The term Select one VENTILATION MINUTE VOLUME RESPIRATION TIDAL VOLUME is the exchange of oxygen and carbon dioxide between the organism at a cellular level.  The term  Select one COMPLIANCE DEAD VENTILATION MINUTE VOLUME RESPIRATION TIDAL VOLUME is the movement of air into and out of the lungs.   Select one VENTILATION MINUTE VOLUME RESPIRATION TIDAL VOLUME is the volume of gas inhaled or exhaled during one breath, which in adults in normally 500 to 600 mL.  Select one VENTILATION MINUTE VOLUME RESPIRATION TIDAL VOLUME is the amount of gas inhaled or exhaled in one minute. 

Select one HYPOCARBIA HYPOXEMIA HYPOXIA ATELECTASIS results from some respiratory diseases (e.g., emphysema) destroy and collapse the alveolar walls.  This results in the formation of fewer but larger alveoli.

Select one HYPOCARBIA HYPOXEMIA HYPOXIA ATELECTASIS is when oxygen levels are low.  Select one HYPOCARBIA HYPOXEMIA HYPOXIA ATELECTASIS is a state of decreased oxygen content in the arterial blood.

Hyperventilation causes an excess loss of CO2 which results in Select one HYPOCARBIA HYPOXEMIA HYPOXIA ATELECTASIS .

(This material will be covered later in the course) We have chemoreceptors located in the Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA and Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA which register the levels of Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA in the body and is know as the Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA .  The chemoreceptor within the Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA registers Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA and is the normal stimulus for respirations in a health person.  The Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA nerve which leaves the spine at C4-5 controls the diaphragm.  The Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA nerve inhibits the lungs and is responsible for what is known as Select one STRETCH RECEPTORS CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA .  When the lungs are full the nerve tells the medulla to stop the stimulus to inspiration.  Respiration works on a Select one CAROTID BODIES OXYGEN NEGATIVE FEEDBACK VAGUS NERVE MEDULLA HYPOXIC DRIVE CO2 PHRENIC AORTA control system as described previously.

Interesting:  Our lungs hold 5,800 mL of air after taking one breath.  We exchange 500 to 600 mL per breath so this means that the lungs are never empty of air.  This is why, at a minimum, a cardiac patient without dyspnea should still be placed  on a NC at 4 LPM.  We are keeping the reserves within the lungs full with exchanges of 500 to 600 mL increments.  KEEP THE LUNGS TOPPED OFF.

What is gag reflex?  Triggered by touching the Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP palate or Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP pharynx. 

1. Deep breath is taken.
2. This raises the hyoid and larynx which opens the esophageal sphincter.
3. Soft palate is elevated which closed the nares.
4. Diaphragm and abdominal muscles contract forcefully.
5. Stomach content expelled.
6. If pt is unconscious or unable to protect airway, pulmonary aspiration may occur.

A&P changes is Pedi versus adult:

1. Trachea in pedi is more Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP .
2. Larynx in pedi is located more Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP and Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP .
3. The tongue in pedi is Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP and takes up more space when comparably compared to an adult.
4. The smallest opening that an ETT has to pass in an adult is the Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP .
5. The smallest opening that an ETT has to pass in a pedi is the Select one GLOTTIS ANTERIOR FLEXIBLE CRICOID CARTILAGE LARGER SUPERIOR POSTERIOR SOFT RISE DROP .

Breathing terms:

1. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES KUSSMAUL TACHYPNEA BRADYPNEA AGONAL respirations indicates onset of respiratory arrest.
2. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES KUSSMAUL TACHYPNEA BRADYPNEA AGONAL is a slow respiratory rate. Examples; CVA, drug overdoses.
3. Central neurogenic hyperventilation is rapid and regular breathing over 25 a minute.  Pt is trying to blow of CO2.
4. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES KUSSMAUL TACHYPNEA BRADYPNEA AGONAL is seen in brain deterioration.  Very ill patients. Fast to slow to absent breathing pattern.
5. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES ATAXIC KUSSMAUL TACHYPNEA BRADYPNEA AGONAL is normal breathing.
6. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES ATAXIC KUSSMAUL TACHYPNEA BRADYPNEA AGONAL is rapid, deep respirations results in hyperpnea.  Example; Anxiety, acid/base balance.
7. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES ATAXIC KUSSMAUL TACHYPNEA BRADYPNEA AGONAL is abnormally deep and very rapid.  Supports DKA present.
8. Select one HYPERVENTILATION EUPNEA CHEYNE-STOKES ATAXIC KUSSMAUL TACHYPNEA BRADYPNEA AGONAL rate more than 20 minute.  Examples; pain, fright, respiratory infection.
    

Oxygen flow:

Body Positioning

Sings of Respiratory Distress.

Diagnostic Testing

Pulse Oximetry offers a rapid and fairly accurate means for assessing oxygen saturations.  The PulseOx probe is placed on the Select one TOE SaO2 LOWER COLD FINGER EAR LOBE , Select one TOE SaO2 LOWER COLD FINGER EAR LOBE or Select one TOE SaO2 LOWER COLD FINGER EAR LOBE and measures the amount of oxygen bonded to the available hemoglobin.  95% and above is adequate saturations.  90% to 94% may indicate a nasal cannula.  Less than 90% usually indicates the need for a non-rebreather mask. 

Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS includes the disease of Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS , Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS and Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS .  COPD is found in 25% of adults in the US.  50% mortality within 10 years of diagnosis.  COPD is caused by Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS and environmental toxins. 

Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS is defined as loss of Select one CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS of the alveoli.  As a result of less alveolar tissue the pulmonary capillary beds decrease leading to pulmonary hypertension which results into right sided heart failure which is termed Select one Cor Pulmonale CHRONIC ASTHMA PINK PUFFER ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS which means when the patient inhales the BP drops and then they exhale it returns.  Due to the loss of elasticity the emphysema patient will purse their lips to create a positive pressure in the lungs to move air trapped in the dead spaces.  This lip pursing is a form of self PEEPing (Positive end-expiratory pressure).  As a result of less alveoli the body produces more RBC to inundate the available alveoli to pick up the slack.  This results in a pink skin color.  Also this patient is working very hard to exchange gasses with more rapid breathing.  As a result we call these patient Select one CHRONIC ASTHMA BARREL NON-PRODUCTIVE PRODUCTIVE CLUBBING PINK PUFFER's ELASTICITY EMPHYSEMA SMOKING COPD CHRONIC BRONCHITIS .

Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS is defined as having bronchitis for at least 2 months per year for Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS or more consecutive years.  History of Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS most common.  Smoking irritates the lining of the lungs resulting is excess Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS production.  The patient is able to deliver oxygen to the alveoli but has trouble exhaling through the mucus.  (Like a milk shake we can suck the milk shake through the straw but it is harder to blow air into the milk shake.). Due to the lack of exhalation a buildup of CO2 in the blood slows metabolism and the patient gains weight.  Also they turn blue as a result of the higher than normal CO2 levels.  This is why we call these patients Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS . 

Select one BLUE BLOATERS CHRONIC ASTHMA MUCUS LOW REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS is the same disease process as a patient with occasional asthma but the Chronic Asthma patient has more occurrences due to triggers.

Asthma is a common respiratory illness what affects many people. Asthma is defined as a Select one BLUE BLOATERS CHRONIC ASTHMA TRIGGER MUCUS LOW EDEMA REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS narrowing if the airways. 50% of patients who die from asthma do so before they can reach the hospital.  Think of asthma as not one attack but rather two attacks.  The first asthma attack is cause by a Select one BLUE BLOATERS CHRONIC ASTHMA TRIGGER MUCUS LOW EDEMA REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS which irritates the lungs  (Dust, temperature, humidity, perfumes, allergies, exercise, foods, stress, medications).  This results in a bronchocontriction resulting in a narrowing of the airways which results in a drying of the airways as well.  As a result of the drying of the mucus linings over the next few hours Select one BLUE BLOATERS CHRONIC ASTHMA TRIGGER STATUS ASTHMATICUS MUCUS LOW EDEMA REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS will develop resulting in once again another narrowing of the airways.  This is why most asthma patients will have two inhalers or one inhaler with a combination of drugs.  One inhaler is albuterol or another class drug to bronchodilate.  The other inhaler is a steroid to keep down edema. 

Almost all patients who die from an asthma attach have mucus plugs in the airway.  Percussion is important to perform by cupping your hand and clapping the back to move the mucus.

Select one BLUE BLOATERS CHRONIC ASTHMA TRIGGER STATUS ASTHMATICUS MUCUS LOW EDEMA REVERSIBLE SMOKING HIGH 2 CHRONIC BRONCHITIS is a severe asthma attack that cannot be broken by conventional means.  Prepare for immediate ETT placement.

Select one SARS VIRAL FEVER FLUID DEEP PNEUMONIA is an infection of the lungs and a common medical problem.  Pneumonia is among the leading causes of death for the elderly and AIDS patients. Bacterial and viral are the most common.  As the infection evolves Select one SARS VIRAL FEVER FLUID DEEP PNEUMONIA and inflammation collects in the alveoli. 

(Covered in Toxicology and Overdose Lecture) Carbon Monoxide is Select one PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS , tasteless and colorless produced from incomplete burning of fossil fuels.  CO binds to hemoglobin Select one PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS times stronger than O2. 

Select one PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS chamber is needed.

Select one NICOTINE PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS is a blood clot (thrombus) that lodges in the pulmonary arteries affecting blood flow. 50,000 US deaths per year but many survive at a 10 to 1 ratio.   Causes; long bone fractures release fat into circulation, recent Select one PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS , childbirth, birth control mixed with or without Select one NICOTINE PULMONARY EMBOLISM HYPERBARIC LATE 300 SURGERY HEMOGLOBIN 200 ODORLESS , prolonged immobilization like travel.  A-fib and sickle cell also can increase the occurrence of a PE.

Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX is defined as a pneumothorax that occurs in the absence of blunt or penetrating Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX .  Spontaneous pneumothorax is a common occurrence; 18/100,000.  50% of patients will have a re-occurrence within 2 years of the first.  Most common type of patients who experience a spontaneous pneumothorax are people who Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX .  Smoking leads to blebs (weakened lung tissue).  Also people with lots of lung Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX which results in scaring/thinning of the lungs.  Tall white males are prone to thin lung tissue.  Most spontaneous pneumothorax's will self seal.

Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX is rapid breathing, chest pain, Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX , and anxiety.  Never treat hyperventilation syndrome until all other cause for rapid breathing have been ruled out.  Hyperventilating blows off too much CO2 resulting in lightheaded, numbness, Select one INFECTIONS CARPOPEDAL SMOKE NUMBNESS HYPERVENTILATION SYNDROME TRAUMA SPONTANEOUS PNEUMOTHORAX spasms.