

What is part of the lower airway and what is the main function
+ what happens at the last part specifically

Trachea → alveoli

main function is to deliver oxygen to alveoli for oxygen exchange
O2 enters capillaries while CO2 leaves cappilaries and enters alveoli

pleura - and what are the 2 → how are they different
whats between the 2

membrane surroudning lungs
parietal which lines the thoracic cavity (touching the ribs)
visceral → directly covers the lungs
fluid between the two in order to reduce friction

What is the main breathing msucle and what are the nerves + where

diaphragm → phrenic nerves at C3 4 5

Ventilation vs oxygenation vs respiration

ventilation → movement of air into and out of lungs (BVM)

Oxygenation → getting oxygen into blood stream and onto hemoglobin

Respiration → actual exchange of O2 and Co2

external respiration vs internal respiration

external = gas exhcnage between alveoli and capillaries

intenral = gas exchange between capillaries adn body cells

Mechanism of ventialation - inhalation - active or passive + what system

active process (muscles contracting) + negative pressure system

Diaphragm + intercostal contract → increase volume of thoraccic cavity → pressure decreases → air moves inwards

Mechanism of ventialation - exhalation - active or inactive

passive process

diaphram and intercostal relaxi → decrease volume and air leaves

how is breathing regulated (2)

Medulla oblongata + pons of the brain stem

• medulla oblongata establishes breathing rhythm by looking at CO2 levels while pons fine tunes the rate and depth

• chemoreceptors monitor many things (Co2 O2 hydrogen ions and pH) → looks at when CO2 is too high → tells medulla to tell body to breath more

Hypoxia and hypoxic drive

hypoxia is lack of oxygen in cells and tissues

hypoxic drive is when person breathes when O2 is low instead of when CO2 is high which is bad

Emphysema / COPD (Chronic obstructive pulmonary disease) - what is typically seen in these patients

usually have hypoxic drive

Which organs are likely to be damaged as a result of low oxygen
0-1 min

1-4 min

4-6 min

6-10 min

0-1 → heart irritability

1-4 min - brain damage unlikely

4-6 → possible brain damage

6-10 → likley brain damage

V/Q rate

ventilation (air reaching alveoli) and perfusion (blood reaching alveoli)
→ need to matched / happen at the same time (blood and air have to reach alveoli at the same time for gas exchange)

Adequate breathing

12- 20 breaths per min

equal bilateral clear breath sounds
equal bilateral chest rises

adequate depth / tidal volume

Inadequate breathing

dyspnea → shortness of breath

inadquate chest rise (shallow), abnormal sounds (lung sounds), color (pale or cyanotic), tripod position , acessory muscle use (skin pulling in = using everything for each breath)

agonal gasps

irregulate/ abnormal breathing that is ineffective and can happen after heart stops / cardiac arrest

Cheyne stokes respiration

ireregular respiration with periods of apnea (no breathing)
often with strokes or head injuries bc brain stem is squeezed

Ataxic respirations

irregular/ unidentifiable pattern of breathing → head injury

Kussmaul respirations

deep and rapid

usually with diabetics (burns fat instead of sugar which produces ketons making it more acidic → breathing out CO2 decreaes acidity

End-tidal Co2
and what is the normal range

high vs low co2

measures amount of CO2 exhaled

normal range is 35-45 mmHG

low co2 → hyperventilating/ breathing too fast (removing CO2 fast) → not enoguht CO2 returnign to lungs + less CO2 produced
High Co2 → not breathing enough / ventilzating so CO2 builds up or apnea (not breathing)

Number 1 airway obstruction and what sounds are common

Tongue → snoring

What 2 maneuevers are used to clear the airway and when for each

head tilt chin lift → when there isnt suspected c spine injury

jaw thrust → concerned about c spine

Used to help maintain a clear airway in an unconscious patient who is not injured and is breathing on their own

Recovery position / left lateral recumbent

Suction - when is it used

• how much pressure should it generate mmHg

• how long can you suction (3) + how much time in between which you should be ____

what should u never do and what motion

when there is fluid causing an obstruciton in the airway

it should generate more the 300 mmHG → test by kinking after setting machine to 350
adult → 15 sec

ped → 10 sec

infant → 5 sec
2 min in between to ventilate

never have it on when inserting into paitent (kink it)

figure 8 motion

OPA

indications

contraindications

oropharyngeal airway → lifts tongue away from posterior pharynx

indications

• use OPA in unresponsive patients wiht no gag reflex

contraindications

• don’t use in patients who are conscious or have gag reflex

NPA

indications or contraindications

nasopharyngeal airway

indications → semiconscious or consciosu patients with gag reflex and patients who cant tolerate OPA

contraindications → facial fractures or head injuries

Room air contains how much percentage oxygen

21%

What is the target SPO2 / good

94-99%

What ensures that we don’t put the wrong regulator onto a tank

PISS sytem

pin index safety system —> 2 holes to attach regulator to oxygen tank

nasal canula

what to set flowmeter on regulator

and provides how much air

for what

1-6 l/min

22-44% oxygen

for mild hypoxemia

NRB what to set flowmeter on regulator

and provides how much air

for what

Non rebreather

10-15 liters/min

90-99% O2

for significant hypoxemia but adequate tidal volume (breathing + chest rises but need more o2)

BVM what does it provide
what is the flow rate

how much o2 is being given to patient
what to avoid

bag valve mask → positive pressure breathing (pushing air in)

15-25 Liters per min

99-100% o2

avoid pressing too hard → too much o2 → gastric distension →vomit → infections or other airway obstruction into lungs

ventilation rate for bvm for adults and children
WITH PULSE (not cardiac arrest)

adult - 1 breath every 6 sec → 10 breaths per min

children - 1 breath every 2-3 sec → 20-30 breaths per min

NRB vs bvm

nrb → breathing adequately but needs o2
bvm → breathing inadequately

assisted vs artificial ventilation with BVM

assisted → patient is breathing but not well enough → squeeze BVM with own inhalation

artificial → patietn is apneic / not breathing at all → provide all breath with BVM

CPAP

continuous positive airway pressure

→ patient needs to still be breathing spontaneously → maintains positive pressure while patient breaths on their own

FBAO

foreign body airway obstructions

Mild airway obstruction

choking but some air still getting through → noising breathing and coughing → allow patient to try and clear it through coughing generally

Severe airway obstruction

little to no air movement

patients cant breathe talk or cough

→ abdominal thrust / heimlich

Pediatric airway differences

larger tongues, undeveloped trachea cartilage rings (head tilt chin lift can collapse it)

more susceptible to choking