Physiology/Anatomy
What is the dividing line between the Upper and Lower Airway?
The Larynx
What is Atelectasis?
Collapse of the alveolar air spaces.
What are the structures in the lower airway?
Trachea
Bronchi
Bronchioles
Alveoli
Capillaries
What is the most common Airway obstruction?
Upper airway wheezing is called what? and is an indication of?
Stridor and obstruction
What is the membrane that connects the thyroid cartilage superiorly to the cricoid ring inferiorly?
Cricothyroid membrane
Signs of normal breathing in Adults?
• A normal rate (Adult: 12 to 20 breaths/min; child: 15 to 30 breaths/min)
• A regular pattern of inhalation and exhalation
• Clear and equal chest rise (chest expansion) and fall
• Adequate depth (tidal volume)
• Unlabored; without adventitious (abnormal) breath sounds (wheezing stridor)
What are the two processes of respiration? which is due to contraction of muscles?
Inspiration and expiration
Inspiration requires the contraction of the diaphragm and intercostal muscles.
How long can we suction the mouth or nose in adults, children and infants?
15, 10, 5 seconds
Abnormal breathing pattern characterized by slow, gasping breaths, seen in cardiac arrest. Defines what?
Agonal Gasps
Differentiate the terms Tidal Volume, Residual Volume, Minute Volume, and Dead Space.
Tidal volume: The amount of air (in mL) that is moved into or out of the lungs during one breath
Residual volume: The air that remains in the lungs after maximal expiration
Minute volume: The volume of air moved through the lungs in one minute; calculated by multiplying tidal volume and respiratory rate
Dead space: The portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange
You are listening to a patient's lung sounds. You hear Bronchial breath sounds and Vesicular breath sounds What does this mean?
The patient has normal sounding lungs.
Vesicular breath sounds: Normal breath sounds made by air moving in and out of the alveoli
Bronchial breath sounds: Normal breath sounds made by air moving through the bronchi
You patient is suffering from Fever, unilateral coarse crackles, SOB, chills, chest pain, green/red rust sputum, decreased skin turgor. What respiratory condition is most likely?
Pneumonia
A cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea. Often seen with stroke patients or patients with serious head injuries. Defines what?
Cheyne-stokes respirations
What is a main differentiator between Croup and Epiglottitis?
Time of Onset.
High vs low grade fever
Viral vs bacterial
Define the terms Oxygenation, Ventilation, and Respiration. Which of these processes can we effect?
Oxygenation: The process of loading oxygen molecules onto hemoglobin molecules in the blood stream.
Ventilation: The physical act of moving air into and out of the lungs
Respiration: The actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body.
What is a venturi mask?
Has several attachments that enable you to vary the percentage of oxygen delivered to the patient while a constant flow is maintained from the regulator. Delivers 24%-40% oxygen
Your patient has only a slight expiratory wheezing and states they may have come in contact with something that they are allergic to. What condition is this patient suffering from?
Allergic reaction
Intrapulmonary shunting is what? and what does it lead to?
It is the bypassing of blood past nonfunctional alveoli leading to O2 poor blood entering the left side of the heart.
Hypoxemia. (low o2 in the blood vs hypoxia which is low o2 in the tissues)
You arrive to Park Rose for an 89F SOB. Staff states the patient has had sudden onset SOB and is a vent dependent patient with a complete tracheostomy. You should suspect?
Obstruction/mucus plug
DOPE (Displacement, Obstruction, Pneumothorax, Equipment failure)
Explain how the body regulates ventilations and the hypoxic drive.
Based upon the acidity of the blood determines the body's need to ventilate. Normally this occurs in relation the buildup of CO2 in the blood.
During Hypoxic drive the patient no longer uses CO2 as regulation and relies on O2 in the blood to determine ventilation rate. This is due to a saturation of CO2 at baseline leading to peripheral chemoreceptors taking over to detect drop in O2 levels thus prompting ventilations.
Indications for CPAP
Is awake and able to follow commands
Is > 12 years old and able to fit in a CPAP / BiPAP mask
Has the ability to maintain an open airway without assistance
Exhibits two or more of the following (with Asthma/COPD or CHF):
You arrive to a 67M with a CC of SOB. Pt is on home O2 at 2LPM. Pt states that they have a persistent non-productive cough. Exam reveals 2-5 word sentences with clear lung sounds. What condition is this patient most likely suffering from?
Emphysema
your patient has a capnography measuring at 55mmhg. What is the name for this and what does this likely mean for the patients respiration rate?
Hypercarbia and that their rate is slower than normal. Page 438
Your patient suffers from severe Orthopnea, and hypertension. What conidiation should you suspect.
Congestive Heart Failure.