Advanced Airway Management Flashcards

Terms Definitions
Define the nasal cavity.
The cavity between the floor of the cranium and the roof of the mouth that opens to the nose anteriorly and to the nasopharynx posteriorly; the uppermost portion of the airway.
Define the nasal septum.
The wall that divides the nasal cavity into halves.
Define the mucous membrane.
A membrane lining many of the body cavities that handle air transport. It usually contains small, mucus-secreting glands.
Define mucus.
A thick, slippery secretion that functions as a lubricant and protects various surfaces of the body.
Define cilia.
Hairlike fibers projecting from the cells that propel mucus.
Define oral cavity.
The mouth.
Define pharynx.
The throat; a muscular tube that extends from the back of the nasal cavity to the upper end of the esophagus and larynx, having three sections. The nasopharynx, oropharynx and the laryngopharynx.
What is also known as the hypopharynx?
The laryngopharynx.
Define gag reflex.
The act of retching or striving to vomit, a normal reflex triggered by touching the soft palate or throat.
Define epiglottis.
A leaf shaped cartilage that prevents food from entering the trachea during swallowing.
Define vallecula.
The depression between the epiglottis and the base of the tongue.
Define larynx.
The complex structure that connects the pharynx with the trachea.
Define arytenoid cartilage.
Cartilaginous structures that form the posterior border of the glottis; an important landmark for endotracheal intubation.
Define glottis.
The opening between the vocal cords.
Define Sellick maneuver.
Posterior displacement of the cricoid ring that occlude the esophagus; also called cricoid pressure.
What is another name for Sellick maneuver?
Cricoid pressure.
Define circothyroid membrane.
The membrane located between the cricoid and thyroid cartilages of the larynx.
How long is the average trachea?
10 to 12 centimeters.
Define trachea.
The 10 to 12 centimeter long tube that connects the larynx with the mainstem bronchi.
Is expiration an active or passive process?
Passive.
Name several factors that could increase respiratory rate.
Fever, anxiety, hypoxia, stimulant drugs, pain, acidosis.
Name several factors that could decrease respiratory rate.
Depressant drugs and sleep.
An Sp02 reading of 95% to 100% would indicate what kind of status?
Normal.
An Sp02 reading of 94% to 91% would indicate what kind of status?
Mild hypoxia.
An Sp02 reading of 85% to 91% would indicate what kind of status?
Moderate hypoxia.
An sp02 reading or 85% or below would indicate what kind of status?
Severe hypoxia.
Name contraindications for use of a nasopharyngeal airway.
Nasal obstructions, history of nosebleeds or suspected basilar skull fracture.
Name indications for use of a nasopharyngeal airway.
Tongue is acting as an airway obstruction, oropharyngeal airway is contraindicated.
Name contraindications for use of a oropharyngeal airway.
Gag reflex.
Name indications for use of a oropharyngeal airway.
Tongue is an airway obstruction. Need for bite block in intubated patient.
Define respiration.
The exchange of gases between a living organism and its enviroment.
Define atelectasis.
Collapse of alveoli. Such as with insufficient surfactant.
Define surfactant.
A chemical that decreases surface tension of the alveoli making it easier for them to expand.
Define parenchyma.
The tissue or essential parts of an organ.
Define ventilation.
The physical process of moving air into and out of the lungs. Either by the body or artificially via BVM etc.
Define pleura.
Connective tissue covering the lungs and the inside of the thoracic cavity.
Define mainstem bronchi.
The first division of the lower airway off the trachea, entering the lungs.
Define carina.
The point at which the trachea bifurcates into the right and left mainstem bronchi.
Define alveoli.
The microscopic air sacs where oxygen-carbon dioxide exchange takes place.
Define respiratory bronchioles.
The first level of the airway in which gas exchange takes place.
Define alveolar/capillary membrane.
The membrane formed by the walls of an alveolus and a capillary, across which gas exchange takes place between the alveolus and the capillary.
Define partial pressure.
The pressure exerted by an individual gas in a gas mixture.
Define diffusion.
The passive movement of gas from an area of high partial pressure to an area of low partial pressure.
Define hypoxemia.
A decrease in the partial pressure of oxygen in the blood.
Define hypoxia.
A decrease in the partial pressure of oxygen in the peripheral tissues.
Define FiO2.
The concentration of oxygen in inspired air.
Define hypercarbia.
Excessive partial pressure from carbon dioxide in the blood.
Define stretch receptors.
Receptors located in the lung parenchyma that prevent overdistention during respiration.
Define chemoreceptors.
Receptors located in the medulla, the carotid bodies, and the arch of the aorta that monitor PaO2, PaCO2, and PH to control respiration.
Hypoxic drive
The condition in persons with chronic CO2 retention in which Pa02, not the PaC02, becomes the main stimulus for respiration.
Tidal Volume (Vt)
The average volume of gas inhaled or exhaled in one respiratory cycle.
Minute volume (V min)
The amount of air inhaled and exhaled in one minute; it equals the respiratory rate times the tidal volume.
Aspiration
The inhalation of foreign material, such as vomit, into the lungs.
Patent
Open(patency: openness)
Pulse oximetry
The measurement of the oxygen saturation of blood hemoglobins.
Capnography
The measurement of exhaled carbon dioxide concentrations.
What is the average oxygen concentration delivered by a nasal cannula?
22% to 44%
What LPM range should a nasal cannula be set at?
1-6 LPM
What is the average oxygen concentration of a simple face mask?
40% to 60%
What LPM range should a simple face mask be set at?
8 to 12 liters. No less than 6 to avoid expired CO2 accumulating in the mask.
What is the average oxygen concentration of a nonrebreather mask?
80% to 100%
What should the average LPM or a nonrebreather mask be set at?
10-15 LPM. No less than 8 to avoid deflation of the reservoir bag and possible suffication of the patient.
What is the maximum suctioning time allowed per attempt when clearing an airway?
15 seconds.
Endotracheal intubation
To pass a tube into the trachea for the purpose of securing a patent airway.
Name the medications that can be administered via the endotracheal tube.
Epinephrine, atropine, lidocaine and naloxone.
What is the maximum amount of time to attempt an endotracheal tube placement?
30 seconds.
Laryngeal manipulation
While performing laryngoscopy; the act of moving the larynx into a position that allows for a better view of the glottic opening.
Pharyngotracheal lumen (ptL) airway
A dual-lumen airway device that permits ventilation with a BVM through either tube, as required.
Laryngeal mask airway (LMA)
A noninvasive single-lumen airway device designed to occlude the supraglottic area and facilitate ventilation.
Esophageal tracheal CombiTube (ETC) airway
A blind-insertion, dual-lumen airway device with a ventilation port for each lumen, allowing for ventilation through either tube, as required.
Cobra perilaryngeal airway (PLA)
A single lumen airway device designed to occlued the supraglottic area and facilitate ventilation.
King LT airway
A supraglottic, single lumen airway device designed to be place in the esophagus, with ventialtion taking place through a proximal port. Proximal and distal ballons seal off the pharynx and esphagus, respectively, creating a closed system capable of supporting positive pressure ventilation.
Magill forceps
Scissor style clamps with circular tips, used to remove foreign materials or to redirect the endotracheal tube.
What does i.d. mean on an endotracheal package?
Internal diameter. It's the measure in millimeters of the tube size.
What size endotracheal tube should be used on an infant?
2.5-3.5 id
What size endotracheal tube should be used on an infant?
3.5 - 4.0 i.d.
What size endotracheal tube should be used on a child?
4.0 - 6.0 i.d.
What size endotracheal tube should be used on an adult?
7.0 - 9.0 i.d. (7 to 8 for female) (7.5 to 8.5 for males)
What is a good standard size endotracheal tube for any adult patient during an emergency?
7.5 i.d.
List the steps to doing a head-tilt/chin-lift maneuver
1. BSI 2. With patient supine, position yourself at the side of the patient't head. 3. Place one hand on the patient's forehead and tilt the head back by applying firm downward pressure with your palm. 4. Put two fingers of the other hand under the bony part of the chin and lift the jaw anteriorly to open the airway. Be careful to keep fingers on the bony part of the chin.
List the steps to performing a jaw-thrust maneuver
1. BSI 2. With patient supine, kneel behind the patient's head. 3. Place the fingertips of each hand on the angles of the patient's lower jaw. 4. Firmly lift the patient's lower lip with your thumbs.
Snoring
A sound resulting from partial obstruction of the upper airway by the tongue.
Gurgling
A sound resulting from the accumulation of blood, vomitus, or other secretions in the upper airway.
Stridor
a harsh, high pitched sound heard on inhalation associated with laryngeal edema or constriction.
Wheezing
A musicial, squeaking, or whistling sound heard in inspiration and or expiration, associated with bronchiolar constriction.
Rales (Crackles)
A crackling sound, much like what is heard when you rub your hair between two fingers near your ear. Associated with fluid in the alveoli and distal airway passages.
Kussmaul's respirations
Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis.
Cheyne's-Stokes respirations
Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury.
Biot's respirations
Irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure.
Central neurogenic hyperventilation
Deep, rapid respirations, indicating increased intracranial pressure.
Agonal, or apneustic respirations
Shallow, slow, or infrequent breathing, indicating brain anoxia.
What is the normal respiration rate in an adult?
12-20 respirations per minute.
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Rales (crackles)
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Wheezing
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Stridor
How many sizes does a laryngeal mask airway(LMA) come in and what are each recommended for?
5 sizes. 1 - neonates/infants up to 6.5kg 2 - infants and children up to 20kg 2 1/2 - children 20-30kg 3 - children and small adults larger than 30 kg 4 - normal sized adults
Which of the following structures is not considered part of the upper airway: trachea, nasopharynx, pharynx, oral cavity
Trachea
All of the following structures is/are considered part of the larynx except the: vocal cords, tracheal rings, cricothyroid membrane, epiglottis
Tracheal rings
What maneuver should be used first when opening the airway of a patient with a suspected cervical spine fracture?
Modified jaw thrust
_____ is defined as a decrease in the partial pressure of oxygen in the blood.
Hypoxemia
____ is the act of a living thing exchanging gases, such as oxygen and carbon dioxide with the enviroment.
Respiration
Which of the following would result in a decrease of carbon dioxide in the blood: fever, hyperventilation, bradypnea, decreased alveolar ventilation
Hyperventilation
What is a normal adult PCO2?
35-45 torr
Which maneuver is best for moving the larynx into the best position for viewing the glottic opening and vocal cords during laryngoscopy?
Laryngeal manipulation
_____ respirations are characterized by an irregular pattern of rate and depth with sudden, periodic episodes of apnea, and indicate increased intracranial pressure.
Biot's
Describe the purpose of performing the Sellick maneuver during BVM ventilations?
To help prevent gastric insufflation.
Use of which of the following devices may result in gastric distention: demand-valve resuscitator, bag-valve mask, pocket mask, all of the above
All of the above
Which of the following is considered the "gold standard" for confirming tracheal placement of an endotracheal tube in a patient with a pulse: end-tidal cabron dioxide detection, listening to lung sounds, pulse oximetry, chest x-ray
End-tidal carbon dioxide detection
Which of the following airways is considered a "blind insertion" device: endotracheal tube, laryngeal mask airway, Combitube, both b & c
Both b & c, the laryngeal mask airway and, combitube
Which of the following is a contraindication
Which of the following airways is considered a "blind insertion" device: endotracheal tube, laryngeal mask airway, Combitube, both b & c
Both b & c, the laryngeal mask airway and, combitube
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