Airway Physiology, Assessment and Management Lecture
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Questions and Answers

What is the primary function of positive end-expiratory pressure (PEEP)?

  • To increase the volume of dead space in the respiratory system
  • To increase intrathoracic pressure and improve gas exchange
  • To prevent end-expiratory collapse of the small airways and alveoli (correct)
  • To decrease the work of breathing during exhalation

    • What is the typical range of anatomical PEEP in healthy individuals?

  • 3-5 cmH2O (correct)
  • 5-7 cmH2O
  • 1-3 cmH2O
  • 7-9 cmH2O

    • What is the primary mechanism by which inhalation occurs during natural inspiration?

  • Passive elastic recoil of the lungs
  • Active contraction of the intercostal muscles
  • Positive pressure ventilation pushing air into the lungs
  • Negative pressure ventilation sucking air into the lungs (correct)

    • What is the primary function of exhalation during normal breathing?

    <p>Passive elastic recoil of the lungs and chest wall</p> Signup and view all the answers

    What is the primary purpose of PEEP in patients with acute respiratory distress syndrome (ARDS)?

    <p>To increase alveolar recruitment and improve oxygenation</p> Signup and view all the answers

    What is the primary complication associated with the use of high levels of PEEP?

    <p>Decreased cardiac output</p> Signup and view all the answers

    What is the primary purpose of CPAP (continuous positive airway pressure) ventilation?

    <p>To provide a controlled level of PEEP to the patient</p> Signup and view all the answers

    What is the approximate percentage of each breath that is comprised of dead space in a healthy individual?

    <p>30%</p> Signup and view all the answers

    What is the primary mechanism by which PEEP improves gas exchange in patients with acute respiratory distress syndrome (ARDS)?

    <p>By increasing alveolar recruitment and reducing intrapulmonary shunting</p> Signup and view all the answers

    What is the primary difference between natural inspiration and positive pressure ventilation in terms of the mechanics of air movement?

    <p>Natural inspiration uses negative pressure to suck air into the lungs, while positive pressure ventilation pushes air into the lungs</p> Signup and view all the answers

    What is the primary mechanism by which carbon dioxide (CO2) is eliminated from the body during respiration?

    <p>Diffusion of CO2 from the pulmonary capillary blood into the alveoli</p> Signup and view all the answers

    What is the primary consequence of a complete cessation of ventilation?

    <p>Rapid increase in arterial partial pressure of carbon dioxide (PaCO2)</p> Signup and view all the answers

    Which of the following conditions is primarily responsible for the mismatch between arterial and end-tidal carbon dioxide levels (PaCO2 and ETCO2)?

    <p>Both pulmonary embolism and COPD</p> Signup and view all the answers

    What is the primary stimulus for breathing in normal physiology?

    <p>Increased arterial partial pressure of carbon dioxide (PaCO2)</p> Signup and view all the answers

    What is the primary benefit of pre-oxygenation and passive oxygenation in patients with respiratory distress?

    <p>Maintaining adequate arterial partial pressure of oxygen (PaO2)</p> Signup and view all the answers

    What is the primary consequence of excessive ventilation in a patient with normal lung function?

    <p>Decreased arterial partial pressure of carbon dioxide (PaCO2)</p> Signup and view all the answers

    What is the primary factor that determines the efficiency of ventilation in patients with lung disease?

    <p>The degree of ventilation-perfusion (V:Q) mismatch</p> Signup and view all the answers

    What is the primary mechanism by which positive end-expiratory pressure (PEEP) improves gas exchange in patients with acute respiratory distress syndrome (ARDS)?

    <p>Improving the ventilation-perfusion (V:Q) matching</p> Signup and view all the answers

    What is the primary consequence of an increase in the arterial partial pressure of carbon dioxide (PaCO2) in patients with chronic obstructive pulmonary disease (COPD)?

    <p>Increased respiratory rate</p> Signup and view all the answers

    What is the primary mechanism by which the body maintains the partial pressure gradient for carbon dioxide (CO2) elimination during respiration?

    <p>Diffusion of CO2 from the pulmonary capillary blood into the alveoli</p> Signup and view all the answers

    What is the best way to manage BVM ventilations according to the text?

    <p>Implementing two-person, two thumbs up technique</p> Signup and view all the answers

    What is the optimal position for intubating non-traumatic adult patients?

    <p>Looking for anatomical landmarks</p> Signup and view all the answers

    Which position is recommended for children and pediatric patients during intubation?

    <p>Sniffing position</p> Signup and view all the answers

    What should be avoided when managing an airway using a BVM?

    <p>Following the bridge of the nose</p> Signup and view all the answers

    What is the traditional method of utilizing the BVM?

    <p>C-E or C-3 method</p> Signup and view all the answers

    What can optimize patient oxygenation prior to intubation?

    <p>Passive oxygenation</p> Signup and view all the answers

    What is the primary purpose of the 'Jaw Thrust' technique in airway management?

    <p>To open the airway by lifting the jaw forward</p> Signup and view all the answers

    What is the significance of the '4-90's' mentioned in the text?

    <p>They represent the ideal target values for airway management</p> Signup and view all the answers

    What is the primary purpose of the 'Mallampati' assessment mentioned in the text?

    <p>To assess the patient's upper airway anatomy</p> Signup and view all the answers

    What is the primary purpose of the 'Scissor Technique' in airway management?

    <p>To open the airway by tilting the head back</p> Signup and view all the answers

    What is the primary goal of the 'System One Training' mentioned in the text?

    <p>To practice airway management techniques in simulation exercises</p> Signup and view all the answers

    What is the significance of the '3:3:2' rule in airway assessment?

    <p>It represents the ideal distances between the patient's teeth, hyoid bone, and thyroid cartilage</p> Signup and view all the answers

    What is the primary purpose of the 'Head Tilt' technique mentioned in the text?

    <p>To open the airway by tilting the head back</p> Signup and view all the answers

    What is the significance of the term 'Airway is a team sport' mentioned in the text?

    <p>It emphasizes the importance of collaboration and communication among healthcare providers during airway management</p> Signup and view all the answers

    What is the primary indication for using a bougie during a difficult adult intubation?

    <p>When the clinician is unable to feel the cricothyroid rings or ridges</p> Signup and view all the answers

    Which of the following is NOT a primary function of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS)?

    <p>Increasing the partial pressure of carbon dioxide (PaCO2) in the blood</p> Signup and view all the answers

    What is the primary purpose of the tongue traction technique described in the text?

    <p>To open the airway by pulling the tongue anteriorly</p> Signup and view all the answers

    Which of the following is the primary mechanism by which positive end-expiratory pressure (PEEP) improves gas exchange in patients with acute respiratory distress syndrome (ARDS)?

    <p>Increasing the partial pressure of oxygen (PaO2) in the blood</p> Signup and view all the answers

    What is the primary purpose of the 'C-DOPE' mnemonic when questioning endotracheal tube (ETT) placement?

    <p>To assess for potential complications related to the ETT placement</p> Signup and view all the answers

    What is the primary consequence of a complete cessation of ventilation in a healthy individual?

    <p>Respiratory arrest and unconsciousness</p> Signup and view all the answers

    What is the primary purpose of the 'Modified Cormack & Lehane Classification' mentioned in the text?

    <p>To assess the degree of difficulty in visualizing the larynx during intubation</p> Signup and view all the answers

    What is the primary stimulus for breathing in normal physiology?

    <p>Decreased partial pressure of carbon dioxide (PaCO2) in the blood</p> Signup and view all the answers

    What is the primary purpose of the 'King Airway' device?

    <p>To maintain a patent airway in unconscious patients</p> Signup and view all the answers

    What is the primary function of exhalation during normal breathing?

    <p>To decrease the partial pressure of carbon dioxide (PaCO2) in the blood</p> Signup and view all the answers

    What is the primary mechanism by which positive end-expiratory pressure (PEEP) improves gas exchange in patients with acute respiratory distress syndrome (ARDS)?

    <p>By preventing alveolar collapse and improving ventilation-perfusion matching</p> Signup and view all the answers

    What is the primary mechanism by which the body maintains the partial pressure gradient for carbon dioxide (CO2) elimination during respiration?

    <p>Increased ventilation rate</p> Signup and view all the answers

    What is the primary consequence of an increase in the arterial partial pressure of carbon dioxide (PaCO2) in patients with chronic obstructive pulmonary disease (COPD)?

    <p>Respiratory acidosis</p> Signup and view all the answers

    What is the primary purpose of the 'System One Training' mentioned in the text?

    <p>To teach clinicians how to effectively manage difficult airway situations</p> Signup and view all the answers

    Which of the following is the primary mechanism by which carbon dioxide (CO2) is eliminated from the body during respiration?

    <p>Diffusion from the alveoli to the ambient air</p> Signup and view all the answers

    Which of the following conditions is primarily responsible for the mismatch between arterial and end-tidal carbon dioxide levels (PaCO2 and ETCO2)?

    <p>Increased physiological dead space</p> Signup and view all the answers

    What is the primary stimulus for breathing in normal physiology?

    <p>Increased arterial partial pressure of carbon dioxide (PaCO2)</p> Signup and view all the answers

    What is the primary mechanism by which positive end-expiratory pressure (PEEP) improves gas exchange in patients with acute respiratory distress syndrome (ARDS)?

    <p>Increases alveolar recruitment and functional residual capacity</p> Signup and view all the answers

    What is the primary difference between natural inspiration and positive pressure ventilation in terms of the mechanics of air movement?

    <p>In natural inspiration, air moves due to negative intrathoracic pressure, while in positive pressure ventilation, air moves due to positive pressure applied to the airway.</p> Signup and view all the answers

    What is the primary consequence of a complete cessation of ventilation?

    <p>Hypercapnia (high carbon dioxide levels in the blood)</p> Signup and view all the answers

    What is the primary function of exhalation during normal breathing?

    <p>To remove carbon dioxide from the body</p> Signup and view all the answers

    What is the primary mechanism by which inhalation occurs during natural inspiration?

    <p>Decreased intrathoracic pressure</p> Signup and view all the answers

    What is the primary consequence of excessive ventilation in a patient with normal lung function?

    <p>Respiratory alkalosis</p> Signup and view all the answers

    What is the primary purpose of the 'S.A.L.A.D.' technique?

    <p>To clear the airway of vomit and other debris during intubation</p> Signup and view all the answers

    Which technique involves applying backward, upward, and rightward pressure to improve visualization of the larynx during intubation?

    <p>BURP</p> Signup and view all the answers

    What is the primary purpose of using a bougie during a difficult intubation?

    <p>To facilitate the insertion of the endotracheal tube through the vocal cords</p> Signup and view all the answers

    Which technique involves applying external pressure on the cricoid cartilage to improve visualization of the larynx?

    <p>Cric Pressure</p> Signup and view all the answers

    What is the purpose of using different blade grips during intubation?

    <p>To master a specific technique for different patient positions</p> Signup and view all the answers

    Which technique involves applying traction on the patient's lips to improve visualization of the larynx?

    <p>Lip Traction</p> Signup and view all the answers

    What is the purpose of inflating the balloon on the endotracheal tube during intubation?

    <p>To secure the tube in place and prevent dislodgement</p> Signup and view all the answers

    Study Notes

    Airway Physiology, Assessment, and Management

    Upper and Lower Airways

    • The upper airway begins at the nose and mouth and ends at the glottic opening
    • The lower airway begins at the glottic opening and ends at the alveoli
    • The trachea (windpipe) is a tube made semi-rigid by rings of cartilage, connecting the glottic opening to the carina
    • The carina is a cartilaginous dividing point where the trachea splits into the two main bronchi

    Trachea Internal Structure Review

    • The trachea is lined by pseudostratified columnar epithelium with cilia on the surface
    • The trachea is composed of 20 rings of tough cartilage, with muscle and connective tissue at the back
    • Inflammation, stenosis, trauma, infection, and cancer can affect the trachea

    Respiratory Volumes

    • Ideal volume with each breath is roughly 6-8 mL/kg of ideal body weight (IBW)
    • "Bagging" patients too hard, too fast, or with too much volume is common
    • Predicted body weight (PBW) should be used instead of actual body weight, especially for obese patients

    Inspiration and Expiration

    • Inspiration is an active process requiring muscle contraction, resulting in negative pressure
    • Exhalation is a passive process using natural elastic recoil
    • Positive pressure ventilation increases intrathoracic pressure, whereas negative pressure decreases it

    Positive End-Expiratory Pressure (PEEP)

    • PEEP is used to prevent alveolar collapse and to recruit alveoli
    • Intrinsic and extrinsic PEEP can be used, with typical pressures ranging from 3-5 cmH2O
    • Complications of high PEEP include decreased cardiac output and barotrauma

    Ventilation

    • Ventilation is the process of mixing fresh inspired gas with alveolar gas
    • Oxygenation is the process of getting oxygen to the tissues via the respiratory system
    • Oxygenation begins with external respiration and involves passive diffusion across the alveolar-capillary membrane

    Oxygenation Terms

    • FiO2: fraction of inspired oxygen
    • SaO2: percentage of hemoglobin saturated with oxygen
    • SpO2: percentage of hemoglobin saturated with oxygen, measured indirectly by pulse oximetry
    • PaO2: partial pressure of oxygen dissolved in plasma
    • SvO2: percentage of oxygen in venous blood

    Increasing Oxygenation

    • Increasing oxygenation can be achieved through natural means or with supplemental oxygen
    • Methods include increasing minute volume, reducing elevation, using auto-PEEP or CPAP/BiPAP, and increasing the FiO2 with supplemental oxygen

    Oxygen-Hemoglobin Dissociation Curve

    • The curve describes the relationship between partial pressure of oxygen and oxygen saturation
    • Factors affecting the curve include body temperature, pH, and 2,3-DPG levels
    • The curve shifts to the right with increased temperature, acidity, or 2,3-DPG levels
    • The curve shifts to the left with decreased temperature, alkalinity, or 2,3-DPG levels

    Carbon Dioxide and Capnography

    • CO2 is a byproduct of metabolism and is eliminated through the lungs during exhalation

    • End-tidal CO2 (ETCO2) is measured indirectly and is lower than arterial CO2 (PaCO2)

    • The gradient between PaCO2 and ETCO2 increases in patients with V:Q mismatch, such as those with COPD or pulmonary embolisms### Difficult Adult Intubation

    • When unable to feel the cricothyroid rings or ridges, place the bougie until it bottoms out at the carina.

    • If the bougie does not hit resistance, it may be in the stomach, not the trachea.

    Tongue Traction

    • Use right-hand traction to pull and push the patient's tongue anteriorly.

    Modified Cormack & Lehane Classification

    • Used for documentation purposes in ETT assessment.

    ETT Placement Assessment

    • C-DOPE:
      • Assess EtCO2
      • Assess for ETT dislodgement
      • Assess for ETT obstruction
      • Assess for pneumothorax (PTX)
      • Reassess equipment.

    References

    • Mercy Air BLS/ALS airway education, 2016
    • EMCrit.org
    • Riverside University Health Systems, Anastasia Department

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