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Chapter 10AirwayRespirations• Every cell of the body requires ____________________ to survive
• Oxygen must come in and carbon dioxide must go outMetabolism§ Metabolism--Process where the body’s cells convert
____________________ to energy
• Adequate oxygen required•• Carbon ____________________ produced as a waste productOxygen Requirements• Normal air consists of 21% oxygen• Exhaled air consists of 16% oxygen• All cells require ____________________ to live• CPR produces only ____________________ of the normal cardiac
outputRespiratory Anatomy• Nose: The ____________________ pathway• Mouth: Secondary pathway• Pharynx: The throat• Larynx: Connects the pharynx and trachea
–voice box–thyroid cartilage–Epiglottis: leaf shaped flap that covers ____________________ to prevent food from entering lungs
Respiratory Anatomy• ____________________ : Windpipe• Bronchial Tree: Branching of trachea
• Bronchi• Bronchioles
• Lungs• -Left lung has 2 lobes
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• Lungs• -Left lung has 2 lobes• -Right lung has 3 lobes
• Alveoli: Tiny air ____________________ where gas exchange occurs
Respiratory Anatomy• Diaphragm: ____________________ that controls breathing• Upper Airway: nasopharynx to just below larynx• Lower Airway: Larynx to ____________________ Diaphragm• Has characteristics of both voluntary and ____________________
muscles• Dome-shaped muscle• Divides thorax from ____________________ • ____________________ during inhalation• ____________________ during exhalationAnatomy ReviewPhysiology of Breathing
VentilationBreathing Process: Inhalation• ____________________ part of breathing in which the diaphragm
and intercostal muscles contract allowing the lungs to expand• The decrease in pressure allows lungs to fill with air.• Air travels to the ____________________ where exchange of gases
occurs.• Partial pressure: the amount of gas in the air or dissolved in fluid
(blood)• Oxygen and carbon dioxide diffuse until their partial pressures in the
air and blood are equal.•Tidal and Minute Volume• Tidal Volume: the amount of air, in milliliters, that is moved in and out
of the lungs with each ____________________ • 6 to 7 mL per kilogram• ____________________ is average for an adult male
• Minute Volume: the amount of air moved through the lungs in one
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• ____________________ is average for an adult male• Minute Volume: the amount of air moved through the lungs in one
minute• Tidal volume X respiratory rate
Breathing Process: Exhalation• Does not normally require muscular effort• Diaphragm and intercostal muscles ____________________ .• The thorax decreases in size, and ribs and muscles assume their
normal positions.• The ____________________ in pressure forces air out.Oxygenation• Process of loading oxygen molecules onto ____________________
molecules in bloodstream• Required for internal respiration to take place
• Ventilation without oxygenation can occur in settings where oxygen levels have been depleted
Respiration• Actual exchange of ____________________ and carbon dioxide in
the alveoli and tissues of the body• Cells take energy from nutrients through metabolism.• External respiration (pulmonary respiration)
• Brings fresh air into the respiratory system• Exchanges oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries
Respiration• Internal respiration
• Exchange of oxygen and ____________________ between the systemic circulatory system and cells
The Body’s Need for OxygenGas Exchange• Inhalation delivers oxygen-rich air to ____________________ i.• Oxygen diffuses into the blood• The body does not use all the inhaled oxygen.
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• Oxygen diffuses into the blood• The body does not use all the inhaled oxygen.Gas Exchange
Control of Breathing• Brain ____________________ controls breathing• Stimulus for breathing is one of the following:• Respiratory Drive: Breathing regulated by the amounts of
____________________ in arterial blood • Normal Stimulus• As CO2 levels increase, rate increases
• Hypoxic Drive: Breathing regulated by the amount of ____________________ in the arterial blood• ____________________ system• As O2 levels increase, rate decreases
Normal Breathing Characteristics• Normal rate and depth• Regular rhythm• ____________________ clear and equal lung sounds• Regular rise and fall movements in the chest• Easy, not labored• Adequate depth (tidal volume) •Hypoxia• Hypoxia is the lack of ____________________ • Signs:
Nervousness, irritability, and fearTachycardiaMental status changesUse of accessory muscles for breathingDifficulty breathing, possible chest pain
Conditions Resulting in Hypoxia• Myocardial ____________________ • Pulmonary edema• Acute narcotic overdose• Smoke inhalation
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• Acute narcotic overdose• Smoke inhalation• Stroke• Chest injury• ____________________ • Lung disease• Asthma
Normal Respiration Rates• Adults 12 to 20 breaths/min•• Children ____________________ to ____________________
breaths/min•• Infants 25 to 50 breaths/min
Recognizing Inadequate Breathing• Fewer than ____________________ breaths/min• More than 20 breaths/min• Irregular rhythm• Diminished, absent, or noisy auscultated breath sounds• Reduced flow of expired air at nose and mouth
•Recognizing Inadequate Breathing
• Unequal or inadequate chest expansion • Increased effort of breathing• Shallow depth • Skin that is pale, ____________________ , cool, or moist• Skin pulling in around ribs or above clavicles during inspiration
Patient Assessment• A patient may appear to be breathing after the heart has stopped.
• Called ____________________ l gasps• Cheyne-Stokes respirations are often seen in patients with stroke or
head injury.
Patient Assessment• Ataxic respirations
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Patient Assessment• Ataxic respirations
• Irregular or unidentifiable pattern• May follow serious ____________________ injuries
• Kussmaul respirations• Deep, rapid respirations• Common in patients with metabolic acidosis
•Opening the Airway• Emergency medical care begins with ensuring an
____________________ airway.• Rapidly assess whether an unconscious patient has an open airway
and is breathing adequately.• Supine position is most effective.
• Unconscious patients should be moved as a unit• Most common airway obstruction is the ____________________
Head Tilt-Chin Lift Maneuver• Will open the airway in most patients• For patients who have not sustained or are not suspected of having
sustained ____________________
Head Tilt-Chin Lift Maneuver• Follow these steps:
• With the patient supine, position yourself ____________________ the patient’s head.
• Place the heel of one hand on the forehead, and apply firm backward pressure with the palm.
• Place the fingertips of the other hand under the lower ____________________
• Lift the chin upward, with the entire lower jaw.
Head Tilt/Chin Lift
Jaw-Thrust Maneuver• If you suspect a ____________________ spine injury, use this
maneuver.
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• If you suspect a ____________________ spine injury, use this maneuver.
• Follow these steps:• Kneel above the patient’s head.• Place your fingers behind the angles of the lower jaw.• Move the jaw upward.• Use your thumbs to help position the jaw.
Jaw ThrustOpening the Mouth• Use the cross-finger technique to open mouth:
• Place the tips of your index finger and ____________________ on the patient’s teeth.
• Push your thumb on the lower teeth.• Push your index finger on the upper teeth.• The index finger and thumb cross over each other.
Assessment of the Airway• ____________________ • Listen.• Feel.Basic Airway Adjuncts (1 of 6)Oropharyngeal airways• Keep the ____________________ from blocking the upper airway• Allow for easier suctioning of the airway• Used in conjunction with ____________________ device• Used on unconscious patients without a gag reflexBasic Airway Adjuncts (2 of 6)Inserting an oropharyngeal airway1. Select the proper size airway.2. Open the patient’s mouth.3. Hold the airway upside down and insert it in the patient’s mouth.4. Rotate the airway ____________________ until the flange rests on
the patient’s lips.Basic Airway Adjuncts (3 of 6)
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Basic Airway Adjuncts (3 of 6)Basic Airway Adjuncts (4 of 6)Nasopharyngeal airways• Used on ____________________ patients who can’t maintain an
airway• Can be used on patients with a gag reflex• Should not be used on patients with possible
____________________ injuries or nose bleeds or history of fractured nasal bone
Basic Airway Adjuncts (5 of 6)Inserting a nasopharyngeal airway1. Select the proper size airway.2. Lubricate the airway.3. Gently push the ____________________ open.4. With the bevel turned toward the septum, insert the airway.Basic Airway Adjuncts (6 of 6)Suctioning Equipment (1 of 2)
Suction Equipment (2 of 2)Suctioning Technique (1 of 4)• Check the unit and turn it on.• Select and measure proper ____________________ to be used.• Open the patient’s mouth and insert tip.• Suction as you ____________________ the catheter.• Never suction for more than:
• Adults 15 seconds• Children 10 seconds• Infants 5 seconds
Suctioning Technique (2 of 4)
Suctioning Technique (3 of 4)• When patients have secretions or vomitus that cannot be suctioned
easily:• Remove the catheter from the patient’s mouth.• Log roll the patient to the ____________________ .• Clear the mouth carefully with a gloved finger.
• Suctioning can result in ____________________ .
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• Clear the mouth carefully with a gloved finger.• Suctioning can result in ____________________ .
• Repeat suctioning only after patient has been reoxygenated.
Suctioning Technique (4 of 4)• If the patient produces frothy secretions as quickly as you can suction
them:• Suction the airway. • Ventilate for ____________________ minutes.• Continue this alternating pattern until all secretions have been cleared.
Recovery PositionSupplemental Oxygen• All patients in cardiac arrest should get oxygen.• Any patient with a respiratory or cardiac emergency needs oxygen.• ____________________ withhold oxygen from anyone who may
benefit from it.Supplemental Oxygen EquipmentOxygen cylinders• Available as a compressed non-combustible gas • Available in several sizes• ____________________ safety system• Oxygen regulators• Humidified oxygen• Liquid oxygen is becoming a more commonly used alternative.•Oxygen Flowmeters• Pressure-compensated flowmeter
–Affected by ____________________ ; must be kept upright• Bourdon-gauge flowmeter
–Not affected by gravity; can be used in any positionUsing Supplemental Oxygen (1 of 3)• Inspect cylinder and markings.• ____________________ the cylinder.
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• Inspect cylinder and markings.• ____________________ the cylinder.• Attach the regulator/flowmeter.• Open the cylinder.• Attach proper delivery device to flowmeter.Using Supplemental Oxygen (2 of 3)• Adjust flowmeter to desired flow rate.• Apply the oxygen device to the patient.• When done, discard the delivery device.• Turn off the flowmeter.• Replace bottle if below ____________________ psi (safe residual)Using Supplemental Oxygen (3 of 3)• Oxygen toxicity
• Not all patients need high concentrations of oxygen.• Can have ____________________ effects on patients with certain illnesses (COPD)
• When pulse oximetry is available, tailor oxygen therapy to administer the minimum amount necessary to maintain oxygen saturation at or ____________________
Hazards of Oxygen• Oxygen supports ____________________ .• Keep possible ignition sources away from the area.• Oxygen tanks are under high pressure.Oxygen Delivery Equipment• Nonrebreathing mask
–Provides up to ____________________ oxygen–Used at 10 to 15 L/min
• Nasal cannula–Provides 24% to 44% oxygen–Used at 1 to 6 L/min–Consider ____________________ for long transports
Calculating Oxygen Duration• (Amount in Bottle (psi)--200 PSI) X FactorFlow (LPM)
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• (Amount in Bottle (psi)--200 PSI) X Factor
Flow (LPM)
• ____________________ is the safety factor to allow for gauge
inaccuracy
• Answer is in minutes of usage
• Factor is determined by the size of the bottle.
–D cylinder: 0.16
–E cylinder: 0.28
–M cylinder: 1.56
–H cylinder: 3.14
Calculating Oxygen DurationExample: You are delivering oxygen to a patient using a NRB flowing
at 10lpm. The bottle is a E cylinder (factor of 0.3). The bottle has
1,500psi remaining. How long will the bottle last?
Calculating Oxygen Duration• (Amount in Bottle (psi)--200 PSI) X Factor
• Flow (LPM)
• (1,500-200) X 0.3
• 10
• 1,300 X 0.3
10
• 390
10
• 39 minutes
Methods of Ventilation• Mouth to mask
• Two-person BVM device
• Flow restricted, oxygen powered device
• One-person ____________________ device
Rate of Artificial Ventilations• Adult — 1 breath every 5 to 6 seconds
–____________________ per minute
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• Adult — 1 breath every 5 to 6 seconds–____________________ per minute
• Children — 1 breath every 3 to 5 seconds–12 to 20 per minute
• Infants — 1 breath every 3 to 5 seconds–12 to 20 per minute
Artificial Ventilation• Mouth to Mouth (Not Recommended)
–____________________ nose closed–take a deep breath–seal your mouth over patients mouth
• Mouth to Nose (Not Recommended)–use chin lift to hold mouth closed–take a deep breath–seal your mouth over patients nose–
Mouth-to-Mask Technique (1 of 2)• Kneel at patient’s head and open airway.• Place the mask on the patient’s face.• Take a deep breath and breathe into the patient for
____________________ second.• Remove your mouth and watch for patient’s chest to fall.Mouth-to-Mask Technique (2 of 2)
Bag-Valve-Mask Device• Can deliver more than ____________________ oxygen• Delivers less tidal volume than mouth-to-mask• Requires ____________________ to be proficient• May be used with advanced airwaysBag-Valve-Mask ComponentsTwo-Person BVM Technique (1 of 2)• Insert an oral airway.• One caregiver maintains ____________________ while the other
delivers ventilations.• Place mask on patient’s face.• Squeeze bag to deliver ventilations.
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• Place mask on patient’s face.• Squeeze bag to deliver ventilations.Two-Person BVM Technique (2 of 2)
One-Person BVM TechniqueManually Triggered Ventilation Devices
Manually Triggered Ventilation Devices• Reduces rescuer fatigue• May be difficult to maintain adequate ventilation without assistance• Should not be used routinely• Should not be used with ____________________ or suspected
cervical spine or chest injuries• Use with caution in pediatric patients
Manually Triggered Ventilation Devices• Automatic transport ventilator (ATV)/ resuscitator
• Manually triggered device attached to a control box• Allows the variables of ventilation to be set• Frees the EMT to perform other tasks
Continuous Positive Airway Pressure (CPAP) (1 of 6)
Continuous Positive Airway Pressure (CPAP) (2 of 6)• Mechanism
• Increases ____________________ in the lungs• Opens collapsed alveoli• Pushes more oxygen across the alveolar membrane• Forces interstitial fluid back into the pulmonary circulation
Continuous Positive Airway Pressure (CPAP) (3 of 6)• Indications
• Patient is ____________________ and able to follow commands• Patient displays obvious signs of moderate to severe respiratory
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• Patient is ____________________ and able to follow commands• Patient displays obvious signs of moderate to severe respiratory distress
• Patient is breathing rapidly• Pulse oximetry reading is less than 90%
Continuous Positive Airway Pressure (CPAP) (4 of 6)• Contraindications
• Patient in respiratory arrest• Signs and symptoms of ____________________ or chest trauma• Patient who has a tracheostomy• Active gastrointestinal bleeding or vomiting• Patient who is unable to follow verbal commands
Continuous Positive Airway Pressure (CPAP) (5 of 6)• Application
• Resistance creates back pressure that pushes open smaller airway structures as the patient ____________________
• 7.0–10.0 cm H2O is acceptable.
Continuous Positive Airway Pressure (CPAP) (6 of 6)• Complications
• Some patients may find CPAP claustrophobic.• Possibility of pneumothorax• Can ____________________ a patient’s blood pressure• If the patient shows signs of deterioration, remove CPAP and begin positive-pressure ventilation using a BVM.
Ongoing Assessment of Ventilation• Adequate Ventilation
–____________________ chest rise and fall–Ventilating at appropriate rate–Heart rate returns to normal
• Inadequate Ventilation–Minimal or no chest rise and fall–Ventilations too fast or slow
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–Minimal or no chest rise and fall–Ventilations too fast or slow–Heart rate does not return to normal
Key Points of Artificial Ventilation• Do not over inflate•• Watch for chest rise•• Always allow patient to exhaleGastric Distention• Artificial ventilation fills ____________________ with air.• Occurs if ventilations are too ____________________ or too
frequent or when airway is blocked• May prevent adequate ventilations• May cause patient to vomit
Sellick Maneuver• AKA: ____________________ Pressure• Also used to facilitate visualization of vocal cords for endotracheal
intubation• Formerly used on unconscious patients to prevent gastric distention.
• No longer recommended for this purpose• Place pressure on cricoid with thumb and index finger.•Sellick Maneuver
Stomas and Tracheostomy Tubes• Ventilations are delivered through the ____________________ .• Attach BVM device to tube or use infant mask.• Stoma may need to be suctioned.• If the patient has a stoma but no tube is in place, use an infant or
child mask with your BVM to make a seal over the stoma.•Causes of Airway Obstruction• Relaxation of the ____________________ • Vomited stomach contents
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• Relaxation of the ____________________ • Vomited stomach contents• Blood clots, bone fragments, damaged tissue• ____________________ caused by allergic reactions• Foreign objects• Infections (especially in children)• Trauma
Recognizing an Obstruction (1 of 2)• Obstruction may be ____________________ or complete.• Is patient able to speak or cough?• If patient is unconscious, attempt to deliver artificial ventilation.
Airway Obstruction• Mild airway obstruction
• Patients can still exchange air, but will have respiratory ____________________ •Noisy breathing, wheezing, coughing
• With good air exchange, ____________________ interfere with the patient’s efforts to expel the object on his or her own.
• With poor air exchange (increased difficulty breathing, stridor, cyanosis), treat immediately.
Airway Obstruction• Severe airway obstruction
• Patients cannot breathe, talk, or cough.• Patient may use the universal distress signal, begin to turn ____________________ , and have extreme difficulty breathing.
Airway Obstruction• Severe airway obstruction (cont’d)
• If patient is unresponsive, not breathing, and has no pulse, begin CPR with chest compressions.
Removing an Obstruction (2 of 2)• Perform ____________________ maneuver.• Use suction if needed.• If attempts to clear the airway are unsuccessful, transport rapidly.
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• Use suction if needed.• If attempts to clear the airway are unsuccessful, transport rapidly.• If patient becomes pulseless, perform CPR
