Chapter 7 - Airway

The diaphragm and muscles of the chest wall play a crucial role in the process of breathing. When we inhale, the diaphragm contracts and moves downward, while the muscles of the chest wall expand, allowing the lungs to expand and fill with air. This causes the chest to rise. On the other hand, when we exhale, the diaphragm relaxes and moves upward, while the chest wall muscles contract, causing the chest to fall. This regular rise and fall of the chest is a normal and essential part of the breathing process. Therefore, the statement is true.

The jaw-thrust maneuver is a technique used to open the airway in patients who have potential or confirmed cervical spine injuries. This maneuver is preferred over the head-tilt/chin-lift technique because it minimizes movement of the neck and reduces the risk of further injury to the cervical spine. By displacing the jaw forward without flexing the neck, the airway can be opened and maintained while ensuring the stability of the cervical spine. Therefore, the statement is true.

The primary function of an airway adjunct is to prevent obstruction of the upper airway by the tongue and allow the passage of air and oxygen to the lungs. This statement is true because airway adjuncts such as oropharyngeal airways and nasopharyngeal airways are designed to keep the tongue from blocking the airway and maintain an open pathway for air to flow into the lungs. These devices are commonly used in emergency medical situations to ensure adequate oxygenation and ventilation.

If you hear gurgling, the patient NEEDS suctioning.

Maintaining the airway refers to the process of ensuring that the airway remains unobstructed and open, allowing for proper breathing. This includes keeping the airway clear of any obstructions, such as mucus or foreign objects, and ensuring that it remains open to allow for the passage of air. Therefore, the correct answer is "All of the above" as it encompasses all the actions required to maintain the airway.

Gastric distention refers to the abnormal accumulation of air or fluid in the stomach. During CPR (cardiopulmonary resuscitation), the chest compressions can cause the stomach to inflate, leading to gastric distention. This can be problematic as the inflated stomach can put pressure on the diaphragm, making it difficult for the person to breathe properly. Additionally, if the person vomits during CPR, there is a higher risk of the vomit being aspirated into the lungs, which can lead to further complications. Therefore, gastric distention can indeed cause vomiting and increase the risk of aspiration during CPR.

Gastric distention refers to the condition where the stomach becomes excessively filled with air or gas. When this happens, it can cause the diaphragm, which is the muscle responsible for breathing, to be pushed upward. This elevation of the diaphragm can lead to a reduction in lung volume, particularly in children and infants. Therefore, it is true that gastric distention can significantly reduce lung volume by elevating the diaphragm.

Clearing the airways means removing any materials that may be obstructing the passage of air in the respiratory system. This can include clearing mucus, foreign objects, or any other obstructions that may be preventing proper airflow. By removing these obstructing materials, the airways can be opened up and the patient can breathe more easily.

The head tilt chin lift is for patients who have NOT sustained trama.

If a tracheostomy tube is present in a stoma patient, it means that there is an opening in the neck leading directly to the trachea. Ventilating through the tracheostomy tube with a BVM (bag-valve-mask) device allows for the delivery of oxygen directly to the patient's lungs. This method ensures that the airway is bypassed and that oxygen is reaching the lungs effectively. Therefore, the statement is true.

Signs of inadequate breathing in adult patients include irregular rhythm, shallow depth, unequal chest expansion, pale, cyanotic, cool, and moist skin, and the use of accessory muscles. These signs indicate that the patient is not breathing effectively and may require intervention to improve their breathing.

Patients with inadequate breathing have inadequate minute volume, which refers to the amount of air that is inhaled and exhaled in one minute. When the minute volume is inadequate, it means that the patient is not getting enough oxygen and is not effectively removing carbon dioxide from their body. This can lead to serious health complications and can be life-threatening. Therefore, it is crucial to treat patients with inadequate breathing immediately to ensure that they receive the necessary support and intervention to improve their breathing and maintain proper oxygenation.

Alveoli are small sacs where the actual exchange of oxygen and carbon dioxide occurs.

When the level of carbon dioxide in the blood increases, it triggers chemoreceptors in the brain to send signals to the respiratory muscles, increasing the impulse to breathe. This is because high levels of carbon dioxide indicate a need for more oxygen in the body. Therefore, the statement is true.

The signs for adequate breathing for adult patients include a regular pattern of inhaling and exhaling, a normal rate of breathing, a regular and equal chest rise and fall, and bilateral clear and equal lung sounds. These signs indicate that the patient is breathing effectively and receiving enough oxygen. The presence of an irregular rhythm or the use of accessory muscles may suggest respiratory distress or a breathing problem. Therefore, these signs are not considered signs of adequate breathing.

Humidified oxygen is usually used for long-term oxygen therapies.

The Sellick maneuver or Cricoid pressure is a technique used during intubation to prevent aspiration of stomach contents into the lungs. It involves applying pressure on the cricoid cartilage to occlude the esophagus. This maneuver should only be performed on unconscious patients because conscious patients may experience discomfort or difficulty in swallowing. Additionally, conscious patients can actively resist the pressure, making the maneuver ineffective. Therefore, it is important to ensure that the patient is unconscious before performing the Sellick maneuver.

Exhalation is the process of expelling air from the lungs. During exhalation, the diaphragm and intercostal muscles relax, allowing the lungs to passively recoil and push air out. This means that exhalation does not require any muscular effort and is a passive process. Therefore, the statement that exhalation does not normally require muscular effort and is a passive process is true.

In unconscious patients, the most common airway obstruction is the tongue. When a person loses consciousness, the muscles in their body relax, including the muscles in the tongue. This relaxation can cause the tongue to fall back and block the airway, making it difficult for the patient to breathe. It is important to recognize this obstruction and take appropriate measures, such as tilting the head back or using a jaw thrust maneuver, to open the airway and ensure proper ventilation.

When we exhale, the air we breathe out contains less oxygen and more carbon dioxide compared to the air we inhale. The percentage of oxygen in the exhaled air is reduced to around 16%, while the remaining percentage is made up of other gases like nitrogen and trace amounts of other gases.

You should use an oral or nasal airway adjunct in conjunction with a BVM device.

Flow-restricted oxygen powered devices should NOT be used on infants and children, or on patients with COPD or suspected cervical spine or chest injuries.

A stoma is an opening through the skin and into an organ or other structure
(EX: a stoma in the neck connects the trachea directly to the skin.)

The Heimlich maneuver is performed on conscious adult or children patients. This means that the maneuver is intended for individuals who are awake and aware. The purpose of the maneuver is to help dislodge an object that is blocking the airway and causing choking. Performing the maneuver on unconscious or dead individuals would not be effective or appropriate, as they may require different forms of medical intervention. Similarly, cardiac arrest refers to a condition where the heart has stopped beating, and in such cases, immediate cardiopulmonary resuscitation (CPR) is typically required instead of the Heimlich maneuver.

Poor lung compliance refers to the decreased ability of the lungs to expand fully during inhalation. This can be caused by various factors such as lung diseases, inflammation, or scarring of the lung tissue. When lung compliance is poor, the alveoli, which are responsible for gas exchange, cannot fully expand, leading to reduced lung function and difficulty in breathing. Therefore, the statement "Poor lung compliance is the inability of the alveoli to expand fully during inhalation" is true.

Suctioning removes not only obstructions but also oxygen, which is a major thing that the patient needs. Suctioning involves the use of a suction catheter to remove secretions or other substances that may be blocking the airway. However, during the suctioning process, there is a risk of removing oxygen along with the obstructions. Therefore, it is crucial to monitor the patient's oxygen levels and provide supplemental oxygen if necessary to ensure adequate oxygenation during and after suctioning.

Hypoxia

The alveoli produce the chemical Surfactant

The explanation for the given correct answer is that the BVM device, also known as a bag valve mask, is a manual resuscitator used to provide artificial ventilation to a person who is not breathing or is breathing inadequately. While it may deliver less tidal volume (the amount of air moved in and out of the lungs during each breath) compared to mouth-to-mouth ventilation, it compensates by delivering a much higher concentration of oxygen. This is because the BVM device is connected to an oxygen source, allowing for a higher concentration of oxygen to be delivered to the patient.

The indications that artificial ventilations are inadequate include ventilation delivered too fast or too slow, heart rate not returning to normal range, and minimal or no chest rise and fall. These signs suggest that the ventilation is not effectively providing enough oxygen to the patient's lungs, resulting in inadequate ventilation.

Performing blind finger sweeps in any patient may force an obstructing object farther down into the airway. This means that using the fingers to blindly sweep the airway of a patient can potentially push the obstruction deeper into the airway, making the situation worse. It is important to avoid this technique to prevent further complications and to ensure the safety of the patient.

Hypoxia is a condition where there is a lack of oxygen supply to the body's vital organs. When a person is not breathing adequately, it means that they are not taking in enough oxygen into their lungs, leading to a decrease in oxygen levels in the blood. This can result in hypoxia, which can be harmful to the vital organs as they require oxygen to function properly.

Injuries to the face and head can result in severe tissue swelling and bleeding into the airway. The face and head are highly vascular areas, meaning they have a rich blood supply. When injured, blood vessels can rupture, leading to bleeding. Additionally, the inflammation and swelling that occur after an injury can further obstruct the airway, making it difficult for the person to breathe. Therefore, injuries to the face and head can be particularly dangerous and require immediate medical attention.

The diaphragm is a skeletal muscle because its attached to the costal arch and vertebrae

Carbon dioxide and cell waste pass from tissue cells through capillaries and into the veins.

small amounts of other gases make up the remaining 1%

When inserting a nasopharyngeal airway, the curvature of the device should follow the floor of the nose, and the bevel should face the septum.

The average tidal volume for a man is 500 mL. Tidal volume refers to the amount of air that is inhaled or exhaled during normal breathing, without any extra effort. This volume is typically around 500 mL for an average adult male.

Air outside the body (atmospheric pressure) normally higher than the air pressure within the thorax.

The correct answer is 15, 10, 5. The time limits for suctioning the mouth or nose are 15 seconds for adults, 10 seconds for children, and 5 seconds for infants.

To prevent gastric distention, it is important to give slow and gentle breaths over 1 second when ventilating adults, children, and infants. This helps to avoid excessive air entering the stomach and causing distention, which can lead to discomfort and complications. Slow and gentle breaths allow for proper ventilation without causing unnecessary pressure in the digestive system.

A fixed suctioning unit should generate a vacuum of more than 300 mm Hg when the tubing is clamped. This level of vacuum is necessary to effectively suction fluids or secretions from a patient's airway or surgical site. A higher vacuum level ensures efficient removal of substances, providing better patient care and preventing complications.

When a patient has a stoma and no tube in place, using a child/infant mask with the BVM device is recommended. This is because the size of the child/infant mask is smaller and more appropriate for creating a seal over the stoma, ensuring effective ventilation. Using an adult mask or a mask that fits the patient may not provide a proper seal and may lead to inadequate ventilation. Connecting the BVM directly to the stoma and ventilating may not be practical or feasible in this situation.

The oropharyngeal airway is indicated for unconscious patients because they are unable to maintain their own airway. It is also indicated for patients without gag reflex because they will not have a protective reflex to prevent the airway from becoming blocked. Additionally, the oropharyngeal airway is indicated for any apneic patient being ventilated with BMV (bag-mask ventilation) because it helps to maintain an open airway and facilitate effective ventilation.

Agonal respirations occur when the respiratory center in the brain continues to send signals to the respiratory muscles even after the heart has stopped. This can happen right before the death of the patient.

Oxygen passes from blood in the arteries through the capillaries to tissue cells.

The correct answer is to ensure the patient's airway is appropriately positioned, ventilate the patient at an appropriate rate, and ventilate the patient with an appropriate volume. These actions are necessary to alleviate gastric distention, which occurs when air enters the stomach during ventilation. Ensuring the airway is properly positioned helps to prevent air from entering the stomach. Ventilating the patient at an appropriate rate and volume helps to maintain adequate oxygenation and ventilation without overinflating the lungs and causing air to enter the stomach.

The BVM device is used on patients who are not ventilating adequately, in respiratory arrest, in cardiopulmonary arrest, and in respiratory failure. This device is designed to provide manual ventilation to patients who are unable to breathe on their own or are experiencing a life-threatening situation where their breathing has stopped or is severely compromised.

When we exhale, the air contains 16% oxygen, which is slightly lower than the 21% present in the air we inhale. It also contains 3% to 5% carbon dioxide, which is significantly higher than the 0.04% present in the air we inhale. The remaining gases in the exhaled air, which make up the majority, are nitrogen. This is because nitrogen is the most abundant gas in the atmosphere, making up around 78% of the air we breathe. Therefore, the correct answer is oxygen carbon dioxide nitrogen, which represents the composition of the air we exhale.

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