Airway
The passageway by which air enters and leaves the body. The structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi and lungs.
Alveolar ventilation
The amount of air that reaches the alveoli.
Artificial ventilation
Forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing. Also called positive pressure ventilation.
Apnea
No breathing.
Bronchoconstriction
The contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resistance to airflow.
Cellular Respiration
The exchange of oxygen and carbon dioxide between cells and circulating blood.
Cyanosis
A bluish or purplish color of the skin due to insufficient oxygen levels in the blood.
Diffusion
A process by which molecules move from an area of high concentration to an area of low concentration.
Dyspnea
Difficult and labored breathing; shortness of breath.
Flail chest
Fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment.
Flowmeter
A valve that indicates the flow of oxygen in liters per minute.
Hypoxia
A deficiency of oxygen reaching the tissues of the body.
Intercostal
Situated or extending between the ribs.
Nasopharyngeal airway
Flexile breathing tube inserted through the patient's nostril into the pharynx to help maintain an open airway.
Oropharyngeal airway
Curved device inserted through the patient's mouth into the pharynx to help maintain an open airway.
Paradoxical motion
Movement of ribs in flail segment that is opposite to the direction of movement of the rest of the chest cavity.
Patent airway
An airway that is open and clear and will remain open and clear without interference to the passage of air into and out of the body.
Pressure regulator
A device connected to an oxygen cylinder to reduce pressure, so it is safe for delivery of oxygen to a patient.
Pulmonary respiration
The exchange of oxygen and carbon dioxide between the alveoli and circulating blood in the pulmonary capillaries.
Respiratory arrest
When breathing stops completely.
Respiratory distress
Increased work of breathing; a sensation of shortness of breath.
Respiratory failure
The reduction of breathing to the point where oxygen intake is not sufficient to support life.
Retractions
Pulling in the skin and soft tissue between the ribs when breathing.
Oropharynx
where the oral cavity joins the nasopharynx.
Nasopharynx,
where the nasal passages empty into the pharynx.
Laryngopharynx
the structures surrounding the entrance to the trachea, also is the point of division between the upper airway and the lower airway.
The The lower airway begins
below the larynx and is composed of the trachea, bronchi, bronchioles, and the alveoli.
Upper Airway
Movement of air into and out of the lungs requires an intact and open airway, or a patent airway. In the upper airway air enters the body through the mouth and nose. Posterior and inferior to the mouth and nasal passages, air enters the pharynx.
The entry point into the larynx is called
the glottis opening and is protected by a large leaf-like structure called the epiglottis. This protective flap closes over the glottis to prevent food and foreign objects from entering the trachea.
The larynx itself is framed and protected by
cartilage. The shield like thyroid cartilage protects the front of the larynx and forms the Adams apple. The cricoid cartilage forms the lower aspect of the larynx and provides structure to the superior trachea.
The trachea is
a tube protected by sixteen rings of cartilage.
The trachea branches at
the carina and forms two mainstream bronchi.
The bronchi branch further into smaller and smaller air passages called
bronchioles.
All the air passages are supported by
cartilage and lined with smooth muscles. This smooth muscle allows the bronchioles to change their diameter in response to specific stimulation.
Air passages get smaller and smaller ending at
alveoli. Alveoli are small sacs within the lungs where gas exchange takes place with the bloodstream across the alveolar-capillary membrane.
Diaphragm divides the chest cavity from
the abdominal cavity and helps a person inhale and exhale.
Anatomic Landmarks
Pharynx, Trachea, Suprasternal Notch, Costal Angle, Vertebra Prominence, Clavicles, Xyphoid Process, Intercostal spaces, Mid-sternal line, Right and left mid-clavicular lines, Right and left anterior axillary lines, Right and left mid-axillary lines, Righ
Stridor
a high pitched sound generated from partially obstructed airflow, it can be present on inhalation and exhalation.
Two procedures are commonly recommended for opening the airway,
the head-tilt chin-lift maneuver and the jaw thrust maneuver.
You may also see patients use position to keep the airway open. Patients may present in the
sniffling position".
The head-tilt, chin-lift maneuver uses
head position to align the structures of the airway and provide for the free passage of air.
The jaw thrust maneuver is
commonly used to open the airway of an unconscious patient with suspected head, neck, or spine injury or unknown MOI.
Is the Airway clear? The patient's airway must be
clear of foreign materials, blood, vomitus, and other secretions. Materials that are allowed to remain in the airway may be forced into the trachea and eventually into the lungs. This will cause complications ranging from severe pneumonia to complete airw
Operation of a suction unit requires:
Tubing, Suction tips, Suction catheters, Collection container, Container of clean or sterile water
The rigid pharyngeal tip suction catheter is called a
Yankauer tip.
When possible, limit suctioning to no longer than
10 seconds at a time.
Airway adjuncts are devices that
aid in maintaining an open airway. They are frequently used to assist in the opening of an airway and to help keep an airway open.
The two most common airway adjuncts are
oropharyngeal airway and the nasopharyngeal airway
An oropharyngeal airway is a
curved device, made of plastic, which can be inserted into the patient's mouth.
Use an oropharyngeal airway only one patient's who do not exhibit a
gag reflex. The gag reflex causes vomiting or retching, when a patient is deeply unconscious, the gag reflex disappears but may reappear as a patient begins to regain consciousness. Have a suction ready prior to inserting airway.
The nasopharyngeal airway does not stimulate the
gag reflex.
Do not use a nasopharyngeal airway if
clear (cerebrospinal) fluid is coming from the nose or ears. This may indicate a skull fracture where the airway would pass.
Cricothyroidotomy
Surgical placement of an airway tube through the cricothyroid membrane.
Inhalation
Active process in which the muscles of the rib cage and the diaphragm contract.
The expanding size of the chest creates a
negative pressure inside the chest cavity pulls air into the lungs.
Exhalation
Passive process during which the intercostal muscles and the diaphragm relax.
The chest decreases in size and
positive pressure builds inside the chest cavity. This positive pressure pushes air out of the lungs.
The amount of air moved in one breath, one cycle of inhalation and exhalation, is called
tidal volume.
The amount of air moved into and out of the lungs per minute is called
minute volume.
Respiratory rate should be
12-20 with adequate depth and a regular rhythm.
Hypoxia
Insufficient supply of oxygen to the body's tissues.
If you determine the patient's breathing is adequate but they are in respiratory distress you will need to provide
supplemental oxygen.
Oxygen is a
drug.
D cylinder
350 liters of oxygen
E cylinder
625 liters of oxygen
M cylinder
3,000 liters of oxygen
G cylinder
5,300 liters of oxygen
H cylinder
6,900 liters of oxygen
switch to a fresh cylinder before a cylinder reaches
200 psi.
Always use medical-grade oxygen (labeled OXYGEN U.S.P.) that is not more than
5 years old.
Flowmeters
Allows control of the flow of oxygen in liters per minute. Most services keep the flowmeter permanently attached to the pressure regulator.
Nonrebreather mask
Maintain a proper flow of oxygen (15 liters per minute).
Provides concentrations of oxygen ranging from 80 to 100 percent.
Minimum flow rate is 8 liters per minute; maximum rate is 12-15 liters per minute.
Nasal cannula
Provides low concentration of oxygen (24 percent to 44 percent).
Deliver no more than 4 to 6 liters per minute.
Partial rebreather mask
Deliver 40 to 60 percent oxygen at 9 to 10 liters per minute.
Bradypnea is slower than
12 breaths per minute.
Tachypnea is faster than
20 breaths per minute.
Hyperventilation is faster than
20 breaths per minute, deep breathing.
Pneumothorax
Air or gas in pleural cavity, (EMERGENCY).
Tension Pneumothorax
Air leaks continually into the pleural space, resulting in a potentially life-threatening emergency from increasing pressure in the pleural space. If is often found with a closed chest injury. The lung may be punctured by a broken rib or other cause. If t
Hemothorax
Accumulation of blood in the intrapleural space after blunt/penetrating chest trauma or other non-traumatic etiology. Bleeding is usually a result of disruption of the tissues/vessels of the chest wall, pleura, or intrathoracic structures. Blood will flow
Pneumothorax
Presence of free air in the intrapleural space. Spontaneous pneumothorax is due to atraumatic rupture of alveolus. Two of every three incidences of primary spontaneous pneumothorax happen to primarily young, healthy patients (20-40 yr. old) with tall, thi
Suspected tension pneumothorax requires immediate
needle thoracotomy (decompression).
In a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax and decompress the chest on the side of the injury with a
14-gauge, 3.25-inch needle/catheter
Tension pneumothorax, Ensure that the needle entry into the chest is not
medial to the nipple line and is not directed towards the heart.
Tension pneumothorax entry should be
over top of the 3rd rib with careful consideration of the neurovascular bundle below the 2nd rib.
An acceptable alternate site for tension pneumothorax is
the 4th or 5th intercostal space at the anterior axillary line (AAL).