RCP 110 UPPER AIRWAY REVISED .docx

Anatomy and Physiology of the Respiratory System- The Upper Airway RCP 110 **The Airways** Conducting airways: passageways between the ambient environment and the gas exchange units of the lungs (alveoli). - Important to the process of ventilation even though no gas exchange occurs here....

Anatomy and Physiology of the Respiratory System- The Upper Airway RCP 110 **The Airways** Conducting airways: passageways between the ambient environment and the gas exchange units of the lungs (alveoli). - Important to the process of ventilation even though no gas exchange occurs here. - Divided into the upper airway and lower airways The Upper Airway The Upper Airways **The Upper Airway consists of:** - Nose - Oral Cavity. -- **Need to be able to list all four of these for the exam** - Pharynx - Larynx **Primary functions of the upper airway** - Act as conductor of air - **Important to remember for the test** - Humidify and warm or cool the inspired air - Prevent foreign materials from entering the tracheobronchial tree - Important area involved in speech and smell - Primary function: - filter - **Test question important** - humidify - condition (warm or cool) - Site for sense of smell and generate resonance in phonation. - Composed of bone and cartilage - Excellent route of administration for a variety of topical drugs - Classic sign of respiratory discomfort...especially in neonates - Caused by... - Increased airway resistance (e.g. asthma) - IMPORTANT TO REMEMBER - Lungs that are stiffer than normal (e.g. pneumonia) -- IMPORTANT TO REMEMBER - Any Airways obstruction -- IMPORTANT TO REMEMBER - Patient generates greater than normal negative pressure during each inspiration to pull air into the airways more rapidly. - Causes patient to be an obligate mouth breather - One of the causes of snoring and obstructive sleep apnea **Anatomy of the Oral Cavity** - The oral cavity is divided into the **hard palate** and **soft palate**. - The **uvula** is a small, soft piece of tissue that hangs from the back of the throat. - The **palatine tonsils** are located on the sides of the back of the throat. **The Pharynx** - The pharynx is divided into three parts: **nasopharynx**, **oral pharynx**, and **laryngeal pharynx**. - The **nasopharynx** is located between the posterior portion of the nasal cavity and the superior portion of the soft palate. - It is lined with **pseudostratified ciliated columnar epithelium** and contains **adenoids**, which are similar to tonsils. **Functions of the Nasopharynx** *\"The nasal pharynx is the back of the nasal cavity, and it goes down to the superior portion of the soft palate.\"* - When the adenoids are swollen and inflamed, it can force breathing through the mouth instead of the nose. - This can lead to a lack of filtering, warming, and humidifying of the air, which is important for respiratory health. **Oral Pharynx** - The **oral pharynx** lies between the soft palate superiorly and the base of the tongue inferiorly. - It contains the **palatine tonsils** and the **epiglottic vallecula**, a depression or crevice that is used as a landmark for intubation. **Intubation** *\"Intubation means helping your lungs breathe because you can\'t.\"* - Intubation involves inserting a tube into the mouth, through the pharynx and larynx, and into the trachea. - The tube bypasses the upper airway, so the respiratory therapist must ensure that the air is filtered, warmed, and humidified. **Important Considerations for Respiratory Therapists** - When intubating, the tube could potentially end up in the esophagus instead of the trachea. - The respiratory therapist must ensure that the air is filtered, warmed, and humidified, as these functions are normally performed by the upper airway. **Term** **Definition** --------------------------------------------------- ---------------------------------------------------------------------------------------- **Superior** Refers to the upper or higher portion of something. **Inferior** Refers to the lower or under portion of something. **Pseudostratified ciliated columnar epithelium** A type of epithelial tissue that lines the nasopharynx. **Adenoids** Small, gland-like tissues located in the nasopharynx that are similar to tonsils. **Epiglottic vallecula** A depression or crevice in the oral pharynx that is used as a landmark for intubation. **Patient Care Considerations** When providing care to patients, it\'s essential to consider their individual needs. For example: - **Humidity levels**: Patients with smoke inhalation injuries require higher humidity, while those with drug overdoses may require cooler temperatures. - **Mucusy patients**: Patients with pneumonia or who are heavy smokers may require more humidity due to **tenacious** (sticky and thick) mucus. **Anatomy and Physiology 🧬** **Larynx (Voice Box)** The larynx, also known as the voice box, is located between the base of the tongue and the upper end of the trachea. It serves three primary functions: - **Passageway**: Connects the pharynx and trachea - **Protective mechanism**: Prevents aspiration of solids and liquids - **Speech generation**: Helps generate speech The larynx consists of 9 cartilages: 3 single and 3 paired. **Cartilages of the Larynx** **Cartilage** **Description** ------------------- -------------------------------------------------------------------------------------------------- Thyroid cartilage Also known as the Adam\'s apple, more pronounced in men Epiglottis Flappy piece, watery, and cartilaginous structure that prevents aspiration of solids and liquids Cricoid cartilage Part of the larynx **Laryngoscope** A laryngoscope is a metal instrument used to displace the epiglottis. There are two types of blades: - **Macintosh blade**: Directly touches the epiglottis - **Miller blade**: Indirectly touches the upper portion of the tissue connected to the epiglottis **Epiglottis** *\"The epiglottis is like a little trap door that closes over the airway to prevent aspiration when you swallow.\"* **Important Landmarks 🔍** - **Epiglottis**: A flap that prevents aspiration of solids and liquids - **Vocal cords**: Two white structures located in the larynx that generate speech - **Trachea**: The entrance to the lungs - **Esophagus**: The tube that leads to the stomach **Pathologies 🏥** - **Laryngeal cancer**: A type of cancer that can grow in the larynx, often requiring surgical removal - **Myringitis**: Inflammation and swelling of the larynx\#\# Anatomy of the Larynx 🗣️ **Cricoid Cartilage** The cricoid cartilage is shaped like a signet ring and is located inferior to the thyroid cartilage, forming a large portion of the posterior wall of the larynx. The inferior border of the cricoid cartilage is attached to C-shaped rings, also known as tracheal cartilages. **Epiglottis** The epiglottis prevents the aspiration of foods and liquids by covering the opening of the larynx when we swallow. It is an important anatomical landmark when inserting an endotracheal tube. **Mucous Membrane and Vocal Cords** The interior of the larynx is lined by a mucous membrane that forms two pairs of folds: - **False Vocal Cords**: The outer, darker-colored tissue that lines the larynx. - **True Vocal Cords**: The lighter-colored, inner tissue that produces sound. **Clinical Connections 💊** **Laryngitis** *\"Inflammation of the mucous membranes lining the larynx, usually accompanied by swelling and edema of the vocal cords.\"* Causes of laryngitis: - Heavy smoking - Bacterial infections - Dry air - Inhalation of irritating fumes - Overuse of voice - Post-extubation laryngeal edema Symptoms of laryngitis: - Hoarseness - Complete loss of voice **Post-Extubation Laryngeal Edema** *\"Inflammation of the larynx following the removal of an endotracheal tube, which can cause aspiration of contents from the sinus cavity or stomach into the lungs.\"* Prevention of post-extubation laryngeal edema: - Use of certain types of tubes - Use of suction - Keeping the bed at a 40-degree angle to prevent acid reflux **Croup** *\"A condition that presents with inspiratory barking or brassy cough, also known as laryngeal bronchitis.\"* Causes of croup: - Parainfluenza virus Treatment of croup: - Steroids - Racemic epinephrine (vasodilator) - Cool mist aerosol - Note: Antibiotics are not effective against viral infections. **Important Note**: Viral infections like croup cannot be treated with antibiotics, and treatment is focused on managing symptoms.\#\# Croup and Epiglottitis 🤧 **Croup** - A viral infection that causes inflammation of the trachea and larynx - Cannot be treated with antibiotics - Treated with: - Racemic epinephrine (a vasodilator) - Clobetasol (a steroid) - Systemic steroids (in severe cases) **Racemic Epinephrine**: *A medication that works like albuterol, but is stronger and more fast-acting, specifically used for upper airway inflammation or swelling.* **Epiglottitis** - A life-threatening emergency caused by bacterial infection (Hemophilus influenza type b) - Inflammation of the epiglottis, leading to supraglottic airway obstruction - Identified by: - X-ray showing a \"church steeple\" sign (narrowing of the airway) Lateral neck view showing a \"thumbprint\" sign (swollen epiglottis) **Supraglottic**: *Above the glottis (vocal cords).* **Subglottic**: *Below the glottis (vocal cords).* **Comparison of Croup and Epiglottitis** **Croup** **Epiglottitis** -------------------- ---------------------------------------------------- --------------------------------------------------- **Cause** Viral infection Bacterial infection (Hemophilus influenza type b) **Treatment** Racemic epinephrine, clobetasol, systemic steroids Antibiotics, airway management **Symptoms** Barking cough, shortness of breath Drooling, difficulty swallowing, tripoding **Identification** \"Church steeple\" sign on X-ray \"Thumbprint\" sign on lateral neck view **Epiglottitis in Adults** - Rare, but can occur in adults who: - Work with toxic fumes without proper gear - Engage in substance abuse (e.g., huffing paint) **Cricothyrotomy (Cric)** - An emergent airway procedure where an incision is made in the cricoid cartilage to establish an airway - Used in severe cases where intubation is not possible - Goal is to stabilize the patient until a formal tracheostomy can be performed in the OR **Tracheostomy (Trach)**: *A surgical procedure to create an artificial airway in the trachea.* Note: A respiratory therapist can assist with bedside trachs and crics, but cannot perform a cric.\#\# Ventilatory Function of the Larynx 🌱 The primary function of the larynx is to ensure a free flow of air to and from the lungs. **Quiet Inspiration** During quiet inspiration, the vocal cords **open** and **abduct**, which means they move apart and widen the glottis. This allows air to flow freely into the lungs. **Exhalation** During exhalation, the vocal cords **close**, but not completely. They move towards the midline, maintaining some level of openness. **Valsalva Maneuver 💪** The Valsalva maneuver is a purposeful closure of the larynx, which occurs during activities that require effort, such as: Lifting Pushing Coughing Throat clearing Vomiting Defecation Giving birth This closure is important to prevent aspiration of foreign substances into the airway. **Laryngeal Walls** During the Valsalva maneuver, there is a massive undifferentiated adduction of the laryngeal walls, which means the lumen of the larynx is tightly sealed, preventing air from escaping.