Chapter 9 Airway

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Respirations

• Every cell of the body requires _______________________ to survive

• Oxygen must come in and carbon _______________________ must go out

2

Metabolism

• Metabolism--Process where the body’s cells convert food to _______________________

• Adequate _______________________ required

• Carbon dioxide produced as a _______________________ product

3

Oxygen Requirements

• Normal air consists of ____________% oxygen

• Exhaled air consists of ____________% oxygen

• All cells require oxygen to live

• CPR produces only ____________% of the normal cardiac output

4

Respiratory Anatomy

• Nose: The _______________________ pathway

• _______________________ : Secondary pathway

• Pharynx: The _______________________ • Larynx: Connects the pharynx and trachea–voice box–_______________________ cartilage–_______________________ : leaf shaped

flap that covers trachea to prevent food from entering lungs

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Respiratory Anatomy

• _______________________ : Windpipe

• Bronchial Tree: Branching of trachea

• Bronchi

• Bronchioles

• Lungs

-Left lung has ___________ lobes

-Right lung has ____________ lobes

• _______________________ : Tiny air sacs where gas exchange occurs

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Respiratory Anatomy

• Diaphragm: _______________________ that controls breathing

• Upper Airway: nasopharynx to just below larynx

• Lower Airway: Larynx to _______________________

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Diaphragm

• Has characteristics of both voluntary and _______________________ muscles

• _______________________ -shaped muscle

• Divides thorax from abdomen

• _______________________ during inhalation

• _______________________ during exhalation

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Anatomy Review

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Breathing Process: Inhalation• _______________________ part of breathing

• Diaphragm and intercostal muscles contract, allowing the lungs to _______________________ .

• The decrease in pressure allows lungs to fill with air.

• Air travels to the _______________________ where exchange of gases occurs.

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Tidal and Minute Volume

• Tidal Volume: the amount of air, in _______________________ , that is moved in and out of the lungs with each breath

– ___________ to ___________ mL per kilogram

– ___________ mL is average for an adult male

• Minute Volume: the amount of air moved through the lungs in one _______________________

–Tidal volume X respiratory _______________________

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Breathing Process: Exhalation

• Does not normally require _______________________ effort

• Diaphragm and intercostal muscles _______________________ .

• The thorax _______________________ 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 _______________________

• The body does not use all the inhaled _______________________ .

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Gas Exchange

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Control of Breathing• Brain _______________________ controls

breathing• Stimulus for breathing is one of the following:• _______________________ Drive: Breathing

regulated by the amounts of carbon dioxide in arterial blood

- _______________________ Stimulus-As CO2 levels increase, rate increases

• _______________________ Drive: Breathing regulated by the amount of oxygen in the arterial blood

- _______________________ system-As O2 levels increase, rate decreases

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Normal Breathing Characteristics

• Normal rate and _______________________

• Regular _______________________ • Good breath _______________________ in

both lungs• Regular rise and fall movements in the chest• Easy, not labored

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Hypoxia

• Hypoxia is the lack of _______________________

• Signs

– _______________________, irritability, and fear

–Tachycardia

–Mental status changes

–Use of _______________________ muscles for breathing

–Difficulty breathing, possible _______________________ pain

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Conditions Resulting in Hypoxia

• Myocardial _______________________

• Pulmonary edema

• Acute narcotic overdose

• Smoke inhalation

• _______________________

• Chest injury

• Shock

• Lung disease

• _______________________

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Normal Respiration Rates

• Adults: ____________ to ____________ breaths/min

• Children: ____________ to ____________ breaths/min

• Infants: ____________ to ____________ breaths/min

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Recognizing Inadequate Breathing

• _______________________ breathing• Use of accessory muscles• Pale or _______________________

skin• Cool, _______________________ skin• Irregular respirations• _______________________ lung

sounds

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Opening the Airway

• Head tilt-chin lift

–_______________________ patients, medical patients

• Jaw-thrust

–Suspected _______________________ injury

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Head Tilt/Chin Lift

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Jaw Thrust

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Assessment of the Airway

• _______________________.

• _______________________.

• _______________________.

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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 _______________________ reflex

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Basic Airway Adjuncts (2 of 6)

Inserting an oropharyngeal airway

1. Select the proper _______________________ airway.

2. _______________________ 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.

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Basic Airway Adjuncts (3 of 6)

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Basic Airway Adjuncts (4 of 6)

• Nasopharyngeal airways

–Used on _______________________ patients who can’t maintain an airway

–Can be used on patients _______________________ a gag reflex

–Should not be used on patients with possible _______________________ injuries or nose bleeds

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Basic Airway Adjuncts (5 of 6)

Inserting a nasopharyngeal airway

1. Select the proper size airway.

2. _______________________ the airway.

3. Gently push the _______________________ open.

4. With the bevel turned _______________________ the septum, insert the airway.

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Basic Airway Adjuncts (6 of 6)

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Suctioning Equipment (1 of 2)

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Suction Equipment (2 of 2)

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Suctioning Technique (1 of 2)

• Check the unit and turn it on.• Select and _______________________ proper

catheter to be used.• Open the patient’s mouth and

_______________________ tip.• Suction as you _______________________

the catheter.• Never suction for more than ___________

seconds.

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Suctioning Technique (2 of 2)

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Recovery Position

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Supplemental Oxygen

• All patients in _______________________ arrest should get oxygen.

• Any patient with a _______________________ or cardiac emergency needs oxygen.

• Never withhold oxygen from anyone who may _______________________ from it.

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Supplemental Oxygen Equipment

Oxygen cylinders

• Available as a compressed ____________-____________________________ gas

• Available in several sizes

• Pin-indexing safety system

• Oxygen _______________________

• _______________________ oxygen

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Oxygen Flowmeters

• _______________________ -compensated flowmeter–Affected by gravity; must

be kept upright• _______________________ -

gauge flowmeter–Not affected by gravity; can

be used in any position

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Using Supplemental Oxygen (1 of 2)

• Inspect cylinder and markings.

• “_______________________ ” the cylinder.

• _______________________ the regulator/flowmeter.

• _______________________ the cylinder.

• Attach proper delivery _______________________ to flowmeter.

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Using Supplemental Oxygen (2 of 2)

• Adjust flowmeter to desired _______________________ rate.

• _______________________ the oxygen device to the patient.

• When done, _______________________ the delivery device.

• Turn off the flowmeter.

• Replace bottle if below ___________ psi (safe residual)

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Hazards of Oxygen

• Oxygen supports _______________________ .

• Keep possible _______________________ sources away from the area.

• Oxygen tanks are under high _______________________ .

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Oxygen Delivery Equipment

• _______________________ mask–Provides up to ___________% oxygen–Used at ___________ to ___________ L/min

• Nasal cannula–Provides ___________% to ___________%

oxygen–Used at ___________ to ___________ L/min

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Calculating Oxygen Duration

• (Amount in Bottle (psi)--200 PSI) X Factor Flow (LPM)

• 200 PSI is the safety factor to allow for gauge inaccuracy

• Answer is in _______________________ of usage• Factor is determined by the

_______________________ of the bottle.–D cylinder: 0.16–E cylinder: 0.28–M cylinder: 1.56 –H cylinder: 3.14

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Calculating Oxygen Duration

Example: 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?

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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 minutes46

Methods of Ventilation

• Mouth to _______________________

• Two-person _______________________ device

• Flow restricted, _______________________ powered device

• One-person BVM device

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Rate of Artificial Ventilations

• Adult — 1 breath every __________ to ___________ seconds

–10 to 12 per minute

• Children — 1 breath every __________ to __________ to ______________________seconds

–12 to 20 per minute

• Infants — 1 breath every __________ to __________ to ______________________seconds

–12 to 20 per minute48

Artificial Ventilation

• Mouth to _______________________ (Not Recommended)• pinch nose closed– take a deep breath– seal your mouth over patients mouth

• Mouth to _______________________ (Not Recommended)• use chin lift to hold mouth closed– take a deep breath– seal your mouth over patients nose

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Mouth-to-Mask Technique (1 of 2)

• _______________________ 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.

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Mouth-to-Mask Technique (2 of 2)

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Bag-Valve-Mask Device

• Can deliver more than ____________ % oxygen

• Delivers less _______________________ volume than mouth-to-mask

• Requires practice to be proficient

• May be used with _______________________ airways

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Bag-Valve-Mask Components

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Two-Person BVM Technique (1 of 2)

• Insert an _______________________ airway.

• One caregiver maintains seal while the other delivers _______________________ .

• Place mask on patient’s face.

• Squeeze bag to deliver ventilations.

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Two-Person BVM Technique (2 of 2)

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One-Person BVM Technique

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Manually Triggered Ventilation Devices

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Manually Triggered Ventilation Devices

• Reduces rescuer _______________________ _______________________

• May be difficult to maintain adequate ventilation without assistance

• Should not be used _______________________ _______________________

• Should not be used with _______________________ _______________________ or suspected cervical spine or chest injuries

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Ongoing Assessment of Ventilation

• Adequate Ventilation–_______________________ chest rise and fall–Ventilating at appropriate _______________________ –Heart rate returns to normal

• Inadequate Ventilation–Minimal or no chest _______________________ and

fall–Ventilations too _______________________ or slow–Heart rate does not return to normal

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Key Points of Artificial Ventilation

• Do not _______________________ inflate

• Watch for _______________________ rise

• Always allow patient to _______________________

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Gastric Distention

• Artificial ventilation fills _______________________ with air.

• Occurs if ventilations are too _______________________ or too frequent or when airway is blocked

• May _______________________ adequate ventilations

• May cause patient to _______________________

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Sellick Maneuver

• AKA: _______________________ Pressure

• Use on _______________________ patients to prevent gastric distention.

• Place pressure on cricoid with thumb and index finger.

• Also used to facilitate visualization of vocal _______________________ for endotracheal intubation

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Sellick Maneuver

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Stomas and Tracheostomy Tubes

• Ventilations are delivered through the _______________________ .

• Attach BVM device to tube or use _______________________ mask.

• Stoma may need to be _______________________ .

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Causes of Airway Obstruction

• Relaxation of the _______________________

• Vomited stomach contents

• Blood clots, bone fragments, damaged tissue

• _______________________ caused by allergic reactions

• Foreign objects• _______________________(especially in

children)65

Recognizing an Obstruction (1 of 2)

• Obstruction may be _______________________ or complete.

• Is patient able to speak or _______________________ ?

• If patient is unconscious, attempt to deliver artificial ventilation.

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Removing an Obstruction (2 of 2)

• Perform _______________________ maneuver.

• Use _______________________ if needed.

• If attempts to clear the airway are unsuccessful, _______________________ rapidly.

• If patient becomes pulseless, perform CPR

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