Download Lesson 14 Airway and Vent FINAL4-29-11

Lesson 14: Airway and Ventilation
You Are the
Emergency Medical Responder
Your medical emergency response team has been called to
the fitness center by building security on a report that an
employee complained of having difficulty breathing. You
and your partner arrive and find the man conscious but in
distress. The patient’s chief complaint is difficulty
breathing. He says he just “overdid it” on the treadmill. He
appears to be out of breath and is having trouble speaking
in full sentences. You begin a primary assessment and
determine that the patient is in respiratory distress.
Emergency Medical Response
An Open Airway is the Priority
 Ensuring an open airway is the most important step
you can take in caring for a patient because a person
cannot breathe without an open airway.
 A patient who can speak or cry is conscious, has an
open airway, is breathing and has a pulse.
Emergency Medical Response
Respiratory System Overview
 Upper airway tract
• Begins at the mouth
• Includes the nose, pharynx and larynx
 Lower airway tract
• Begins below the level of the vocal cords
• Includes the trachea, bronchi, bronchioles and
alveoli
Emergency Medical Response
Oxygenation
 Oxygenation refers to the amount of oxygen in the
bloodstream.
 An insufficient amount of oxygen delivered to the
cells is referred to as hypoxia.
Emergency Medical Response
Types of Respiratory Emergencies
 Respiratory distress: when someone has difficulty
breathing
 Respiratory arrest: the cessation of breathing
Emergency Medical Response
Causes of Respiratory Distress
 A partially obstructed
airway
 Illness
 Chronic conditions,
such as asthma
 Electrocution
 Heart attack
 Injury to the head, chest,
lungs or abdomen
 Allergic reactions
 Drugs
 Poisoning
 Emotional distress
Emergency Medical Response
Signs and Symptoms
of Respiratory Emergencies
 Slow or rapid breathing
 Unusually deep or
shallow breathing
 Gasping for breath
 Wheezing, gurgling or
high-pitched noises
 Unusually moist or cool
skin
 Flushed, pale, ashen or
bluish skin color
 Shortness of breath
 Dizziness or lightheadedness
 Pain in the chest or
tingling in the hands,
feet or lips
 Apprehensive or fearful
feelings
Emergency Medical Response
Activity
You and your partner are summoned to a local
conference center in response to an emergency call. A
person who was scheduled to speak at a conference
began complaining of difficulty breathing about 10
minutes before he was scheduled to speak. On arrival
at the scene, you find the patient sitting on the floor,
breathing rapidly. The patient states that all of sudden
he began to feel dizzy and his lips started tingling.
Emergency Medical Response
Specific Respiratory Emergencies
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Chronic obstructive pulmonary disease (COPD)
Asthma
Pneumonia
Acute pulmonary edema
Hyperventilation
Pulmonary embolism
Emphysema
Emergency Medical Response
Signs of an Open Airway
 Chest is rising and falling.
 Air is heard and felt coming out of patient’s mouth
and nose with exhalation.
 The conscious patient is able to speak in full
sentences without distress.
 The conscious patient is speaking in normal tones.
Emergency Medical Response
Signs of an Inadequate Airway
 Visibly unable to catch breath
 Gasping for air
 Abnormal breath sounds
• Grunting
• Stridor
• Snoring
Emergency Medical Response
Causes of Airway Obstruction
 Mechanical
• Foreign body
o Solid object, such as food, in adults
o Large chunks of food and small objects (toy
parts or balloons) in children younger than
4 years
 Anatomical
• Tongue
• Swelling due to trauma, infection, asthma,
emphysema or anaphylaxis
Emergency Medical Response
Techniques to Clear Airway Obstruction
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Abdominal thrusts
Back blows
Chest thrusts
Modified CPR for unconscious patients
Emergency Medical Response
Techniques to Remove Foreign Material
from the Upper Airway
 Finger sweeps
• Only for an unconscious patient
• Only when foreign matter is seen in a patient’s
mouth
• Use the index finger for an adult or child and the
little finger for a smaller child and an infant
 Suctioning
Emergency Medical Response
Signs of Inadequate Breathing
 Rib muscles pulling
in on inhalation
 Pursed lip breathing
 Nasal flaring
 Fatigue or sweating
 Excess use of
abdominal muscles
 Tripod position
 Deviated trachea
 Abnormal breath sounds
(stridor, wheezing,
crackles/rales)
 Inadequate depth of
breathing
 Too slow or too rapid rate
 Unusual/irregular chest
wall movement
 Irregular respiratory
patterns
Emergency Medical Response
Signs of Inadequate Oxygenation
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Cyanosis
Pale, cool, clammy skin
Mottling
Altered mental state, such as restlessness, agitation,
confusion or anxiety
Emergency Medical Response
Artificial Ventilation Methods
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Mouth-to-mask
Mouth-to-nose breathing
Mouth-to-stoma breathing
Bag-valve-mask resuscitator (BVM)
Emergency Medical Response
BVM Resuscitator Ventilations
 Three-part device: a bag, a valve and a mask
 Advantages:
• Increased oxygen blood levels
• Ability to be connected to emergency oxygen
• Increased effectiveness of ventilations when used
correctly by two rescuers
• Protection against disease transmission and
inhalation hazards
• Useful with advanced airway adjuncts
Emergency Medical Response
BVM Ventilation Rates
and Patient Age
 30 to 60 breaths per minute: 1 ventilation about
every 1 to 2 seconds for a newborn (0 to 1
month)
 12 to 20 breaths per minute: 1 ventilation about
every 3 seconds for a child or an infant
 8 to 10 breaths per minute: 1 ventilation about
every 5 seconds for an adult
Emergency Medical Response
You Are the
Emergency Medical Responder
While waiting for emergency medical services
personnel to arrive, you complete a SAMPLE history and
secondary assessment. You have helped the patient
into a position of comfort for breathing when he
suddenly loses consciousness and stops breathing. He
has a pulse.
Emergency Medical Response
Assessing Breath Sounds
 Use a stethoscope to listen to lungs
• In the front, listen along the midclavicular line
at the second intercostal space
• On the sides, listen along the midaxillary line
between the fourth and fifth intercostal spaces
• In the back, listen along the midclavicular line
below the scapula
 Compare sounds heard on both sides
 Suspect obstruction if abnormal sounds, such as
wheezing, rales, rhonchi or stridor, are heard
Emergency Medical Response
Sellick’s Maneuver
 Also known as cricoid pressure
 Appropriate during positive pressure ventilation
situations when a patient requires intubation
 Two rescuers needed: one to perform the
maneuver, another to perform the intubation
 Application of pressure on both sides of cricoid
cartilage using the thumb and index finger, with
pressure applied firmly toward the back of the
neck
Emergency Medical Response
Asthma Medications
 Long-term control medications
 Quick-relief medications (rescue medications)
 Medications for allergy-induced asthma
Emergency Medical Response
Asthma Medication
Delivery Systems
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Metered-dose inhaler
Dry powder inhaler
Small-volume nebulizer
Pill or liquid
Injection
Emergency Medical Response
Peak Flow Meter
 Measurement of person’s ability to push air out
of lungs in one quick breath
 Tool for evaluating response to treatment and for
warning if asthma is worsening
Emergency Medical Response
Common Side Effects
of Asthma Medications
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Increased heart rate
Palpitations
Nausea or vomiting
Nervousness
Sleepiness
Emergency Medical Response
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Dry mouth
Cough
Hoarseness
Headache
Throat irritation