METC Mod 3 (ch: 8 9)

Patent airway

an airway (passage from the nose to the mouth or mouth to the lungs) that is open and clear and will remain open and clear, without interferemce to the passage of air into and out of the body

pharynx

This is "the throat" , divided into three regions: orophyarynx, nasopharynx, and laryngopharynx

upper airway

Airway that begins at the mouth and nose and ends at the glottic opening

lower airway

airway that begins at trachea and ends at the alveoli

Alveoli

-Tiny sacs in grapelike bunches at the end of the airway
-Surrounded by pulmonary capillaries
-Oxygen and carbon dioxide diffuse through pulmonary capillary membranes

Airway Obstructions

- interferes with air flow
Foreign bodies: food, small toys
Liquids: blood, vomit
-may result from poor muscle tone caused by altered mental status

glottic opening

the entry point into the larynx

epiglottis

the protective flap that sits above the glottic opening which seals off the trachea during swallowing

oropharynx

where the oral cavity joins the pharynx

nasopharynx

where the nasal pasages empty into the pharynx

laryngopharynx

the structure surrounding the entrance to the trachea, also known as the hypopharynx

Acute

type of Airway Obstruction that involves:
Foreign bodies
Vomit
Blood

Occurring over time

type of Airway Obstructions: Edema from burns, trauma, or infection
Decreasing mental status

Bronchoconstriction

Disorder of lower airway
Smooth muscle constricts internal diameter of airway

Is the airway open?
Will the airway stay open?

Addressed in primary assessment
Two questions that must be answered

stridor

a high pitched sound generated from partially obstructed air flow in the upper airway

signs of inadequate airway

-Inability to speak
-Unusual raspy quality to voice
-Stridor
-Snoring
-Gurgling
-Foreign bodies in airway
-No air felt or heard (air exchange below normal)
-Absent or minimal chest movements
-Abdominal breathing

pediatric

Retractions and Nasal flaring are involved in ______ airway assessment

hoarseness

voice changes that often reflect a narrowing of the upper airway passages

snoring

the sound of soft tissue of the upper airway creating impedance ( or partial obstuction) to the flow of air

gurgling

the sound of flid obstructing the airway

Head Tilt Chin Lift Maneuver

means of correcting blockage of the airway when no trauma or injury is suspected:
-Place one hand on forehead and fingertips of other hand under patient's lower jaw
-Tilt head
-Lift chin
-Do not allow mouth to close

Jaw Thrust Maneuver

means of correcting blockage of the airway without causing further damage to the spinal cord in the neck:
-Place one hand on each side of patient's lower jaw at angles of jaw below ears
-Using index fingers, push angles of patient's lower jaw forward
-Do

infants children

______ and ____________often have larger occipital regions of their heads
-Lying flat may cause hyperflexion of neck and airway occlusion
-Evaluate need to pad behind patient's shoulders to achieve neutral airway position

Oropharyngeal Airway (OPA)

-Device used to move tongue forward as it curves back to pharynx
-Sizes: infant to large adult

Inserting OPA

-Open mouth with crossed-finger technique
-Position airway with tip pointing toward roof of mouth
-Insert until you meet resistance
-Gently rotate airway 180� so tip is pointing down into pharynx
-Check that flange of airway is against lips
-Monitor patie

Airway Adjuncts

Rules for using __________:
-Use OPA only on patients not exhibiting gag reflex
-Open patient's airway manually before using device
-When inserting airway, take care not to push patient's tongue into pharynx
-Have suction ready
-Do not continue inserting

OPA

measure the ________ from the corner of the patients mouth to the tip of the earlobe to make sure it is the correct size

pediatic

when inserting the OPA for __________:
-Use tongue depressor or rigid suction tip and insert OPA directly
-Do not rotate into place

airway

the passageway by which air enters or leaves the body. The structures invloved include the nose, mouth, pharynx, larynx, trachea, bronchi, and lungs

nasopharyngeal airway (NPA)

-a flexible breathing tube inserted through the patients nose into the pharynx to help maintain an open airway
-Can be used in patients with intact gag reflex or clenched jaw
-Contraindicated if clear (cerebrospinal) fluid coming from nose or ears

french

Nasopharyngeal Airway Come in various sizes
Must be measured
Typical adult sizes: 34, 32, 30, and 28 ________(unit of measurement)

Inserting NPA

-Lubricate outside of tube with water-based lubricant before insertion
-Push tip of nose upward; keep head in neutral position
-Insert into nostril; advance until flange rests firmly against nostril

Suctioning

-Use vacuum device to remove liquids from airway
-Obvious liquids (blood, secretions, vomit) must be removed from airway to prevent aspiration into lungs

components

_________of Suction Unit:
-Suction source
-Collection container
-Tubing
-Suction tips or catheters

Fixed or portable

Types of Suction Systems:

Suction Device Requirements

-Must furnish air intake of at least 30 Lpm at open end of collection tube
-Must generate vacuum of no less than 300 mmHg when collecting tube is clamped

flexible

________ suction catheter
-Designed to be used when a rigid tip cannot be used
-Can be passed through a tube such as the nasopharyngeal or endotracheal tube
-Can be used for suctioning the nasopharynx
-Come in various sizes identified by a number "French

rigid

________ pharyngeal suction tip
-Suction only as far as you can see
-Do not lose sight of distal end
-Careful insertion helps prevent gag reflex or vagal stimulation

Flexible Suction Catheter

__________:
-Measured in similar way as OPA
-Length of catheter that should be inserted into patient's mouth equals distance between corner of patient's mouth and earlobe

Suctioning Techniques

__________:
-Use appropriate infection control practices while suctioning
-Protective eyewear, mask, disposable gloves
-Suction no longer than 10 seconds at a time
-Prolonged suctioning can cause hypoxia and bradycardia
-If patient vomits for longer than

Definitive Care

-Keeping the airway open may exceed capabilities of a basic EMT. Medications and/or surgical procedures may be necessary to resolve airway obstruction
-Quickly recognize when more ________ is necessary:
-May be advanced life support intercept
-May be clos

Facial Injuries

Special Considerations: _________
-Frequently result in severe swelling or bleeding that may block or partially block airway
-Bleeding may require frequent suctioning or more definitive airway

Obstructions

Special Considerations: _________
-Many suction units are not adequate for removing solid objects
-Objects may have to be removed with manual techniques: abdominal thrusts, chest thrusts, finger sweeps

Dental Appliances

Special Considerations: _________
-Leave in place during airway procedures when possible
-Partial dentures may become dislodged during an emergency
-Be prepared to remove if airway endangered

pediatric

Special Considerations: _______ Anatomical Considerations
-Airway structures more easily obstructed
-Smaller mouth and nose
-Larger tongue
-Narrow, flexible trachea

Pediatric

________ Management Considerations:
-Open airway gently
-Do not hyperextend neck
-Consider adjuncts when other measures fail
-Use rigid tip with adjunct, but do not touch back of airway

gag reflex

vomiting or retching that results when something is placed in the back of the pharynx. This is tied to the swallow reflex.

Ventilation

Process of moving air into and out of chest, both inhaling and exhaling
( mechanical process)

minute volume

tidal volume x respiratory rate = _________

tidal volume

one cycle of inhalation and exhalation

inhalation

-Active process
-Negative pressure pulls air into lungs

Exhalation

-Passive process
-Muscles relax
-size of chest decreases
-Positive pressure created; air pushed out

Dead space air

air moved in ventilation not reaching alveoli

Alveolar ventilation

air actually reaching alveoli

500 mL

Tidal volume of an average adult?

Diffusion

movement of gases from high concentration to low concentration

Pulmonary respiration

diffusion of oxygen and carbon dioxide (exchange of gases) between alveoli and circulating blood

Cellular respiration

exchange of gases between blood and cells

Cardiopulmonary

Categories of __________ System Failure:
-Mechanics of breathing disrupted
-Gas exchange interrupted
-Circulation problems

Hypoxia

low oxygen level in cells

Hypercapnea

high carbon dioxide level

oxygen
Carbon dioxide

Evaluating Respiration:
Brain and body cells need a steady supply of ________
Also _________ must be continuously removed

Compensation

__________ for hypoxia or hypercapnea is predictable
Signs:
-Shortness of breath (symptom)
-Increased respiratory rate and depth
-Increased heart rate

Respiratory Distress

Body compensating for a respiratory challenge and meeting metabolic needs

Respiratory Distress

Signs of __________
-Relatively normal mental status
-Relatively normal oxygen saturation and end tidal carbon dioxide
-Relatively normal skin color
-Shortness of breath
-Increased respiratory rate and heart rate
-Accessory muscle use and position changes

Respiratory Failure

_________:
-Occurs when challenge overcomes compensation or compensatory steps can no longer continue
-Also known as inadequate breathing
-Exceptionally important to recognize; often a precursor to respiratory arrest

Respiratory

Signs of _________ Failure:
-Signs of respiratory distress
-Evidence that compensation is no longer effective
-Signs of poor oxygenation and/or poor removal of CO2
-Signs of decompensation

Cyanosis

Signs of failed oxygenation and/or removal of CO2:
-Altered mental status
-___________

Decompensation

Signs of __________:
-No or poor air movement
-Diminished or absent breath sounds
-Breathing rate too rapid, too slow, or irregular
-Patient unable to speak
-Unusual noises (wheezing, crowing, stridor, snoring, gurgling, gasping)

nasal flaring

Signs of Respiratory Failure in Pediatric:
In addition to other signs, look for retractions and ________

inadequate

When to Intervene:
If breathing is _________, immediate intervention is necessary

Positive Pressure

__________ Ventilation:
-Forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing
-Uses force exactly opposite of how the body normally draws air into the lungs

Gastric distention Hyperventilation

Negative Side Effects of Positive Pressure Ventilation:
-Decreasing cardiac output/dropping blood pressure
-__________
-__________

positive pressure ventilation

Key Concerns with ________ :
-Do not ventilate patient who is vomiting or has vomitus in airway� will force vomitus into patient's lungs
-Watch chest rise and fall with each ventilation
-Ensure rate of ventilation is sufficient

Mouth to Mask

Performing ___________ Ventilation:
-Open airway
-Connect oxygen and run at 15 Lpm
-Position mask on patient's face
*Apex over bridge of nose
*Base between lower lip and prominence of chin
-Hold mask firmly in place; maintain head tilt
-Exhale into mask p

pocket face mask

Mouth to Mask Ventilation Performed using a : ____________

Bag Valve Mask (BVM)

-Handheld ventilation device
-Used to ventilate nonbreathing patient and/or patient in respiratory failure

Bag Valve Mask

Standard Features of ________:
-Self-refilling shell that is easily cleaned and sterilized
-Non-jam valve that allows an oxygen inlet flow of 15 Lpm
-Nonrebreathing valve

Bag Valve Mask

Mechanics of _______:
Supply of 15 Lpm O2 attached and enters reservoir
When squeezed, air inlet closed and oxygen delivered to patient
When released, passive expiration by patient occurs

Two Rescuer

________ BVM Ventilation:
-Strongly recommended by American Heart Association
-Most difficult part of BVM ventilation is obtaining adequate mask seal
-Hard to maintain seal while squeezing bag
-One rescuer squeezes bag; other rescuer maintains seal

No Trauma

Two-Rescuer BVM Ventilation when ________ is Suspected:
-Open airway with head-tilt, chin-lift maneuver
-Select correct bag-valve mask size
-Kneel at patient's head; position thumbs over top half of mask, index fingers over bottom half
-Place apex of tria

Trauma

Two-Rescuer BVM Ventilation with _________Suspected:
-Open airway using jaw-thrust maneuver
-Select correct bag-valve mask size
-Kneel at patient's head; place thumb sides of your hands along mask to hold it firmly on patient's face
-Use remaining fingers

One Rescuer

________ BVM Ventilation:
-Open airway
-Select correct size mask
-Position mask on patient's face
-Squeeze bag
-Release pressure on bag and let patient exhale passively

Stoma

Artificial Ventilation of a _______ Breather:
-Clear mucus plugs or secretions from stoma
-Leave head and neck in neutral position
-Use pediatric-sized mask to establish seal around stoma
-Ventilate at appropriate rate for patient's age
-If unable to arti

Flow Restricted Oxygen Powered

Using ________________ Ventilation Device:
-Use on adults only
-Follow same procedures for mask seal as for BVM
-Trigger device until chest rises

Automatic Transport Ventilator (ATV)

-Provides automated ventilations
-Can adjust ventilation rate and volume
-Provider must assure appropriate respiratory rate and volume for patient's size and condition

Supplemental Oxygen

Conditions Requiring __________:
-Respiratory or cardiac arrest
-Heart attacks and strokes
-Shock
-Respiratory distress and lung diseases
-Head injuries
-Other serious injuries

Portable installed

Oxygen Systems can be _______ or _________

Oxygen System

_________ Components:
-main valve
-pressure regulator
-O2 source
-flow meter
-tubing
-O2 delivery device

Oxygen Cylinders

_________ Come in various sizes:
*D�about 350 L of O2
*E�about 625 L of O2
*M�about 3,000 L of O2
*G�about 5,300 L of O2
*H�about 6,900 L of O2

Oxygen Safety

________:
-Use pressure gauges, regulators, and tubing intended for use with oxygen
-Use non-sparking wrenches
-Replace disposable gaskets each time a cylinder is changed
-Properly secure oxygen cylinders in a cool, ventilated space
-Never drop cylinder o

Humidifier

________:
-Connected to flowmeter
-Provides moisture to dry oxygen from supply cylinder

Nonrebreather Mask

Delivery Device ___________ :
-Best way to deliver high concentrations of oxygen to a breathing patient
-Provides oxygen concentrations of 80%-100%
-Minimum flow rate 8 Lpm
-Maximum flow rate 12-15 Lpm

Nasal Cannula

Delivery Device ___________ :
-Best choice for a patient who refuses to wear an oxygen face mask
-Provides oxygen concentrations of 24%-44%
-Should deliver no more than 4-6 liters per minute

Partial Rebreather Mask

Delivery Device ___________ :
-Very similar to nonrebreather mask
-No one-way valve in opening to reservoir bag
-Delivers 40%-60% oxygen at 9-10 Lpm

Venturi Mask

Delivery Device ___________ :
-Delivers specific concentrations of oxygen by mixing oxygen with inhaled air
-Some have set percentage and flow rate; others have adjustable Venturi port

Tracheostomy Mask

Delivery Device ___________ :
-Placed over stoma or tracheostomy tube to provide supplemental oxygen
-Connected to 8-10 Lpm

Facial Injuries

Special Considerations ___________ :
-Bleeding and swelling can disrupt movement of air
-Aggressive suction and advanced airway maneuvers may be necessary

Obstructions

Special Considerations ___________ :
-Foreign bodies can impede ventilation of patients
-If unable to ventilate always consider the possibility of obstruction

children

-Hypoxia often occurs rapidly
-_______ burn oxygen at twice the rate of adults
-Account for many anatomical differences associated with airway

Pediatric

Ventilating _______ Patients:
-Avoid excessive pressure and volume
-Use properly sized face masks
-Flow-restricted, oxygen-powered ventilation devices contraindicated
-Gastric distention may impair adequate ventilations

Advanced Airway

Types of _______ Devices:
-Devices requiring direct visualization
-Devices inserted "blindly

Intubation

Assisting with ________:
-Maximize oxygenation prior to procedure
-Position patient in sniffing position
-Cricoid pressure
-Confirmation
-Securing tube in place

Trauma

Assisting with a ________ Intubation:
-Provide manual in-line stabilization throughout procedure
-Position hands to hold stabilization, but allow for movement of jaw

Blind Insertion

__________ Devices:
-Examples
*King LT-D� airway
*Combitube�
*Laryngeal Mask Airway (LMA�)
-Usually do not require head to be placed in sniffing position

cyanosis

condition in which the patient's skin, lips, tongue, ear lobes, or nail beds are blue or gray

adult

adequate breathing normal rate for ______:
*12-20

child

adequate breathing normal rate for ______:
*15-30

infant

adequate breathing normal rate for ______:
*25-50

pressure regulator

a device conected to an oxygen cylinder to reduce cylinder pressure so it is safe for delivery of oxygen to a patient

stoma

a permanent surgical opening in the neck through which the patient breathes