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Flashcards in Airway Management And Ventilation Deck (138):
0

What is the the anatomical space between the base of the tongue and the epiglottis? It also is an important landmark for endotracheal intubation.

The vallecula

1

What is the sellick maneuver?

Compressing the cricoid cartilage that occludes the esophagus resulting in reduced gastric distention during ventilation and placement of an endotracheal tube.

2

What is the total lung capacity in an average adult male?

6L

3

What is the normal tidal volume in an adult male?

5-7 mL/kg

(Approximately 500mL)

4

What is the normal tidal volume for pediatric patients?

6-8 mL/kg

5

What is alveolar air?

The amount of gas that reaches the alveoli with each breath.

6

What is the formula for alveolar air?

Tidal volume➖dead space volume

It is approximately 350mL

7

What are the two phases of ventilation?

Inspiration
Expiration

8

What is the nervous system mechanism that terminates inhalation and prevents lung over-expansion?

Hering-Breuer reflex

9

What is external (pulmonary) respiration?

Exchange of gases between the lungs and the blood cells in the pulmonary capillaries

10

What is internal (cellular) respiration?

Exchange of gases between blood cells and tissues

11

What is a minute volume?

The amount of air moved in and out of the lungs in one minute

(Tidal volume ➖ dead space volume)✖️respiratory rate

12

The amount of air that can be forced from the lungs in a single forced exhalation is called what?

Functional reserve capacity

13

What is residual volume?

The air that remains after maximal expiration

14

What is the residual volume of an average male?

1200 mL

15

What is inspiratory reserve volume?

The amount of air you can inhale after a normal inhalation

16

What are the two motor nerves of respiration?

Phrenic nerves
Intercostal nerves

17

What do the phrenic nerves do?

Innervates the diaphragm

18

What do the intercostal nerves do?

Innervates the external intercostal muscles (muscles between the ribs)

19

What is the percentage of oxygen that makes up hemoglobin?

97%

20

What is the remaining oxygen that is dissolved in plasma called?

Partial pressure of oxygen (PaO2 , PO2)

21

What is a byproduct of cellular respiration?

Carbon dioxide

22

What are three conditions that decrease the surface area of the alveoli?

COPD
Pneumonia
Pulmonary edema

23

What is intrapulmonary shunting?

If the alveoli are not functional, carbon dioxide and oxygen will not be allowed to diffuse. Therefore the blood will bypass the alveoli and will return to the left side of the heart and in an unoxygenated state

24

What is Dalton's law?

The total pressure exerted equals the sum of the partial pressures of the components of that gas, or the pressure exerted by a specific atmospheric gas

25

What is the total pressure of air at sea level?

About 760 mm Hg (760 torr)

26

What connects the medulla and the respiratory muscles?

The vagus nerve

27

What three things does the medullary respiratory centers control?

Rate
Depth
Rhythm

...Of breathing

28

What is the secondary control center of respiration if the medulla fails to initiate respiration?

The apneustic center of the pons

29

How does the apneustic center influence the respiratory rate?

By increasing the number of inspirations per minute

30

What does the pneumotaxic center inhibit?

Inhibits the influence of inspiration

31

Where are peripheral chemoreceptors that measure the amount of CO2 (Paco2) and arterial blood located?

The carotid bodies and the aortic arch

32

What two nerves send signals to the respiratory center if CO2 levels change?

Glossopharyngeal nerve (9th cranial nerve)
Vagus nerve (10th cranial nerve)

33

What do central chemoreceptors constantly monitor?

The pH of cerebrospinal fluid

34

Where are central chemoreceptors located?

Adjacent to the respiratory centers in the medulla

35

What is the average rate of respirations for an adult?

12-20 breaths/min

36

What is the average of the respiration rate for children?

15-30 breaths/min

37

What is the average respiration rate for infants?

25-50 breaths/min

38

What are four causes of respiratory distress?

Upper/lower airway obstruction
Inadequate ventilation
Impairment of respiratory muscles
Impairment of nervous system

39

What is orthopnea?

Positional dyspnea (difficulty breathing while supine)

40

What is pulsus paradoxus?

When the systolic blood pressure drops more than 10 mmHg with inspiration and/or a change in quality or even disappearance of a pulse

41

What two patients generally have pulsus paradoxus?

Patients with decompensating COPD
Severe pericardial tamponade

42

An increase in intrathoracic pressure could indicate what?

Pulsus paradoxus

43

What is atelectasis?

A condition of airless or collapsed alveoli

44

What are Cheyne-Stokes respirations?

A gradual increase of rate and tidal volume followed by a gradual decrease

45

What are Cheyne-Stokes respirations associated with?

Brain stem insult

46

What are Kussmaul respirations?

Deep gasping respirations

47

What two things are Kussmaul respirations associated with commonly?

Common diabetic coma and keto acidosis

48

What are Biot respirations?

Irregular pattern, rate, and volume with intermittent periods of apnea

49

What are Biot respirations commonly caused by?

Increased intracranial pressure

50

What is central neurogenic hyperventilation?

Deep, rapid respirations similar to Kussmaul respirations

51

What's is central neurogenic hyperventilation commonly caused by?

Increased intracranial pressure

52

What are agonal respirations?

Slow, shallow, irregular respirations or occasional gasping breaths

53

What are agonal respirations a result of?

Results from brain anoxia. The heart has stopped but the brain continues to send signals to the muscles of respiration

54

What is hyperkalemia?

High potassium levels

55

What three things does atelectasis cause?

Pulmonary shunting
Ventilation perfusion mismatching
Possibly hypoxemia

56

What is aspiration?

Vomit or foreign body's in the lungs

57

What is lung compliance?

The ability of the alveoli to expand when air is drawn in during inhalation

58

How do you measure the length of a suction catheter?

Measure from the corner of the lips to the earlobe to the xiphoid process

59

What are 2 kinds of suctioning catheters?

Ridged/hard tips (Yankauer, tonsil tip)
Non ridged/soft tips (French, whistle tip)

60

Where do you insert ridged tip catheters?

Oropharynx

61

Where can you insert nonridged tip catheters (French,whistle tip)

Oropharynx
Nasopharynx
Endotracheal tube

62

How long do you suction an adult?

15 seconds

63

How long do you suction a child?

10 seconds

64

How long do you suction an infant?

5 seconds

65

How much oxygen do M cylinders contain?

3450L

66

How much oxygen do D (super D) cylinders contain?

400L

67

What are the two most common laryngoscope blades?

Straight blades (Miller)
Curved blades (Macintosh)

68

What laryngoscope blade is popular with intubating children?

Wisconsin blade

69

What is the narrowest portion of the pediatric airway?

The cricoid ring

70

What are the size ranges for laryngoscope blades?

Range from size 0-4

71

What size laryngoscope blades do children and infants use?

Sizes 0,1, and 2

72

What size laryngoscope blades do adults use?

Sizes 3,4

73

In endotracheal intubation what does the stylet do?

It enables you to guide the tip of the tube over the arytenoid cartilage even if you cannot see the entire glottic opening

74

In endotracheal intubation what two things does Magill forceps do?

Used to remove instructions from the airway under direct visualization
Guide the tip of the ET tube through the glottic opening if you are unable to get the proper angle with simple manipulation of the tube

75

What size endotracheal to do you use for an average adult females?

7.0-8.0

76

What size endotracheal tube do you use for an average adult male?

7.5-8.5

77

What is Murphy's eye?

The opening on the side of the endotracheal tube at its distal end
It prevents occlusion of the tube with secretions

78

What position do you place the patient in endotracheal intubation?

"Sniffing position"

79

What does Burp in the Burp maneuver stand for?

Backward
Upward
Rightward
Pressure

80

What is the Burp maneuver?

If you are having difficulty seeing the glottic opening take your right hand and locate the lower third of the thyroid cartilage by applying backward upward and rightward pressure you can often move the larynx into view

81

What is the gum bougie?

A flexible device that is rigid enough to be able to be easily directed through the glottic opening but flexible enough so it doesn't cause damage to the tracheal walls

82

What does condensation on the endotracheal tube indicate?

Correct placement in the trachea

83

How does a capnographer indicate correct tube placement?

It attaches between the ET tube and BVM device and contains colorimetric paper which turns yellow during exhalation

84

What are adenoids?

Lymph tissues in the mouth and nose that filter bacteria

85

What is the bone that the brain sits on just above the palate?

Cribriform plate

86

What is the narrowest part of the adult trachea?

The glottic opening

87

What is the hilum?

Part of an organ where structures such as blood vessels and nerves enter

88

Well are four differences in the upper airway for pediatric patients

Proportionately larger tongue
Proportionately smaller jaw which makes tongue encroach upon the airway
Smaller narrower airways
Floppy U shaped epiglottis

89

What are five differences in pediatric lower airways?

Larynx is more superior
Larynx is funnel shaped
Narrowest part is cricoid ring (until 10)
Softer trachea
Smaller narrower airways

90

What are two differences in pediatric chest walls?

Ribs and cartilage are softer so they can't optimally contribute to lung expansion
Rely more heavily on diaphragm for breathing

91

What is expiratory reserve?

Amount of air that can be expired after a relaxed expiration

92

What is FiO2?

Percentage if oxygen in inspired air

93

What means cyanosis around the lips?

Circumoral

94

What are 6 airway obstructions?

Tongue
Foreign body obstruction
Laryngeal spasm
Laryngeal edema
Fractured larynx
Aspiration

95

How many liters of oxygen do you give for albuteral with a nebulizer?

6L

96

How much oxygen do you administer albuterol with an NRB?

10L

97

What is the concentration of albuterol?

.083%

98

What's the dose of albuterol?

2.5mg/3ml in a concentration of .083%

99

How many liters of air should a fixed suctioning unit generate?

40L/min

100

How much should a fixed suctioning unit vacuum when the tubing is clamped?

300mmHG

101

How many liters of oxygen do flow restricted, oxygen powered ventilation devices deliver? (FROPVD)

40 L/min at a fixed flow rate
Operates at or below 30cm of water to prevent gastric inflation
(when the patient breaths in a trigger goes off to give off oxygen)

102

What are two kinds of multilumen airways?

Pharyngeotracheal lumen airways (PtL)
Combitube

103

What flow meter gauge is not affected by gravity?

Bourdon-gauge flow-meter?

104

What's the purpose of pin-indexing system?

Prevent oxygen cylinders from being connected to carbon dioxide cylinders. Ect..

105

How much oxygen will a simple face mask deliver?

40%-60% at 10 L/min

106

How much oxygen do nasal cannula' deliver?

24%-44%

107

How much oxygen do non rebreather masks deliver?

Up to 90%

108

How much oxygen do BVM device with reservoir deliver?

Nearly 100%

109

Why do you clear out an oxygen tank before putting it in service?

To get dust out of the tank

110

What is an antagonist to apneustic control center?

Pneumotaxic center

111

Which oxygen device allows a specific concentration of oxygen to be delivered?

Venturi mask

112

What three things do oxygen humidifiers help with?

Croup
Epiglottitis
Bronchiolitis

113

What is the narrowing of the stoma called?

Stenosis of the stoma

114

What are four things you check if a patient's airway decreases?

Displacement
Obstruction
Pneumothorax
Equipment failure

115

What does DOPE stand for regarding airway quality?

Displacement
Obstruction
Pneumothorax
Equipment failure

117

In endotracheal intubation what is the average tube depth at the teeth for adult males?

22 cm

118

In endotracheal intubation what is the average tube depth at the teeth for adult females?

21 cm

119

What is the formula for selecting endotracheal tube size for pediatrics? (2)

(Age➕16)➗4

Or

(Age➗4)➕4

120

What are 4 contraindications of combitubes?

Can't use in children
Esophageal disease or trauma
After swallowing a caustic
Pt's 7ft

121

Which cuff so you inflate first with combitubes?

Proximal cuff (big one)
Then distal cuff (small one)

122

What is the normal CO2 level in patients with adequate ventilation and Perfusion?

35-45 mmHg

123

What is the cause if a patient has less than 35 mmHg of CO2?

Hyperventilation (blowing off too much CO2)
"Alkalodic"

124

What is the cause if a patient has more than 45 mmHg of CO2?

Hypoventilation (patient holding in too much CO2)
"Acidotic"

125

What causes the "shark fin" capnography reading?

Resistance while exhaling. (COPD, Asthma)

126

What is minute volume formula?

(Tidal volume➖dead space)✖️respiratory rate

127

What are four advantages of Combitubes?

Rapid insertion
Doesn't require sniffing position
No face mask needed to seal
No special equipment needed

128

What are four disadvantages of combitubes?

Impossible to suction trachea tube is in esophagus
Cant be used in children
Unconscious pts only
Difficult to intubate around

129

What are three indications for endotracheal intubation?

Present or impending respiratory failure
Apnea
Inability of patient to protect own airway

130

What are three advantages of endotracheal intubation?

Provides a secure airway
Protects against aspiration
Provides a route for certain medications

131

What are two disadvantages of endotracheal intubation?

Special equipment needed
Bypasses physiologic function of upper airway (warming/filtering/humidifying)

132

What are seven complications of endotracheal intubation?

Bleeding
Hypoxia
Laryngeal swelling
Laryngospasm
Vocal cord damage
Mucosal necrosis
Barotrauma

133

What are three complications of Combitubes?

Pharyngeal or the esophageal trauma can result from poor technique
Unrecognized displacement of tracheal tube into the esophagus
Displacement of the pharyngeal balloon

134

What will happen if you use a larger oral pharyngeal airway than the pt needs?

It could push the tongue back into the pharynx, blocking the airway

135

How much air do you inject into nasogastric and orogastric tubes to check stomach placement?

50 cc

136

At what size do et tubes begin to have cuffs on them?

5.5

137

Generally what age do kids start having a cuffed et tube?

8 years

138

What tool do you use measure et tubes for children?

Length based resuscitation tape
(Broslow tape)