upper airway
nasopharynx, oropharynx, laryngopharynx
Larynx
(voice box) demarcation between upper and lower airway
lower airway
trachea, bronchi, bronchioles, alveoli
inspiration
breathing in (inhalation)
expiration
breathing out (exhalation)
Hypoxia
lack of oxygen
hypoxic drive
backup system to control respirations when oxygen levels fall
ventilation
movement of air in and out of the lungs
Oxygenation
the process of delivering oxygen to the blood
Respiration
exchange of oxygen and carbon dioxide in alveoli and body tissues
agonal respirations
Slow, shallow, irregular respirations or occasional gasping breaths; sometimes seen in dying patients.
cheyne-stokes respirations
deep, rapid breathing followed by a period of apnea; can indicate stroke or head injury
ataxic respirations
Irregular or ineffective pattern
May follow serious head injuries
Kussmaul respirations
rapid/shallow to deep/labored/gasping breaths, can indicate metabolic issues
Airway assessment
Look (for the rise and fall of the chest), Listen (for the movement of air), Feel (for the air on cheek)
How to open the airway:
head tilt chin lift
How to open the airway when a spinal injury is suspected.
jaw thrust
airway adjuncts
devices that aid in maintaining an open airway
nasopharyngeal airway
a flexible breathing tube inserted through the patient's nostril into the pharynx to help maintain an open airway
oropharyngeal airway
Airway adjunct inserted into the mouth of an unresponsive patient to keep the tongue from blocking the upper airway, can induce vomiting in conscious patients
Suction times for adult child and infant
adult - 15 sec
child - 10 sec
infant - 5 sec
suction on the way OUT
nonrebreather mask
flow rate: 12-15 L/min
90% oxygen concentration
nasal cannula
flow rate: 1-6 L/min
24-44% oxygen concentration
artificial ventilation techniques
mouth-to-mask
one to two person BVM
CPAP
bag valve mask
squeeze every 5-6 seconds (for adults)
flow rate 15L/min
gastric distention
inflation of the stomach with air
prevented by head tilt chin lift to open airway
normal breathing pressure
negative pressure is created when diaphragm contracts
assisted breathing
air is forced into lungs creating positive pressure
peep value
positive end-expiratory pressure
attached to BVM
set to 5
CPAP (continuous positive airway pressure)
pressurized air delivered to lungs to keep them expanded during exhalation
opens collapses alveoli
CPAP indications
signs of respiratory distress
pulse oximetry less than 90%
patient breathing rapidly
alert and can follow directions
CPAP contraindications
respiratory arrest, pneumothorax or chest trauma, tracheostomy, GI bleeding or vomiting, unable to follow verbal commands
CPAP complications
cause pneumothorax
can lower patient's blood pressure
COPD (chronic obstructive pulmonary disease)
disease with enlarged lung spaces, usually from smoking can cause shortness of breath
CHF (congestive heart failure)
condition in which the heart cannot pump enough blood to the rest of the body
tracheostomy tube
neither head tilt chin lift or jaw thrust required
ventilate through tube
alpha and beta receptors
alpha receptor is stimulated by epinephrine or norepinephrine, the arteries constrict
beta receptors are mostly involved in the relaxation of effector cells and dilatation of blood vessels (beta blockers imply high blood pressure --> dilate vessels)
Hyperventilation
the condition of taking abnormally fast, deep breaths
tension pneumothorax
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping
Adult breathing rate
12-20 breaths per minute