Airway and Ventilation Flashcard

B. Rationale: This unconscious patient has multiple traumatic injuries. It is critical to keep the airway open to allow continued oxygenation. If the jaw thrust is insufficient to keep the airway open, simple airway adjuncts such as the OPA and NPA can be used. The OPA should only be used in unconscious patients so as not to stimulate a gag reflex. The NPA can be used in both conscious and unconscious patients, however, it is contraindicated in patient with concern for facial or basilar skull fractures. Consequently, the OPA is the better option for this patient. Never turn a patient with a possible spinal cord injury to the side without first ensuing adequate spinal precautions, even if there is a concern for aspiration. Intubation is not immediately required in this spontaneously breathing patient if the airway can be opened and should be approached with significant caution due to the facial trauma and likely associated swelling. Only highly trained clinicians with adequate support staff to stabilize the head should attempt intubation in patients with suspected cervical spine injuries.

C. Rationale: The end-tidal CO₂ went from normal (45 mm Hg) to 0 mm Hg. There is no exhaled CO₂, which is concerning for obstruction, kinking, or dislodgement. It is vital to evaluate for any of these three scenarios and remedy this immediately as the patient is no longer being ventilated or oxygenated. While a slight end-tidal CO₂ may indicate cardiorespiratory arrest with correct placement of the ETT, this is less likely. An abnormality of the ET tube should be assessed for before evaluating the circulatory system, especially if other vital signs are still normal. It is not appropriate just to monitor this significant change, because the patient will become hypoxic with risk for permanent neurologic damage.

B. Rationale: Supplementary oxygen is recommended to be given at the highest setting to provide the maximal inspired oxygen dose.

B. Rationale: Indications for suctioning include of the choices EXCEPT for increased oxygen saturation levels. Typically, oxygen saturation levels will decrease when the patient needs to be suctioned.

A. Rationale: Bronchoconstriction, airway inflammation, and mucus impaction are the three pathophysiologic conditions that lead to acute asthma exacerbation. Bronchoconstriction can lead to airway obstruction and air trapping, and mucus impaction causes hyperinflation and increased obstruction. Additionally, airway inflammation is due to inflammatory mediators recruited to the airway. Bronchodilation does not occur in asthma; this is actually the goal of treatment. Air trapping is a result of the underlying three conditions and leads to a buildup of inhaled air that cannot be exhaled.

B. Rationale: Hyperventilation should be avoided in the cardiac arrest patient receiving CPR. With cardiac arrest, less blood flow goes to the lungs and patients require a reduced tidal volume and respiratory rate. Hyperventilation leads to increased thoracic pressure and the resulting reduced venous return and cardiac output. This leads to a ventilation-perfusion mismatch as the increased ventilation does not match the reduced pulmonary blood flow.

D. Rationale: Iatrogenic effects of hyperventilation via ET tube include aspiration, stomach insufflation, tension pneumothorax, and neurologic deterioration.

A. Rationale: Confirm advanced airway placement with continuous quantitative waveform capnography.

C. Rationale: Quantitative waveform capnography in intubated patients monitors CPR quality, optimizes chest compressions, and detects ROSC during chest compressions. Measurements of end-tidal carbon dioxide determines blood perfusion to the lungs. After 20 minutes of resuscitation, a value < 20 mm Hg suggests that return of spontaneous circulation is unlikely.