Airway / Pulmonology Airway / Pulmonology Flash Cards

Term Definition
The trachea divides into the right and left mainstem bronchi at the ___________. Carina
Normal tidal volume for an adult is? 500mL (5-7mL/kg)
Approximately how much air is filtered, warmed and humidified by the adult respiratory system? 10,000 liters
Where in your nose is the most common spot for an epistaxis? The Kiesselbach's plexus (a.k.a. The Little's Area)
What are Cilia? Cilia are fine, fingerlike projections that have the ability to contract in a single direction.
The trachea is approximately ____ cm in length and is composed of a series of C-shaped cartilaginous rings. 11
Approximately how many alveoli are contained in the adult lungs? 300 million
The alveoli are moistened and kept open because of the presence of an important chemical called __________. Surfactant
What is a physiologic shunt in regards to the pulmonary system? Not all of the alveoli remain patent during gas exchange – this means that a small percentage of blood will pass through the alveoli without exchanging oxygen and carbon dioxide – this usually affects approximately 2% of the total blood flow to the lungs.
The right lung contains ___ major divisions or lobes and the left lung has ___. The right lung has 3 and the left has 2
What are the three important processes that allow gas exchange to occur? Ventilation, Diffusion and Perfusion
What is Ventilation? Ventilation is the mechanical process of moving air in and out of the lungs.
What is the Diaphragm? The Diaphragm is a big dome-shaped muscle that separates the thorax and the abdomen. Nerve impulses from the phrenic nerve stimulates the diaphragm to contract.
How do we breathe? During inspiration, the diaphragm contracts & flattens, the intercostal muscles contract producing an expansion in the chest cavity. These two actions cause an expansion in the chest volume, which produces a decrease of 1-2 mmHg below atmospheric pressure
What is the Total Lung Capacity of the adult? Approx. 6,000 mL.
The respiratory membrane, which normally measures ___ to ___ in thickness, must remain intact for gas exchange to occur. 0.5 – 1.0 micrometer.
What is the Hering-Breuer Reflex? Stretch receptors, located on the visceral pleura and on the walls of the bronchi and bronchioles provide input to the respiratory center – these stop the body from over-inflating the lungs.
What is the most important determinant of the ventilatory rate? Arterial PCO2
What values are present during the Bohr Effect? Decrease in pHIncrease in CO2Increase in temperatureIncrease in 2,3 BPG
What values are present during the Haldane Effect? Increase in pHDecrease in CO2Decrease in temperatureDecrease in 2,3 BPG
What are Kussmaul's Respirations? Kussmaul's Respirations are deep, rapid breaths that result as a corrective measure against conditions such as diabetic ketoacidosis that produce metabolic acidosis.
What are Cheyne-Stokes Respirations? These respirations have a pattern with progressively increasing tidal volume, followed by a declining volume, separated by periods of apnea at the end of expiration. This pattern is typically seen in older patients with terminal illness or brain injury.
What is Central Neurogenic Hyperventilation? Central neurogenic hyperventilation also produces deep, rapid respirations that are caused by strokes or injury to the brainstem. In this case, there is loss of normal regulation of ventilatory controls and respiratory alkalosis is often seen.
What are Ataxic (Biot's) Respirations? Ataxic (Biot's) Respirations are characterized by repeated episodes of gasping ventilations separated by periods of apnea. This pattern is seen in patients with an increase in ICP.
What are Apneustic Respiration? Apneustic Respirations are characterized by long, deep breaths that are stopped during the inspiratory phase and separated by periods of apnea. This pattern is usually a result of a stroke or severe CNS disease.
What is paroxysmal nocturnal dyspnea (PND)? It is a sudden episode of difficult breathing that occurs after lying down; most commonly caused by left-heart failure.
What is orthopnea? Difficulty breathing while lying supine.
What is hemoptysis? Coughing up of blood
What is tactile fremitus? Vibration felt in the chest during speaking.
Clubbing of the fingers may indicate what? Any clubbing may indicate chronic respiratory or cardiac disease. A clubbed finger has a degrees greater than 180
What is pulsus paradoxus? A drop in systolic blood pressure of 10mmHg or more with each respiratory cycle.
What is tachypnea? Tachypnea describes a respiratory pattern with a rate that exceeds 20 breaths per minute.
What is bradypnea? Bradypnea describes a respiratory pattern with a rate slower than 12 breaths per minute.
ETCO2 detectors may be either qualitative or quantitative – what is the difference between the two? Qualitative they simply the detect the presence of CO2Quantitative they determine how much CO2 is actually present.
At the end of what phase of the capnogram is the ETCO2 number recorded from? At the end of Phase III
What is Phase I of the Capnogram? It is the respiratory baseline – it is flat when no CO2 is present.
What is Phase II of the Capnogram? It is the respiratory upstroke – this reflects the appearance of CO2 from the alveoli.
What is Phase III of the Capnogram? It is the respiratory plateau – it reflects the airflow through uniformly ventilated alveoli.
What is Phase IV of the Capnogram? It is the inspiratory phase – it is the sudden downstroke and ultimately returns to the baseline during inspiration.
What are the two different types of capnography? Mainstream and sidestream
What starts to appear on your capnograph when NMBAs start to wear off and the Pt starts to have contractions of his diaphragm? Curare Cleft
Excess oxygen can result in the formation of toxic chemicals called ___________. Free radicals.The goal of oxygen therapy is to provide just enough oxygen to treat hypoxia without causing hyperoxia.
What is a "Cafe Coronary" It is a complete airway obstruction that is thought to be a heart attack.
What is Emphysema? Emphysema results from the destruction of the alveolar walls distal to the terminal bronchioles.
What is the major contributing factor for the development of Emphysema? Cigarette smoking
What does PEEP stand for? Positive End-Expiratory Pressure
What is polycythemia? It is an excess of red blood cells resulting in an abnormally high hematocrit.
What is Chronic Bronchitis? Chronic Bronchitis results from an increase in the number of the goblet (mucus-secreting) cells in the respiratory tree. It is characterized by the production of a large quantity of sputum.
During a mild asthma attack – what would expect to see the patient's ETCO2 level at? <35 due to hyperventilation
During a moderate asthma attack – what would expect to see the patient's ETCO2 level at? 35-50 due to the patient now becoming tired.
During a severe asthma attack – what would expect to see the patient's ETCO2 level at? >50 due to the patient now severely tired of breathing.
____________ risk factors are those that are influenced by or are from within the patient. Intrinsic
The ____________ airway extends from below the larynx to the alveoli. Lower
The ____________ airway extends from the mouth and nose to the larynx. Upper
_______________ is the exchange of gases between the alveoli and the red blood cells. Pulmonary or external respiration
_______________ is the exchange of gases between the red blood cells and the various body tissues. Cellular or internal respiration.
Normal inspired air contains what percentage of oxygen? 21%
What is the normal dead space volume for an average adult? 150ml
How can you calculate how long your oxygen will last using different types of cylinders? D Cylinder = psi x 0.16 / lpmE Cylinder = psi x 0.28 / lpmM Cylinder = psi x 1.56 / lpm
How can you estimate what size of ET tube to use in a pediatric patient? Age + 16 / 4 or Age /4 + 4
The depression between the base of the tongue and the epiglottis is called the: Vallecula
The average volume of gas inhaled or exhaled in one respiratory cycle is the: Tidal volume
The ______________ is the most superior part of the airway. Nasal cavity
The ______________ is the only bone in the axial skeleton that does not articulate with any other bone. Hyoid
The _______________ is the amount of gas in the tidal volume that remains in the air passageways unavailable for gas exchange. Dead-space volume
The _______________ comprise(s) the key functional unit of the respiratory system. Alveoli
Open surgical cricothyrotomy is contraindicated in children under the age of ________ because the cricothyroid membrane is small and underdeveloped. 8
What drug is an antagonist for an opiate overdose? Narcan
What drug is an antagonist for an benzodiazepine overdose? Flumazenil (Romazicon)
What test is used to determine if your patient is showing signs of finger clubbing? Shamroth’s test – Finger clubbing is when the angle of your finger tip is greater than 180 degrees.
What respiratory disease process can make a patient be referred to as a “Pink Puffer?” Emphysema
You arrive on scene with a patient in moderate to severe respiratory distress and you notice the patient is breathing with pursed lips. What does this finding tell you? Pursed lip breathing is the patients attempt to auto PEEP.
Carbon dioxide is transported from the cells to the lungs in three different ways – what are they and what are the percentages? As a bicarbonate ion (70%), Bound to hemoglobin (23%), Dissolved in plasma (7%)
What abnormal sound can usually be heard without a stethoscope and is found on the inhalation phase of the respiratory drive – it is also classified as an “extra-thoracic sound.” Stridor
What accessory muscles can be utilized by the body in an effort to compensate for a severe respiratory problem? Scalene and Sternocleidomastoid muscles (SCM’s)
Where on a hemoglobin molecule does oxygen bind to? On one of the four heme sites.
_____________ is the mechanical process of moving air in and out of the lungs. Ventilation
What are the three important processes that allow gas exchange to occur? Ventilation, Diffusion and Perfusion
Your larynx is made up of how many different cartilages? 9 – 3 single (epiglottic, thyroid and cricoid) and 3 paired (arytenoid, corniculate & cuneiform)
What structures make up the upper airway? Nasal cavity, pharynx and the larynx
What is the most important intrinsic risk factor for respiratory diseases in the human body? Genetics
What is the most important extrinsic risk factor for respiratory diseases in the human body? Smoking
What causes lightheadedness, parasthesia and syncope to a patient experiencing hyperventilation syndrome? Cerebral vasoconstriction due to hypocapnia and the alkalosis causing a relative hypocalcemia
What causes the patient to become dyspneic with emphysema? Emphysema causes the destruction of the alveoli wall distal to the terminal bronchioles which causes a decrease in alveolar volume and diffusion.
What is the correct dose of Albuterol for an adult patient? 2.5mg in 3mL
What causes a patient to exhibit a pink like skin characteristic with emphysema? Polycythemia (an excess of red blood cells resulting in an abnormally high hematocrit).
What is the correct dose of Ipratropium for an adult patient? 500mcg /2.5mL
What causes the patient to become dyspneic with chronic bronchitis? Chronic bronchitis causes an increase in mucous from an increase in goblet cells – this causes a blockage of the airways before it gets to the alveoli
What is the correct dose of Methylprednisolone? 125-250mg IV / IO
What happens to the pulmonary system during the first stage of asthma? 1st stage is bronchoconstriction and mucous production caused by histamine – this stage usually responds to our prehospital treatment of bronchodilators
Why is Terbutaline a good drug to administer to a patient with a significant past cardiac history that presents with moderate dyspnea? Terbutaline is more Beta-2 selective
What happens to the pulmonary system during the second stage of asthma? 2nd stage of asthma is caused by the body’s own immune system that causes inflammation of the airways – this usually doesn’t respond to our bronchodilators but needs steroids to help
What is the correct dose of Terbutaline for an adult patient with dyspnea? 0.25 mg IM
What is the difference between qualitative vs. quantitative ETCO2? Qualitative just shows us the presence of ETCO2 – this is what we use when we use a colormetric ETCO2 device. Quantitative determines how much ETCO2 is present
When a patient starts to come out of being sedative for RSI – what unique characteristic pattern will we see on our capnography waveform? Curare cleft
What is the difference between pulmonary respiration and cellular respiration? Pulmonary respiration takes place in the pulmonary capillaries and cellular respiration takes place in the peripheral tissues
What is your main goal when treating a patient with severe CHF? The main goal in treating a patient with severe CHF is to reduce both preload and afterload
What is the maximum pressure setting that you would use with your CPAP device? No more than 10 cm H20 pressure
What is phonation? Phonation is speech – or sounds made by air passing through the vocal cords
On average, how long is the trachea in an adult patient? 11 cm
How many main divisions or lobes are found in the left and right lungs? Left 2, Right 3
The most important determinant of the ventilation rate of a patient is the _________. Arterial PCO2
What is the “Hypoxic Drive?” Hypoxic drive happens in patients with COPD – they will breathe off of the level of O2 detected in the arterial blood by receptors in the aortic arch. – Measured PO2 levels between 50 and 60 mmHg are not uncommon in these patients.
How many molecules of oxygen can a single hemoglobin carry? 4
You are taking care of a patient that is found to be unconscious and unresponsive from a suspected heroin overdose. The patient’s ABG is as follows: pH: 7.05, PO2: 70, CO2 70, BICARB 24. What is this patient suffering from? Uncompensated respiratory acidosis

Leave a Reply

Your email address will not be published. Required fields are marked *