Emt management of airway and breathing

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Emt management of airway and breathing

  1. 1. Management of Airway and Breathing Emergency Medical Technician - Basic
  2. 2. Airway Functions <ul><li>Passage that allows air to move from atmosphere to alveoli </li></ul><ul><li>Must remain patent (open) at all times </li></ul><ul><li>Anything that blocks airway will cause decrease in oxygen available to body </li></ul><ul><li>Size of obstruction affects available air exchange </li></ul>
  3. 3. Opening the Airway <ul><li>Techniques </li></ul><ul><ul><li>Head-tilt/Chin-lift </li></ul></ul><ul><ul><li>Jaw Thrust </li></ul></ul><ul><ul><li>Suctioning </li></ul></ul><ul><ul><li>Nasopharyngeal airway </li></ul></ul><ul><ul><li>Oropharyngeal airway </li></ul></ul>
  4. 4. Head-Tilt/Chin-Lift <ul><li>Used when no neck injury is suspected </li></ul><ul><li>Temporary procedure </li></ul><ul><li>Must be replaced with an airway adjunct unless patient begins adequate spontaneous ventilation </li></ul>
  5. 5. Head-Tilt/Chin-Lift <ul><li>Technique </li></ul><ul><ul><li>Place one hand on patient’s forehead </li></ul></ul><ul><ul><li>Apply firm, backward pressure with palm causing head to tilt backward </li></ul></ul><ul><ul><li>Place fingers of other hand under bony part of patient’s lower jaw near chin </li></ul></ul><ul><ul><li>Lift jaw upward to bring chin forward </li></ul></ul>
  6. 6. Head-Tilt/Chin-Lift <ul><li>Patients needing head-tilt/chin-lift </li></ul><ul><ul><li>Unresponsive patient without history of trauma </li></ul></ul><ul><ul><li>Cardiac arrest patients without signs of trauma </li></ul></ul><ul><ul><li>Apneic patients without signs of trauma </li></ul></ul>
  7. 7. Jaw Thrust <ul><li>Used when spinal injury suspected </li></ul><ul><li>Temporary procedure </li></ul><ul><li>Must be replaced with airway adjunct unless patient begins adequate spontaneous ventilation </li></ul>
  8. 8. Jaw Thrust <ul><li>Technique </li></ul><ul><ul><li>Place one hand on either side of patient’s head, resting elbows on surface on which victim is lying </li></ul></ul><ul><ul><li>Grasp angles of patient’s lower jaw, lift with both hands </li></ul></ul><ul><ul><li>If patient’s lips close, retract lower lips with thumbs </li></ul></ul>
  9. 9. Jaw Thrust <ul><li>Patients needing jaw thrust </li></ul><ul><ul><li>Unresponsive trauma patient </li></ul></ul><ul><ul><li>Unresponsive patient with undetermined mechanism of injury </li></ul></ul>
  10. 10. Suctioning <ul><li>Purpose </li></ul><ul><ul><li>Remove blood, vomit, other liquids, food particles from airway </li></ul></ul><ul><ul><li>May not be adequate for removing large, solid objects (teeth, foreign bodies, food) </li></ul></ul><ul><ul><li>Should be performed immediately when gurgling is heard with spontaneous or artificial ventilation </li></ul></ul>
  11. 11. Suctioning <ul><li>Suction devices </li></ul><ul><ul><li>Mounted in ambulance </li></ul></ul><ul><ul><li>Portable </li></ul></ul><ul><ul><ul><li>Electrical </li></ul></ul></ul><ul><ul><ul><li>Hand operated </li></ul></ul></ul><ul><ul><li>Should generate 300mm Hg vacuum </li></ul></ul><ul><ul><li>Ensure batteries in units remain properly charged </li></ul></ul>
  12. 12. Suctioning <ul><li>Rigid Suction Catheter </li></ul><ul><ul><li>Used to suction mouth, oropharynx of unresponsive patient </li></ul></ul><ul><ul><li>Inserted only as far as you can see </li></ul></ul><ul><ul><li>Take caution not to touch back of airway, particularly in infants and children (can cause heart rate to drop) </li></ul></ul>
  13. 13. Suctioning <ul><li>Soft Suction Catheter </li></ul><ul><ul><li>Useful for suctioning nasopharynx or tracheostomy tubes </li></ul></ul><ul><ul><li>Should be inserted only as far as base of tongue or end of tracheostomy tube </li></ul></ul>
  14. 14. Suctioning <ul><li>Techniques </li></ul><ul><ul><li>Turn on unit </li></ul></ul><ul><ul><li>Attach catheter </li></ul></ul><ul><ul><li>Insert catheter into oral cavity without suction </li></ul></ul><ul><ul><li>Insert only to base of tongue </li></ul></ul><ul><ul><li>Apply suction, move catheter from side to side </li></ul></ul><ul><ul><li>Suction no longer than 15 seconds in adults, 10 seconds in children, 5 seconds in infants </li></ul></ul><ul><ul><li>Rinse catheter with saline or water to prevent obstruction </li></ul></ul>
  15. 15. Nasal Airways <ul><li>Used on responsive patients who need help keeping tongue out of airway </li></ul><ul><li>Insertion is uncomfortable for responsive patients </li></ul>
  16. 16. Nasal Airways <ul><li>Technique </li></ul><ul><ul><li>Measure from tip of nose to earlobe </li></ul></ul><ul><ul><li>Ensure airway will fit through nostril </li></ul></ul><ul><ul><li>Lubricate with water-soluble lubricant </li></ul></ul><ul><ul><li>Insert with bevel toward base of nostril or septum </li></ul></ul><ul><ul><li>If resistance is met, try other nostril </li></ul></ul><ul><ul><li>Do not use in patients with mid-face trauma or possible basilar skull fractures </li></ul></ul>
  17. 17. Nasal Airways <ul><li>Patients needing nasal airway </li></ul><ul><ul><li>Unresponsive patients who are snoring </li></ul></ul><ul><ul><li>Unresponsive patients with gag reflex </li></ul></ul>
  18. 18. Oral Airways <ul><li>Used on unresponsive patients without gag reflex </li></ul><ul><li>Helps hold tongue away from back of throat </li></ul>
  19. 19. Oral Airways <ul><li>Technique </li></ul><ul><ul><li>Measure from corner of mouth to earlobe or angle of jaw </li></ul></ul><ul><ul><li>Open patient’s mouth </li></ul></ul><ul><ul><li>In adults insert with tip facing roof of patient’s mouth, advance until resistance encountered, turn 180 o until flange comes to rest on patient’s teeth </li></ul></ul><ul><ul><li>In infants and children use tongue depressor to lift tongue, insert oral airway right side up </li></ul></ul>
  20. 20. Oral Airways <ul><li>Patients needing oral airway </li></ul><ul><ul><li>Unresponsive, apneic patients with or without trauma </li></ul></ul><ul><ul><li>Any apneic patient being ventilated with a BVM </li></ul></ul>
  21. 21. Airway Limitations <ul><li>Nasal/oral airways are not definitive devices </li></ul><ul><li>Manual maneuvers must be used with nasal/oral airways to ensure airway stays open </li></ul><ul><li>Patients may require frequent suctioning to remove blood, vomit, other secretions from airway </li></ul><ul><li>Definitive devices such as endotracheal tubes are required to completely protect the airway </li></ul>
  22. 22. Adequate Breathing <ul><li>Normal Rate </li></ul><ul><ul><li>Adult: 12 to 20/minute </li></ul></ul><ul><ul><li>Child: 15 to 30/minute </li></ul></ul><ul><ul><li>Infant: 25 to 50/minute </li></ul></ul><ul><li>Regular Rhythm </li></ul><ul><li>Adequate Quality </li></ul><ul><ul><li>Movement of air at mouth, nose </li></ul></ul><ul><ul><li>Chest expansion adequate, symmetrical (equal) </li></ul></ul><ul><ul><li>Breath sounds present, equal </li></ul></ul><ul><ul><li>Minimum effort of breathing </li></ul></ul><ul><ul><li>Adequate tidal volume (depth) </li></ul></ul>
  23. 23. Inadequate Breathing <ul><li>Abnormal Rate </li></ul><ul><ul><li>Adult: <12 to >20/minute </li></ul></ul><ul><ul><li>Child: <15 to >30/minute </li></ul></ul><ul><ul><li>Infant: <25 to >50/minute </li></ul></ul><ul><li>Irregular Rhythm </li></ul><ul><li>Inadequate Quality </li></ul><ul><ul><li>Absent or reduced at mouth, nose </li></ul></ul><ul><ul><li>Chest expansion inadequate or asymmetrical (unequal) </li></ul></ul><ul><ul><li>Breath sounds diminished, unequal, noisy, absent </li></ul></ul><ul><ul><li>Increased effort of breathing, use of accessory muscles </li></ul></ul><ul><ul><li>Indequate (shallow) tidal volume </li></ul></ul>
  24. 24. Inadequate Breathing <ul><li>Skin changes </li></ul><ul><ul><li>Pale, cool, clammy: Early sign </li></ul></ul><ul><ul><li>Cyanosis: Late, unreliable sign </li></ul></ul><ul><li>Retractions of soft tissues above clavicles, between ribs, below rib cage </li></ul><ul><li>Flaring of nostrils </li></ul><ul><li>“ Seesaw” breathing in infants </li></ul>
  25. 25. Ventilation Techniques (In order of preference) <ul><li>Mouth-to-mask with supplemental oxygen </li></ul><ul><li>Two-person bag-valve mask with oxygen reservoir and supplemental oxygen </li></ul><ul><li>Flow restricted, oxygen-powered ventilation device (manually-triggered ventilator) </li></ul><ul><li>One-person bag-valve mask with oxygen reservoir and supplemental oxygen </li></ul>
  26. 26. Ventilation Techniques <ul><li>Mouth-to-Mouth </li></ul><ul><ul><li>Open airway </li></ul></ul><ul><ul><li>Pinch nose closed or seal nose with cheek </li></ul></ul><ul><ul><li>Take deep breath </li></ul></ul><ul><ul><li>Seal lips around patient’s mouth to create airtight seal </li></ul></ul><ul><ul><li>Blow into patient’s mouth slowly over 2 seconds until patient’s chest rises </li></ul></ul>
  27. 27. Ventilation Techniques <ul><li>Mouth-to-Mask </li></ul><ul><ul><li>Connect mask to oxygen at 15 liters per minute </li></ul></ul><ul><ul><li>Kneel directly above patient’s head </li></ul></ul><ul><ul><li>Apply mask to patient’s face </li></ul></ul><ul><ul><li>Place thumbs along sides of mask, index fingers of both hands under patient’s mandible </li></ul></ul><ul><ul><li>Lift jaw into mask, tilt head if neck injury not suspected </li></ul></ul><ul><ul><li>Blow into one-way valve slowly over 2 seconds until patient’s chest rises </li></ul></ul>
  28. 28. Ventilation Techniques <ul><li>Bag-valve mask </li></ul><ul><ul><li>Self-inflating bag </li></ul></ul><ul><ul><li>One-way valve </li></ul></ul><ul><ul><li>Face mask </li></ul></ul><ul><ul><li>Oxygen reservoir </li></ul></ul>Must be connected to oxygen to perform most effectively
  29. 29. Ventilation Techniques <ul><li>BVM Issues </li></ul><ul><ul><li>Provides less volume than mouth-to-mask </li></ul></ul><ul><ul><li>Single rescuer may have difficulty maintaining air-tight seal </li></ul></ul><ul><ul><li>Two rescuers using device are more effective </li></ul></ul><ul><ul><li>Position yourself at top of patient’s head for best performance </li></ul></ul><ul><ul><li>Oral or nasal airway should be inserted </li></ul></ul>
  30. 30. Ventilation Techniques <ul><li>BVM Technique (Two Rescuer) </li></ul><ul><ul><li>Open airway, insert oral or nasal airway </li></ul></ul><ul><ul><li>Position thumbs over top half of mask, index and middle fingers over bottom half </li></ul></ul><ul><ul><li>Place apex of mask over bridge of nose, lower mask over mouth/upper chin </li></ul></ul><ul><ul><li>Use ring and little fingers to bring jaw up to mask </li></ul></ul><ul><ul><li>Have assistant squeeze bag with two hands until chest rises </li></ul></ul><ul><ul><li>Ventilate every 5 seconds for adults, every 3 seconds for infants and children </li></ul></ul>
  31. 31. Ventilation Techniques <ul><li>BVM Technique (One Rescuer) </li></ul><ul><ul><li>Open airway, insert oral or nasal airway </li></ul></ul><ul><ul><li>Form a “C” around ventilation port with thumb, index finger </li></ul></ul><ul><ul><li>Use middle, ring, little fingers under jaw to maintain chin lift, complete seal </li></ul></ul><ul><ul><li>Squeeze bag with other hand until chest rises </li></ul></ul><ul><ul><li>Ventilate every 5 seconds for adults, every 3 seconds for infants and children </li></ul></ul>
  32. 32. Ventilation Techniques <ul><li>BVM Technique (Suspected Trauma) </li></ul><ul><ul><li>Open airway, insert oral or nasal airway </li></ul></ul><ul><ul><li>Have assistant hold patient’s head or use your knees to prevent movement </li></ul></ul><ul><ul><li>Position thumbs over top half of mask, index and middle fingers over bottom half </li></ul></ul><ul><ul><li>Place apex of mask over bridge of nose, lower mask over mouth/upper chin </li></ul></ul><ul><ul><li>Use ring and little fingers to bring jaw up to mask without tilting head or neck </li></ul></ul><ul><ul><li>Have assistant squeeze bag with two hands until chest rises </li></ul></ul><ul><ul><li>Ventilate every 5 seconds for adults, every 3 seconds for infants and children continue to hold jaw up without moving head or neck </li></ul></ul>
  33. 33. Ventilation Techniques <ul><li>If chest does not rise, reevaluate </li></ul><ul><ul><li>If abdomen rises, reposition head or jaw </li></ul></ul><ul><ul><li>If air escapes under mask, reposition fingers and mask </li></ul></ul><ul><ul><li>Check for obstruction </li></ul></ul><ul><ul><li>If chest still does not rise and fall use another method of ventilation </li></ul></ul>
  34. 34. Ventilation Techniques <ul><li>Flow Restricted, Oxygen-Powered Ventilation Devices (Manually-Triggered Ventilator) </li></ul><ul><ul><li>Peak flow of 100% oxygen at maximum of 40 lpm </li></ul></ul><ul><ul><li>Pressure relief valve that opens at 60 cm H 2 O </li></ul></ul><ul><ul><li>Audible alarm that sounds when relief valve pressure is exceeded </li></ul></ul><ul><ul><li>Trigger so both hands remain on mask to maintain seal </li></ul></ul>Do NOT use on children or infants!!!
  35. 35. Ventilation Techniques <ul><li>Manually-Triggered Ventilator </li></ul><ul><ul><li>Open airway, insert oral or nasal airway </li></ul></ul><ul><ul><li>Position thumbs over top half of mask, index/middle fingers over bottom half </li></ul></ul><ul><ul><li>Place apex of mask over bridge of nose, lower mask over mouth and chin </li></ul></ul><ul><ul><li>Use ring/little fingers to bring jaw up to mask </li></ul></ul><ul><ul><li>Trigger device until chest rises </li></ul></ul><ul><ul><li>Repeat every 5 seconds </li></ul></ul>
  36. 36. Ventilation Techniques <ul><li>Manually-Triggered Ventilator (Suspected Trauma) </li></ul><ul><ul><li>Open airway, insert oral or nasal airway </li></ul></ul><ul><ul><li>Have assistant hold head manually or use knees to prevent movement </li></ul></ul><ul><ul><li>Position thumbs over top half of mask, index/middle fingers over bottom half </li></ul></ul><ul><ul><li>Place apex of mask over bridge of nose, lower mask over mouth and chin </li></ul></ul><ul><ul><li>Use ring/little fingers to bring jaw up to mask without tilting head and neck </li></ul></ul><ul><ul><li>Trigger device until chest rises </li></ul></ul><ul><ul><li>Repeat every 5 seconds </li></ul></ul>
  37. 37. Assisting Patients Who Are Breathing <ul><li>Who needs assistance? </li></ul><ul><ul><li>A patient who is not breathing </li></ul></ul><ul><ul><li>A patient who has reduced respiratory rate and tidal volume </li></ul></ul><ul><ul><li>A patient whose breathing rate is increased, but whose tidal volume is inadequate </li></ul></ul>
  38. 38. Assisting Patients Who Are Breathing <ul><li>Patients with rapid, shallow breathing </li></ul><ul><ul><li>Explain procedure to patient </li></ul></ul><ul><ul><li>Place mask over patient’s mouth and nose </li></ul></ul><ul><ul><li>Initially assist ventilations at rate at which patient is breathing. Squeeze bag as patient inhales </li></ul></ul><ul><ul><li>Slowly adjust rate and tidal volume until adequate ventilations are achieved </li></ul></ul>
  39. 39. Assisting Patients Who Are Breathing <ul><li>Patients with slow, shallow breathing </li></ul><ul><ul><li>Place bag over patient’s mouth and nose </li></ul></ul><ul><ul><li>Squeeze bag each time patient inhales </li></ul></ul><ul><ul><li>Adjust rate and tidal volume until adequate ventilations are achieved </li></ul></ul>
  40. 40. Special Considerations <ul><li>Stoma or tracheostomy tube </li></ul><ul><ul><li>Attach BVM to tube, or use infant/child mask to make seal over stoma </li></ul></ul><ul><ul><li>Seal mouth/nose if air is escaping when ventilating at stoma </li></ul></ul><ul><ul><li>If unable to ventilate </li></ul></ul><ul><ul><ul><li>Suction stoma or tracheostomy tube </li></ul></ul></ul><ul><ul><ul><li>Seal stoma, attempt to ventilate through mouth/nose </li></ul></ul></ul>
  41. 41. Special Considerations <ul><li>Infants and children </li></ul><ul><ul><li>Place infant’s head in neutral position </li></ul></ul><ul><ul><li>Extend child’s head slightly past neutral </li></ul></ul><ul><ul><li>Avoid excessive hyperextension </li></ul></ul><ul><ul><li>Avoid excessive ventilation, just make chest rise </li></ul></ul><ul><ul><li>Gastric distension is more common in children </li></ul></ul><ul><ul><li>Do not use BVMs with pop-off valves </li></ul></ul>
  42. 42. Special Considerations <ul><li>Dentures </li></ul><ul><ul><li>Leave in place unless obviously loose </li></ul></ul><ul><ul><li>Remove if loose </li></ul></ul><ul><ul><li>Be prepared to remove if displacement occurs </li></ul></ul>
  43. 43. Oxygen <ul><li>Oxygen cylinder sizes </li></ul><ul><ul><li>D cylinder 350 liters </li></ul></ul><ul><ul><li>E cylinder 625 liters </li></ul></ul><ul><ul><li>M cylinder 3,000 liters </li></ul></ul><ul><ul><li>G cylinder 5,300 liters </li></ul></ul><ul><ul><li>H cylinder 6,900 liters </li></ul></ul><ul><li>Contents under pressure </li></ul><ul><li>Should be positioned to prevent falling, blows to valve-gauge assembly </li></ul>
  44. 44. Oxygen <ul><li>Operating procedures </li></ul><ul><ul><li>Remove protective seal </li></ul></ul><ul><ul><li>Quickly open, then shut valve </li></ul></ul><ul><ul><li>Attach regulator-flow meter to tank </li></ul></ul><ul><ul><li>Select proper size of oxygen mask for patient </li></ul></ul><ul><ul><li>Attach oxygen mask to flowmeter </li></ul></ul><ul><ul><li>Open flow meter to desired setting </li></ul></ul><ul><ul><li>Apply device to patient </li></ul></ul><ul><ul><li>When complete, remove device from patient, turn off device, remove all pressure from regulator </li></ul></ul>
  45. 45. Oxygen <ul><li>Non-rebreather mask </li></ul><ul><ul><li>Preferred method of giving oxygen to prehospital patients </li></ul></ul><ul><ul><li>Up to 90% oxygen can be delivered </li></ul></ul><ul><ul><li>Non-rebreather bag must be full before mask is placed on patient </li></ul></ul><ul><ul><li>Flow rate should be adjused so when patient inhales, bag does not collapse (~15 lpm) </li></ul></ul>
  46. 46. Oxygen <ul><li>Nasal cannula </li></ul><ul><ul><li>Rarely best method for giving adequate oxygen in emergency care settings </li></ul></ul><ul><ul><li>Should be used only if patient will not tolerate non-rebreather mask in spite of coaching </li></ul></ul>
  47. 47. Oxygen <ul><li>Concerns about giving too much oxygen to patients with COPD, infants, and children are NOT valid during short-term emergency administration </li></ul><ul><li>Patients with COPD, infants, and children who require oxygen should be given high concentration oxygen. </li></ul>

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