| Term | Definition |
| Without oxygen, brain tissue will begin to die within how many minutes? | Four to six |
| Nasopharynx | Pathway for air from the nose to the larynx |
| Oropharynx | Pathway for air and food from the mouth to the larynx |
| Pharynx
Includes: | Area extending from the nose and mouth to the esophagus and trachea
Nasopharynx
Oropharynx |
| Larynx | Formed by several structures of cartilage below the pharynx |
| Epiglottis | Tissue that can prevent food and liquid from entering the trachea |
| Thyroid cartilage
Where is it?
What are its characteristics? | Forms what is also known as the "adams apple"
Large cartilage in the larynx
V shape in the front, inferior to the Epiglottis |
| Cricoid cartilage
Where is it?
What are its characteristics? | Lowest portion of the larynx
Inferior to the Thyroid cartilage
Forms a ring above the trachea |
| Trachea | Begins below the cricoid cartilage |
| Bronchi | Divides from the trachea into two main stems |
| Bronchioles | Smaller branches from the main bronchi, ending with sacks of alveoli |
| Alveoli | Where the blood in capillaries picks up oxygen and nutrients exchanges it with carbon dioxide and waste |
| The mediastinum contains | Heart, great vessels, esophagus, trachea, major bronchi, many nerves |
| Ventilation
EMT example: | Physical act of moving air into the lungs
Using a BVM to push air into the lungs |
| Diaphragm | Muscle below the lung that increases/decreases the pressure with contraction and relaxation |
| Inspiration/inhalation | Delivers oxygen to alveoli |
| Tidal volume | Measure of depth of breathing |
| Dead space | Portion of inspired air that fails to reach any alveoli |
| Expiration/exhalation | Air leaves the lungs through the trachea |
| Hypoxia | When tissues and cells do not get enough oxygen |
| COPD | (Chronic Obstructive Pulmonary Disease)
Difficulty eliminating carbon dioxide
Chronic Bronchitus and Emphysema |
| Pneumonia | Lung inflammation caused by bacterial or viral infection, alveoli fill with fluid |
| Acute pulmonary edema
Symptoms:
DO NOT: | Fluid backing up into the lungs from congestive heart failure
Low blood pressure, chest pain, dyspnea, pedal adema, tachycardia
DO NOT administer medications or place patient in fowlers position |
| Pulmonary embolism | The blockage of the pulmonary artery by a blood clot |
| Simple or tension pneumothorax | When air enters the pleural space but cannot exit, increasing the pressure and collapsing the lung |
| Open pneumothorax | Pleural space increases with air because of a hole or wound |
| Hemothorax | Blood in the pleural cavity |
| Hemopneumothorax | Blood accumulating in the pleural cavity, increasing the pressure and collapsing the lung |
| Regular or adequate breathing | 12-20 breaths/min
Regular inhalation/exhalation
Bilateral clear and equal lung sounds
Equal chest rise and fall
Adequate depth (tidal volume) |
| Abnormal breathing | Less than 12 breaths/min, more than 20 breaths/min
Irregular rhythm
Diminished, absent or noisy auscultated breath sounds
Reduced flow of expired air at nose and mouth
Unequal chest expansion
Shallow depth |
| Agonal gasps | Breathing after the heart has stopped |
| Cheyne-Stokes | Often seen in patients with stroke or head injury |
| Ataxic respirations | irregular or unidentifiable pattern
May follow serious head injuries |
| Kussmaul respirations | Deep, rapid respirations
Common in patients with metabolic acidosis |
| Best practices for suctioning
Never ________ | Never suction the mouth or nose for more than
15 seconds - adults
10 seconds - children
5 seconds - infants |
| Best practices for suctioning
Suctioning can result in _______ | Suctioning can result in hypoxia |
| Oropharyngeal airway device
Appropriate for ______
Contranindications _______ | Unresponsive patients without gag reflex
Apneic patients with BVM
Concious patients
Any patient with intact gag reflex |
| Nasopharyngeal airway device
Appropriate for ________
Contraindications _______ | Unresponsive patients
Patient with intact gag reflex
Patient unable to maintain their airway spontaneously
Sever head injury with blood in nose
History of fractured nasal bone |
| Nonrebreathing masks
Best for:
Can provide: __%, ___ lpm | Patients who are breathing adequately but are suspected of having hypoxia
80 % to 90 %, 12-15 lpm |
| Bag-valve masks
Best for:
Can provide: __% | Patients who cannot breathe on their own
Without supplementary oxygen: 21 %
with oxygen and no reservoir: 50 % - 60 %
With oxygen and reservoir: 90 % |
| Nasal cannulas
Best for:
Can provide: __%, ___ lpm | Secondary option for spontaneously breathing patients who do not like the nonrebreather. Not a preferred option
24 % to 44 %, 1-6 lpm |
| Partial rebreathers
Best for:
Can provide: __%, ___ lpm | Hyperventilating patients
40 % to 60 %, 9-10 lpm |
| Venturi masks
Best for:
Can provide: __%, ___ lpm | Not often used for EMT/prehospital care, adjustable settings
24 % to 40 % |
| What is positive pressure ventilation?
What are the risks/downsides? | Ventilation generated by a device (such as a BVM) that forces air into the chest cavity
More volume is required to have the same effect as normal breathing
Air is forced into the stomach, causing distention |
| CPAP
Benefits: | (Continuous Positive Airway Pressure)
Increases pressure in the lungs
Opens collapsed Alveoli
Forces interstitial fluid back into pulmonary circulation |
| Cyanotic/cyanosis | Skin turning blue |
| Carina | The ridge at the base of the trachea before it splits into two |
| Upper airway components | Larynx, pharynx |
| Lower airway components | Trachea, bronchi, bronchioles, alveoli |
| Intercostal | Space or tissue between the ribs |
| Pleural cavity | The small amount of space between the lungs and the ribs |
| Phrenic nerve | Originates from the cervical spine and innervates the diaphragm |
| Respiration
EMT Example: | Exchange of gases and waste via the alveoli
This is not a something the EMT has tools to solve |
| Oxygenation
EMT Example | Attaching oxygen molecules to hemoglobin
Using an oxygen tank to provide high concentration of oxygen |
| When the diaphragm relaxes, pressure ______
When the diaphragm contracts, pressure ______ | ^ Increases
- Decreases |
| Primary breathing stimulous is... | Elevated CO2 levels in arterial blood |
| Secondary breathing stimulous is.... | Hypoxic drive using arterial O2 levels |
| Chemoreceptors measure | Levels of O2, CO2 |
| V/Q mismatch | Ventilation or blood exposure is not compatible
(not enough oxygen getting to the blood)
(not enough blood getting to the oxygen) |
| Aerobic metabolism | With oxygen glucose turning into energy (ATP) |
| Anaerobic metabolism | Not enough oxygen converts into glucose and leaves lactic acid as byproduct |
| Normal respirations for
Adult
Child
Infant | Adult: 12-20 respiration/min |
| Types of breathing rhythms | Cheyne-Stokes, Kussmaul, Biot's, Ataxic |
| Types of breathing quality | labored/non-labored
deep/shallow
chest expansion |
| Lung sounds | Apnic, wheezing, stridor, rales, crackling, rhonchi |
| Lung sounds:
Wheezing
Example: | High pitched sound, lower airway
Asthma |
| Lung sounds:
Crackling | Bubbling, rice crispy popping sound |
| Lung sounds:
Rhonchi
Example: | Low pitched vibrations, "snoring"
Pneumonia, bronchitus |
| Lung sounds:
Stridor | High pitched sound on inspiration, upper airway
Can be heard without stethoscope |
| Lung sounds:
Rhonchi | Low pitched, rattling sound |
| Lung sounds:
Apnic
Example: | No sounds, not breathing
Respiratory arrest |
| Chronic Bronchitus | Bronchioles are inflamed, increased mucous presence, cilia are unable to filter blood properly
*hypoxic drive |
| Emphysema | Alveoli losing its elasticity, "atelectasis". Actual destruction (not just inflammation) in the lungs
*hypoxic drive |
| COPD signs and symptoms | Shortness of breath
Use of secondary muscles
Cyanosis
Barrel chest (muscular development from secondary muscles)
Small sentences
Deep/shallow breath
Body positioning (tripod, sitting up) |
| Asthma | Inflammation or swelling of the bronchioles |
| Tachypnea | Fast, shallow breathing |
| Bradypnea | Abnormally slow breathing |
| Silent chest | Extremely severe asthma absent of wheezing |
| Dyspnea | Labored breathing |
| Lung sounds:
Rales
Example: | Swishing, bubbly sound
Acute Pulmonary Edema |
| Head tilt chin lift
vs.
Jaw thrust maneuvor | Hands on forehead and lower jaw. Superior method of clearing airway
vs.
Pushing jaw forward with thumbs. Less effective, but protects the neck.
Use when there is suspected trauma |
