Airway - greene-co.comgreene-co.com/files/7_Airway.pdf · Assessment of the Airway •Assess...
Transcript of Airway - greene-co.comgreene-co.com/files/7_Airway.pdf · Assessment of the Airway •Assess...
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Airway
Chapter 6
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Breathing Process: Inhalation
• Active part of breathing
• Diaphragm and intercostal muscles contract, allowing the lungs to expand.
• The decrease in pressure allows lungs to fill with air.
• Air travels to the alveoli where exchange of gases occurs.
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Breathing Process: Exhalation
• Does not normally require muscular effort
• Diaphragm and intercostal muscles relax.
• The thorax decreases in size, and ribs and muscles assume their normal positions.
• The increase in pressure forces air out.
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The Body’s Need for Oxygen
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Gas Exchange
• Inhalation delivers oxygen-rich air to alveoli.
• Oxygen diffuses into the blood.
• Breathing is primarily adjusted by the level of carbon dioxide in the blood.
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Hypoxia
• Not enough oxygen for metabolic needs
• Develops when patient is:
– Breathing inadequately
– Not breathing
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Signs of Hypoxia
• Nervousness, irritability, and fear
• Tachycardia
• Mental status changes
• Use of accessory muscles for breathing
• Difficulty breathing, possible chest pain
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Conditions Resulting in Hypoxia
• Myocardial infarction
• Pulmonary edema
• Acute narcotic overdose
• Smoke inhalation
• Stroke
• Chest injury
• Shock
• Lung disease
• Asthma
• Premature birth
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Recognizing Adequate Breathing
• Normal rate and depth
• Regular pattern
• Regular and equal chest rise and fall
• Adequate depth
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Normal Respiration Rates
• Adults 12 to 20 breaths/min
• Children 15 to 30 breaths/min
• Infants 25 to 50 breaths/min
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Recognizing Inadequate Breathing
• Fast or slow rate
• Irregular rhythm
• Abnormal lung sounds
• Reduced tidal volumes
• Use of accessory muscles
• Cool, damp, pale or cyanotic skin
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Head Tilt–Chin Lift
• Kneel beside patient’s head.
• Place one hand on forehead.
• Apply backward pressure.
• Place tips of finger under lower jaw.
• Lift chin.
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Jaw-Thrust Maneuver
• Kneel above patient’s head.
• Place fingers behind angle of lower jaw.
• Use thumbs to position the lower jaw.
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Assessment of the Airway
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Assessment of the Airway
• Assess whether breathing has returned using look, listen, and feel technique.
– Listen by placing your ear about 10 inches above patient’s nose and mouth.
– Feel and listen for movement of air.
– Watch the patient’s chest and abdomen.
– Place a hand on patient’s chest to feel for movement.
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Severe Airway Obstruction
• There will be no movement of air.
• Chest and abdomen may rise and fall with
patient’s attempts to breathe.
• Chest wall movement alone does not
indicate breathing.
• Always use three-part approach: look,
listen, and feel for movement of air.
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Basic Airway Adjuncts
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• Oropharyngeal airways
– Keep the tongue from blocking the upper airway
– Allow for easier suctioning of the airway
– Used in conjunction with BVM device
– Used on unconscious patients without a gag reflex
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Inserting an oropharyngeal airway
• Select the proper size airway.
• Open the patient’s mouth.
• Hold the airway upside down and insert it in the patient’s mouth.
• Rotate the airway 180° until the flange rests on the patient’s lips.
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• Nasopharyngeal airways
– Conscious patients who cannot maintain airway
– Can be used with intact gag reflex
– Should not be used with head injuries or nosebleeds
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Inserting a nasopharyngeal airway
1. Select the proper size airway.
2. Lubricate the airway.
3. Gently push the nostril open.
4. With the bevel turned toward the septum, insert the airway.
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Suctioning
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Suctioning Equipment
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Suctioning Technique
• Check the unit and turn it on.
• Select and measure proper catheter to be used.
• Open the patient’s mouth and insert tip.
• Suction as you withdraw the catheter.
• Never suction adults for more than 15 seconds.
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Recovery Position
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Supplemental Oxygen
• All patients in cardiac arrest should get oxygen.
• Any patient with a respiratory or cardiac emergency needs oxygen.
• Never withhold oxygen from anyone who may benefit from it.
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Supplemental Oxygen Equipment
• Oxygen cylinders – Available as a compressed combustible gas
– Available in several sizes – H, A, K
– G
– M
– E
– Super D
– D
– Pin-indexing safety system
– Oxygen regulators
– Humidified oxygen
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Oxygen Flowmeters
• Pressure-compensated flowmeter
– Affected by gravity; must be kept upright
• Bourdon-gauge flowmeter
– Not affected by gravity; can be used in any position
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Using Supplemental Oxygen
• Inspect cylinder and markings.
• “Crack” the cylinder.
• Attach the regulator/flowmeter.
• Open the cylinder.
• Attach proper delivery device to flowmeter.
• Adjust flowmeter to desired flow rate.
• Apply the oxygen device to the patient.
• When done, discard the delivery device.
• Turn off the flowmeter.
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Hazards of Oxygen
• Oxygen supports combustion.
• Keep possible ignition sources away from the area.
• Oxygen tanks are under high pressure.
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Oxygen Delivery Equipment
• Nonrebreathing mask – Provides up to 90% oxygen
– Used at 10 to 15 L/min
• Nasal cannula – Provides 24% to 44% oxygen
– Used at 1 to 6 L/min
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Methods of Ventilation
• Mouth to mask
• Two-person BVM device
• Flow-restricted, oxygen-powered device
• One-person BVM device
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Rate of Artificial Ventilations
• Adult — 1 breath every 5-6 seconds
• Children — 1 breath every 3-5 seconds
• Infants — 1 breath every 3-5 seconds
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Mouth-to-Mask Technique
• 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 1 second.
• Remove your mouth and watch for patient’s chest to fall.
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Bag-Valve-Mask Device
• Can deliver more than 90% oxygen
• Delivers less tidal volume than mouth-to-mask
• Requires practice to be proficient
• May be used with advanced airways
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Two-Person BVM Technique
• Insert an oral airway.
• One caregiver maintains seal while the other delivers ventilations.
• Place mask on patient’s face.
• Squeeze bag to deliver ventilations.
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One-Person BVM Technique
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Flow-Restricted, Oxygen-Powered Devices
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Ongoing Assessment of Ventilation
• Adequate Ventilation – Equal 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
– Heart rate does not return to normal
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Sellick Maneuver
• Also referred to as cricoid pressure.
• Use on unconscious patients to prevent gastric distention.
• Place pressure on cricoid with thumb and index finger.
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Gastric Distention
• Artificial ventilation fills stomach with air.
• Occurs if ventilations are too forceful or too frequent or when airway is blocked
• May cause patient to vomit and increase risk of aspiration
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Stomas and Tracheostomy Tubes
• Ventilations are delivered through the stoma.
• Attach BVM device to tube or use infant mask.
• Stoma may need to be suctioned.
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Causes of Foreign Body Obstruction
• Relaxation of the tongue
• Vomited stomach contents
• Blood clots, bone fragments, damaged tissue
• Swelling caused by allergic reactions
• Foreign objects
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Recognizing an Obstruction
• Obstruction may be mild or severe.
• Is patient able to speak or cough?
• If patient is unconscious, attempt to deliver artificial ventilation.
• Perform Heimlich maneuver.
• Use suction if needed.
• If attempts to clear the airway are unsuccessful, transport rapidly.