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10 Objectives
airway management
| Question | Answer |
|---|---|
| Major structures of the respiratory system | Upper -nasopharynx -nasal air passage -pharynx -oropharynx -mouth -epiglottis -larynx Lower -trachea -bronchioles -main bronchus Lungs Carina Diaphragm Alveoli Pulmonary capillaries |
| Physiology of breathing | -lungs inhale -diaphragm contracts and pulls down. - intercostal muscles the ribs contract and pull up -increase the size of the thoracic cavity -alveoli transfer o2 and co2 |
| Factors affecting pulmonary ventilation | Intrinsic -infections -allergic Rx -tongue obstruction -swelling from allergic reactions -medications depress CNS hypercarbia -trauma head, SC -dystrophy Extrinsic -FBAO -trauma -burns -chest wall swelling -punctures/bruising |
| Factors affecting respiration | -atmospheric -closed environment -medical conditions (pneumonia, edema, COPD) -nonfunctional alveoli -drowning victims -hypoxia -hypoglycemia -infection |
| Conditions that obstruct blood flow | Pulmonary embolism Simple or tension pneumothorax Open pneumothorax (sucking chest wound) Hemothorax Hemopneumothorax blood loss anemia hypovolemic shock |
| signs of adequate breathing | -normal rate 12-20 -regular pattern of inhale and exhale -clear and adequate lung sounds -bilateral sounds -regular and equal chest rise and fall -adequate tidal volume |
| Signs of inadequate breathing | -rate fever than 12-20 -SOB -irregular rhythm -deep breaths apnea -low tidal volume -pale,clammy cyanotic -skin pulling around ribs |
| Assessment and care for apnea | -airway management -supplemental o2 -ventilator support |
| Use of pulse oximetry to determine inadequate/adequate respiration | -check skin pallor and moisture -condition worsens cyanosis set in -anaerobic metabolism kicks in -O2 should be 98% -100% |
| Assess for patent airway | -asses for pulse/breathing -if pulse see if breathing is adequate -supine -cardiac arrest start CPR |
| Head tilt, chin, lift maneuver | 1. Supine at Pt head 2. Heel of hand at forehead tilt head back 3. Extension of neck moves tongue forward 4. Fingertips of hand under jaw near bony part of chin 5. Don’t compress tissue 6. Lift chin up, bring lower jaw up, tilt head up |
| Jaw, thrust maneuver | -use for trauma -at Pt head -hands behind the angles the lower jaw and move jaw upward -use thumbs to help position lower jaw to help bresthing |
| Importance and techniques for suctioning | -tonsil-tip catheter is the best for infant -no longer 15 sec for adult 10 sec for kids -only remove if visible -ventilation every 2 mins |
| Measuring and inserting, oropharyngeal airway | -keep tongue from blocking 1. Size urine tip of mouth to earlobe 2. Open mouth cross-fingers insert airway with tip facing roof 3. Rotate 180 until flange on lips |
| Measure and insert nasopharyngeal airway | -don’t use in trauma Pt 1. Size using tip of nice to earlobe 2. Insert lubed airway into larger nostril with curve following floor of nose 3. Gently advance airway if left nostril rotate 180 4. Continue until flange rests against nostril |
| Recovery position to maintain clear airway | -helps keeps clear airway in unconscious Pt -Pt is not injured and is breathing on own -roll on side with head, shoulder and torso move together -extend lower arm -upper hand under cheek |
| Supplemental Oxygen for hypoxic | -always give supplemental O2 to hypoxic -never withhold if Pt might need o2 -check date -use D or jumbo D cylinder -M cylinder remain on board as main supply tank |
| Oxygen storage and hazards | -Pin-indexing systems ensures regulator is to same cylinder -pressure in full tank 2,000psi -pressure regulator reduce to 40-70psi Hazards -o2 does not burn or explode -does support combustion -O2 toxicity ~excessive O2 cellar or tissue damage |
| Nonrebreather mask in oxygen flow requirements | -90% inspired o2 -2/3 flow rate or 10-15L -keep bag inflated |
| Using nasal cannula instead of non rebreather mask | -tube in nostrils -up to 6 L (up 4 % between levels) - 1L is 24% and 6L is 44% -use NRM if hypoxia |
| humidifier during supplemental oxygen therapy | -for conditions such as Croup -long term O2 therapy -only for fixed O2 unit in ambulance |
| Mouth, mouth or mouth to mask ventilation | -Never do mouth to mouth Mouth to mask -use EC clamp to seal on Pt face -breathe until chest rise -remove and watch fall -gives about 21% O2 |
| Use of one or two person, BVM & M TV device | BVM -use when not ventilating adequately - in full arrest -respiratory failure ~at Pt head ~CE clamp ~1 breath 6 sec in CPR or ~5sec for adult 3 kids |
| Signs of adequate/inadequate, artificial ventilation | Adequate ventilations -10-12 breaths/min adult 12-20 kids -heart rate normal range -pallor improving (pink) Inadequate ventilations -minimal/ no chest rise + fall -heart range not normal -pallor not improving (cyanotic, ashen, molted) |
| CPAP | -continuous positive airway pressure -for Pt compensatory mechanisms are not enough to keep up with O2 demand -Pt must be alert/ able to follow commands -distress caused by underlining pathology (edema, pulmonary disease) -rapid breathing -o2 > 90 |
| Recognize and care for foreign body airway obstruction | -tongue usually FBAO -swelling from infection or allergic Rx -mild airway obstruction still exchange air, varying degree of distress -severe airway obstruction cannot breathe talk or cough, might turn cyanotic |
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emt2023deal
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