Organization of the Human Body BMS 231: 2015/2016 DR SOBIA IKRAM DR AQEELA BANO DR SADIA FARHAN.
Patient Assessment: Airway Evaluation Dr Aqeela Bano EMS 352.
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Transcript of Patient Assessment: Airway Evaluation Dr Aqeela Bano EMS 352.
![Page 1: Patient Assessment: Airway Evaluation Dr Aqeela Bano EMS 352.](https://reader031.fdocuments.us/reader031/viewer/2022020200/5697c0091a28abf838cc7515/html5/thumbnails/1.jpg)
Patient Assessment: Airway Evaluation
Dr Aqeela BanoEMS 352
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Patient Assessment: Airway Evaluation
• Quality of care depends on assessment• Adequate breathing– Patient is responsive, alert, able to speak– Rate between 12 and 20 breaths/min– Adequate depth – Regular pattern of inhalation and exhalation– Clear and equal breath sounds– Tendency toward stability in the body– Requires balance between acids and bases
• Acid in the body can be expelled as carbon dioxide from the lungs.
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Acid-Base Balance
• Acidosis can develop if respiratory function is inhibited.
• Alkalosis can develop if the respiratory rate is too high.– Respiratory acidosis/alkalosis– Metabolic acidosis/alkalosis
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Recognizing Inadequate Breathing
• Breathing rate of less than 12 breaths/min or more than 20 breaths/min
• Cyanosis: indicator of low blood oxygen• Note the following:
– Position– Chest rise/fall– Flared nostrils – Pursed lips– Retractions– Use of accessory muscles– Quick breaths, long exhalation– Labored breathing
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Recognizing Inadequate Breathing
• Airway management steps:– Open the airway.– Clear the airway.– Assess breathing.– Provide appropriate intervention(s).
• Evaluation includes:– Observe– Palpate– Auscultate
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Inadequate Breathing
• Feel for air movement.• Observe chest for symmetry.• Note any paradoxical motion.• Assess for pulsus paradoxus.– Systolic blood pressure drops more than
10 mm Hg during inhalation.
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Inadequate Breathing
• Ask about history of present illness– Onset, trigger, duration?– Other symptoms? – Interventions, previous hospitalization?– Medications and overall compliance?– Risk factors?
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Protective Airway Reflexes
• Evaluate protective reflexes.– Coughing, sneezing,
gagging
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Assessment of Breath Sounds
• Auscultate breath sounds with stethoscope.– Should be clear and equal
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Assessment of Breath Sounds
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Assessment of Breath Sounds
• Duration: length of time for inspiratory and expiratory phases– Normal I/E ratio: 1:2– Expiration is prolonged with lower airway
obstruction.– Expiration is short with tachypneic patients.
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Assessment of Breath Sounds
• Pitch: higher or lower than normal (stridor or wheezing). – Intensity of sound depends on:• Airflow rate• Constancy of flow throughout inspiration• Patient position• Site selected for auscultation
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Pulse Oximetry
• Pulse oximeter: measures oxygen saturation of hemoglobin (Hb)– Normal: SpO2 of greater than 95%
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Pulse Oximetry
• Erroneous readings may result from:– Patient motion– Poor perfusion– Nail polish – Venous pulsations– Abnormal hemoglobin
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Arterial Blood Gas Analysis
• Blood is analyzed for pH, PaO2, HCO3
−, base excess, and SaO2.– pH, HCO3
−: acid-base status
– PaCO2: effectiveness of ventilation
– PaO2 and SaO2: oxygenation
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End-tidal Carbon Dioxide (ETCO2) Assessment
• Detects carbon dioxide in exhaled air – Adjunct for determining ventilation adequacy– Confirms advanced airway placement– ETCO2 detector types:• Digital• Waveform• Digital/waveform• Colorimetric
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End-tidal Carbon Dioxide (ETCO2) Assessment
• Capnometer– Numeric reading of
exhaled CO2
• Capnographer– Graphic
representation of exhaled CO2
– Three types:• Waveform• Digital/waveform• Colorimetric
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End-tidal Carbon Dioxide (ETCO2) Assessment
• Waveform capnography– Exhaled carbon dioxide level displayed as a graphic
waveform – Includes contour, baseline level, rate, and rise of
carbon dioxide level
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End-tidal Carbon Dioxide (ETCO2) Assessment
• Waveform capnography (cont’d)
– Phase A–B: initial stage of exhalation
– Phase B–C: expiratory upslope
– Phase C–D: expiratory or alveolar plateau
– Phase D–E: inspiratory down stroke
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End-tidal Carbon Dioxide (ETCO2) Assessment
• Capnography can:– Indicate
effectiveness of chest compressions
– Detect return of spontaneous circulation
• Use is limited with cardiac arrest
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SUMMARY OF PATIENT ASSESSMENT
• Clinical examination of patient– Assessment of respiration rate rythym– Clinical signs of adequate respiration– Assessment of breath sounds
• Pulse oximetre• Acid base balance• end tidal CO2 assessment