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Functions of the Conducting Zone 1. Provides a low-resistance pathway for air flow; resistance is physiologically regulated by changes in contraction.

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Presentation on theme: "Functions of the Conducting Zone 1. Provides a low-resistance pathway for air flow; resistance is physiologically regulated by changes in contraction."— Presentation transcript:

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5 Functions of the Conducting Zone 1. Provides a low-resistance pathway for air flow; resistance is physiologically regulated by changes in contraction of airway smooth muscle and by physical forces acting upon the airways.1. Provides a low-resistance pathway for air flow; resistance is physiologically regulated by changes in contraction of airway smooth muscle and by physical forces acting upon the airways. 2. Defends against microbes, toxic chemicals, and other foreign matter, cilia, mucus, and phagocytes perform this function.2. Defends against microbes, toxic chemicals, and other foreign matter, cilia, mucus, and phagocytes perform this function. 3. Warms and moistens the air.3. Warms and moistens the air. 4. Phonates (vocal cords).4. Phonates (vocal cords).

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9 ALVEOLAR VENTILATION Alveolar ventilation is defined as the volume of atmospheric air entering alveoli each minute.Alveolar ventilation is defined as the volume of atmospheric air entering alveoli each minute. Minute ventilation is the total ventilation per minute.Minute ventilation is the total ventilation per minute.

10 Regulation of Respiration Respiratory Center Dorsal respiratory group of neurons - its inspiratory and rhythmical function Pneumotaxic center limits the duration of inspiration and increases the respiratory rate Ventral respiratory group of neurons - functions in both inspiration and expiration Possibility of an Apneustic Center in the lower pons Lung inflation signals limit inspiration - The Herring-Breuer Inflation Reflex Control of Overall respiratory Center Activity

11 Pathophysiologic Causes of Hypoxemia Respiratory Diffusion impairment (edema, fibrosis)Increased Physiologic shuntIncreased Generalized hypoventilation (emplysema)Normal Local low V A /Q (depressed respiration)Increased Nonrespiratory Intracardiac right-to-left shuntIncreased Decreased P IO 2, low P B, low F IO 2 Normal Reduced oxygen content (anemia and carbon monoxide poisoning)Normal. Causes Effect on P( A -a)O 2 Gradient CO 2 20 X O 2 P V O = 40 mmHg P A O = 104 mmHg P V CO = 47 mmHg P A CO = 40 mmHg mmHg 7 mmHg

12 Manifestations of Respiratory Distress Altered mental status Increased work of breathing –Tachypnea –Accessory muscle use, retractions, paradoxical breathing pattern Catecholamine release –Tachycardia, diaphoresis, hypertension Abnormal arterial blood gas values Altered mental status Increased work of breathing –Tachypnea –Accessory muscle use, retractions, paradoxical breathing pattern Catecholamine release –Tachycardia, diaphoresis, hypertension Abnormal arterial blood gas values ®

13 Acute Respiratory Failure Management Oxygen supplementation –Increase F IO 2 –Match flow between delivery device and inspiratory demand –High- vs. low-oxygen systems –High- vs. low-flow systems Oxygen supplementation –Increase F IO 2 –Match flow between delivery device and inspiratory demand –High- vs. low-oxygen systems –High- vs. low-flow systems ®

14 Orotracheal Intubation – Preparation Appropriate monitoring – oximetry, ECG, BP –Assemble equipment –Laryngoscope – test light, select blade –Endotracheal tube – test cuff, lubricate –Stylet – insert, angulate –Suction – test –Magill forceps Appropriate monitoring – oximetry, ECG, BP –Assemble equipment –Laryngoscope – test light, select blade –Endotracheal tube – test cuff, lubricate –Stylet – insert, angulate –Suction – test –Magill forceps

15 Orotracheal Intubation – Preparation Don protective garb Elevate occiput with pad if no cervical spine injury suspected Provide anesthesia, sedation, amnesia, and neuromuscular blockade as required Don protective garb Elevate occiput with pad if no cervical spine injury suspected Provide anesthesia, sedation, amnesia, and neuromuscular blockade as required

16 Orotracheal Intubation – Technique Proper operator position Holding the laryngoscope handle Application of cricoid pressure Mouth opening methods

17 Orotracheal Intubation – Technique Insertion of laryngoscope blade – tongue control Tongue displacement medially – visualize epiglottis Insertion of laryngoscope blade – tongue control Tongue displacement medially – visualize epiglottis

18 Orotracheal Intubation – Technique Advance laryngoscope into position (vallecula for curved blade; under epiglottis for straight blade) Elevate base of tongue and expose glottic opening Advance laryngoscope into position (vallecula for curved blade; under epiglottis for straight blade) Elevate base of tongue and expose glottic opening

19 Orotracheal Intubation – Technique Elevate base of tongue further to fully expose glottic opening and surrounding anatomyElevate base of tongue further to fully expose glottic opening and surrounding anatomy

20 Orotracheal Intubation – Technique Insert endotracheal tube under direct vision to 23–25 cm at lipInsert endotracheal tube under direct vision to 23–25 cm at lip Remove stylet and laryngoscope, inflate tube cuffRemove stylet and laryngoscope, inflate tube cuff Confirm tube position – breath sounds, CO 2 detectorConfirm tube position – breath sounds, CO 2 detector Secure endotracheal tubeSecure endotracheal tube Obtain chest radiographObtain chest radiograph

21 Orotracheal Intubation – Technique Straight blade position, elevating the epiglottisStraight blade position, elevating the epiglottis Be aware of laryngospasm when epiglottis is touchedBe aware of laryngospasm when epiglottis is touched

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24 Traqueostomias

25 Traqueostomias

26 Traqueostomias

27 Traqueostomias

28 Traqueostomias

29 Traqueostomias

30 Traqueostomias

31 Traqueostomias Cuidados –RX tórax –Pressão balonete –Sangramento –Secreções –Nebulização –Hidratação –Troca

32 Traqueostomias Complicações –Per-operatórias –Precoces –Tardias

33 Traqueostomias Per-operatórias –Sangramento –Lesão nervosa –Lesão tireóide –Lesão parede posterior traquéia –Colocação cânula posição inadequada –Arritmias

34 Traqueostomias Precoces –Pneumomediastino –Pneumotórax –Embolia gasosa –Fístula tráqueo-esofágica

35 Traqueostomias Tardias –Infecção –Sangramento –Obstrução cânula –Fístula tráqueo-esofágica –Fístula tráqueo-cutânea –Cicatriz hipertrófica –Traqueomalácia –Estenose traquéia


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