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Anatomy
o Nares (Nostrils)
o Nasal Turbinate’s – Adds humidity and warmth to incoming air
o Upper Airway
 Pharynx – Nasopharynx, Oropharynx, Laryngopharynx
 Epiglottis
 Larynx
 Trachea – Average 10-12 cm. 16-20 rings.
o Corina – Where bronchi stems into two
o Right main stem bronchi – straighter than left
o Bronchioles – different than bronchi because they’re 100% smooth muscle
o Alveolis
 Air sac=200-300 microns or about 20-30 cells in diameter(average cell in body)
 Site of gas exchange
 Pulmonary artery drops off CO2 from heart. Pulmonary vein brings O2 to heart
 Stay open with surfactant
 Approx. surface area where o2 can be absorbed/co2 released = 75 meters
o Diaphragm – Contracts = flattens, lungs expand. Relaxes = air flows out, lungs deflate
o Visceral pleural tethered to parietal pleural
o Intrapulmonary pressure (inter alveoli pressure) – 760mmHG
o Intrapleural pressure – always about 4mm less that intrapulmonary (756mmHG)
o Atmospheric pressure (barometric pressure) – 760mmHG
o Pleural cavity – pleural fluid, no friction
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Physiology
o External Respiration – breathing, inhalation/exhalation
o Internal respiration - oxygen and carbon dioxide are exchanged between cells and
blood vessels
o Oxyhemoglobin disassociation curve
o SpO2 – peripheral oxygen saturation – percentage of hemoglobin molecules in the
peripheral blood saturated with oxygen (pulse ox)
o SaO2 – oxygen saturation of arterial blood (as measured by blood analysis) – percentage
of hemoglobin molecules in the arterial blood saturated with oxygen
o PaO2 – partial pressure of oxygen in the blood, as measured by blood analysis
Signs/Symptoms of an Airway Problem
o Using intercostal muscles
o Tachypnea/Bradypnea
o Cyanosis
o Posturing(Tripod)
o Lung Sounds
o Dyspnea – shortness of breath
o Dysphagia – blockage
Lungs
o Atmospheric pressure 766mL at sea level
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Parietal pleural, pleural space, visceral pleural, lung
Inspect
Auscultate
 Wheezing – narrowing of airway
 Stridor – upper airway (above epiglottis), whistle sound
 Rales – thin sound (blood, plasma) “fine rhonchi”
 Rhonchi – thicker fluid “coarse rales”
 Cheyne-strokes: Abnormal/irregular breathing/hyperventilation
Palpate
Percuss - Melon
Management
o Jaw Thrust
o Head tilt Chin lift
o Monitoring
o RR: 12-20/min
o pH: 7.35-7.45
o EtCO2: 35-45 mmHg (5-6% CO2 with every exhale)
 Respiratory
 Opposite
 Metabolic
 Equal
 etCO2 increase, pH decrease
 HCO3 increase, pH increase
o Pulse Ox
 Measures O2 saturation of hemoglobin
 95% +
o Vents
 Dislodged
 Obstruction
 Pneumothorax
 Equipment
Adjuncts
o NPA – use largest diameter that can be easily inserted (right nostril)
o King LTD-S
o Superglottic Device IGEL
o CRIC
 Less than 1% of patients that need airway adjuncts survive