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Pharyngeal esophageal airway device

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  • Feel free to share this with anybody, so long as credit is given….Thanks
  • I am an avid cat lover and have 4 cats of my own. Even still, I laugh at this clip!
  • General function of the respiratory system Remove carbon dioxide from the blood Transfer oxygen into the blood
  • Structures: Nose, Nasopharynx, mouth, oropharynx, hypopharynx, larynx, epiglottis Functions: Passage way for air, warms, humidifies, filters, protection – gag reflex & cough, speech
  • Trachea, main stem bronchi, secondary bronchi, bronchiolus Function: Air passage, gas exchange, warm and humidify
  • Transcript

    • 1. EMT Basic Advanced Airway Management Pharyngeal Esophageal Airway Device (PEAD) A.K.A. Combitube © PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer West Valley Fire District, Willamina, OR
    • 2. The Cat Fan (No Pun Intended)
    • 3. Agenda
      • Review Objectives
      • Lesson 1
        • Respiratory Anatomy & Physiology
      • Lesson 2
        • Respiratory Volume and Management
      • Lesson 3
        • Assessing Respiratory Problems
    • 4. Agenda cont’d
      • Lesson 4
        • Respiratory/Cardiac Arrest
        • Basic Airway Management
      • Lesson 5
        • Suctioning
      • Lesson 6
        • Dual-Lumen Airway Devices
    • 5. Agenda cont’d
      • Demonstration
      • Practical Stations
        • Basic Airway Management
          • Manual Maneuvers and Simple Adjuncts
          • Supplemental Oxygen
          • Ventilation
          • Suctioning
        • Combitube Insertion
    • 6. Practical
      • Testing must be done with the Physician Advisor (or another Physician of his / her choosing)
    • 7. Objectives
      • Describe the anatomy and function of the upper and lower airways
      • Describe respiratory volumes and capacities in relationship to the need for assisted ventilations
      • Identify the specific observations and physical findings commonly found in patients presenting in respiratory and/or cardiac arrest.
      • Identify the basic principles of airway management
    • 8. Objectives (cont’d)
      • Describe the indications for suctioning.
      • Identify rigid and flexible suction catheters and the indications for use.
      • Identify indications and contraindications for use of the PEAD’s.
      • Identify the advantages and disadvantages of using PEAD’s.
    • 9. Objectives (cont’d)
      • Identify those situations in which PEAD’s may be removed.
      • Demonstrated placement of PEAD’s.
      • Demonstrate methods of assuring and maintaining correct placement of PEAD’s.
      • Demonstrate re-ventilation for missed placement of PEAD’s.
    • 10. Objectives (cont’d)
      • Demonstrate on a manikin the proper technique for the use and maintenance of the following airway adjuncts:
        • Nasal cannula
        • Non-rebreather mask
        • Bag-Valve-Mask
      • Demonstrate sterile suctioning techniques on a manikin with a PEAD in place.
    • 11. Lesson 1 Respiratory Anatomy & Physiology
    • 12. Respiratory Anatomy & Physiology
    • 13. Function of the Respiratory System
      • Removes carbon dioxide from the blood
      • Transfers oxygen to the blood
    • 14. The Upper Airway
      • Epiglottis
      • Mandible
      • Frontal Sinus
      • Soft Palate
      • Trachea
      • Glottis
      • Esophagus
      • Vocal Cords
      A B C D E F G H
    • 15. The Upper Airway
      • Other Structures
        • Nasopharynx
        • Oropharynx
        • Hypopharynx
        • Larynx
      • Functions
    • 16. Functions of the Upper Airway
      • Passageway for air
      • Warm
      • Filter
      • Humidify
      • Protection
        • Gag Reflex
        • Cough
      • Speech
    • 17. The Lower Airway
      • Primary Bronchi
      • Hyoid Bone
      • Right Lung
      • Secondary Bronchi
      • Tracheal Ligament
      • Trachea
      • Larynx
      • Esophagus
      • Left Lung
      • Trachea
      A B C D E F G H I J
    • 18. Alveoli
      • Gas Exchange
    • 19. Lungs
      • Structure
      • Lobes
      • Pleura
    • 20. Physiology of Respiration
      • Define Respiration
        • The exchange of gases between a living organism and the environment
      • Define Ventilation
        • Mechanical Process that moves air in and out of the lungs
    • 21. Muscles of Breathing
      • Intercostal Muscles
      • Diaphragm
    • 22. Regulation of Respiration
      • Where is the Respiratory Center Controlled?
      • Brainstem
        • Medulla
        • Apeustic Center (pons)
        • Pneumotaxic center (pons)
      • Stretch receptors
        • Hering-Breuer reflex
      • Chemoreceptors
        • CSF
        • Blood
    • 23. Voluntary or Involuntary
      • Both
        • Humans can override body’s urge to breathe
        • But only for so long
    • 24. Respiratory Cycle
      • Inspiration
        • Active phase
        • Lasts 1-2 seconds
      • Expiration
        • Passive phase
        • Lasts 5 seconds
    • 25. Lesson 2 Respiratory Volume and Management
    • 26. Drinking Straw Exercise
      • Breathe through straws for 1 minute
    • 27. Carbon Dioxide & The Respiratory System
      • High CO2
        • Increases respiratory rate
      • Low CO2
        • Decreases respiratory rate
      • Hypoxic Drive
        • Chronic COPD patients
    • 28. Normal Respiratory Rates
      • Adult
      • Children
      • Infants
      • Newborns
      • 12 – 20 / min
      • 18 – 24 / min
      • 22 – 36 / min
      • 40 – 60 / min
    • 29. Factors Affecting Respiratory Rate
      • Fever
      • Depressant Drugs
      • Anxiety
      • Insufficient Oxygen
      • Stimulant Drugs
      • Sleep
    • 30. Respiratory Volumes
      • Lung Capacity
      • Tidal Volume
      • Dead Space
      • Alveolar Air
      • 6000 mL of air
      • 500 mL at rest
      • 150 mL
      • 350 mL
    • 31. Minute Volume
      • Total air moved per minute
      • Rate X Volume = Minute volume
      • Important Assessment Item
    • 32. Factors Affecting Minute Volume
      • Head, neck, chest injury
      • Shock
      • Diabetes
      • CO2 / O2 rapid changes
    • 33. Maintaining the A in ABC
      • Patient positioning
      • Suctioning
      • Supplemental Oxygen
      • Mechanical Assistance
    • 34. Pulse Oximetry
      • Measures amount of oxygen in the blood.
      • Gives percent of hemoglobin saturated
        • Tool only, do not rely on totally
        • Why?
      • Normal Values
        • 95% - 100% Normal
        • 90% - 95% - Mild – Normal for COPD
        • < 90 % Moderate – High Flow Oxygen
    • 35. End-Tidal CO2 Detection
      • Measured
        • Colorimetric and Digital
      • Tool to aid in determining correct placement
    • 36. Lesson 3 Assessing Respiratory Problems
    • 37. Patient Assessment
    • 38. General Patient Assessment
      • Primary Survey
        • LOC
        • ABC’s
        • Speech Pattern
        • Obvious Respiratory Noise
        • Patient Position
    • 39. General Assessment (cont’d)
    • 40. Secondary Assessment
      • SAMPLE history
      • Chief Complaint
      • Pertinent Negatives
      • Chest Pain (pleuritic vs cardiac)
      • Cough History
      • Edema
      • Vitals
    • 41. Respiratory Assessment
      • Confusion, Agitation, Orientation
      • Cyanosis (late sign)
      • Diaphoresis
      • Retractions
      • Accessory Muscle Use
      • Jugular Venous Distention
      • Nasal Flaring / Pursed Lip Breathing
    • 42. Palpation
      • Skin
        • Turgor
        • Color
        • Temperature
        • Diaphoresis
      • Pulse
        • Rate
        • Rhythm
        • Quality
      • Chest Wall Pain
      • Tracheal Deviation
    • 43. Assessing Lung Sounds
      • Methods
      • Hand Out
    • 44. Lung Sounds
      • Normal
      • Wheezes
      • Rales (Crackles)
      • Stridor
      • Rhonchi
      • Pleural Rub
      • Listen on every patient
      • End of Expiration
      • End of Inspiration
      • During both phases
      • Expiration
      • End of Inspiration
    • 45. Respiratory Diseases
      • COPD
      • Asthma
      • Pneumonia
      • Pulmonary Edema
      • Pulmonary Embolus
      • Trauma
    • 46. COPD
    • 47. Chronic Obstructive Pulmonary Disease
      • Pink Puffers and Blue Bloaters
      • Frequently on Home oxygen
      • Assessment
        • Typical Lung Sounds
      • Common Medications
      • May or May not be Hypoxic Drive
    • 48. Asthma
    • 49. Asthma
      • Bronchiole Constriction & Mucous Production
      • Lung Sounds
        • Wheezes
        • Diminished
        • None
      • Usually Diagnosed
    • 50. Pneumonia
    • 51. Pneumonia
      • Fever
      • Productive Cough
        • Colored Sputum
      • General Illness
      • Elderly & Pediatric most at risk
      • Lung Sounds
        • Rhonchi, Rales, Wheezes
    • 52. Pulmonary Edema
    • 53. Pulmonary Edema
      • Congestive Heart Failure
        • Acute – Flash Pulmonary Edema
        • Chronic – Heart Failure
          • Medications
          • Orthopnea, PND
      • Lung Sounds
      • Keep them upright with legs dangling
    • 54. Pulmonary Embolus
    • 55. Pulmonary Embolus
      • Lung Sounds
      • History
        • Surgery
        • Bed Confined
        • Long trip
      • Rapid Transport & High Flow Oxygen
    • 56. Trauma
    • 57. Trauma
      • Maintain spinal control
      • Airway Management
      • High Flow Oxygen
      • Rapid Transport
      • Seal Chest Wounds
      • Stabilize Impaled Objects
    • 58. Lesson 4 Respiratory/Cardiac Arrest Basic Airway Management
    • 59. Respiratory & Cardiac Arrest
    • 60. Assessing the Patient
      • First Steps of CPR
      • Annie, Annie You Okay?
      • Other Signs and Symptoms
        • Unconsciousness
        • Cardiac Seizure
        • Agonal respirations or apnea
        • Cyanosis, Ashen, Mottled
        • No signs of spontaneous respiration or circulation
        • No Pulse
    • 61. Combitube
    • 62. When to Use the Combitube
      • CPR
        • Remember to do CPR!
        • Attach AED!
      • Respiratory Arrest
        • Agonal Respirations without intact gag reflex
        • Respiratory Arrest leads to Cardiac Arrest
    • 63. Airway Management – The Basics
      • Manual Maneuvers
      • Chin Lift
      • Jaw Lift
      • Jaw Thrust
      • Head Tilt – Chin Lift
      • Modified Jaw thrust
    • 64. Airway Management – The Basics
      • Mechanical Airways
      • NPA’s
      • OPA’s
      • Description
      • Advantages
      • Disadvantages
      • Indications
      • Contraindications
      • Methods of Insertion
    • 65. Airway Management – The Basics
      • Ventilation
      • Mouth to Mask
      • BVM
      • Description
      • Advantages
      • Disadvantages
      • Indications
      • Contraindications
      • Methods of Use
    • 66. Evaluation of Effectiveness
      • How do I know I am ventilating?
        • Chest movement
        • Lung Sounds
        • Epigastric sounds/Abdominal distention
        • Patient Response
    • 67. Lesson 5 Suctioning
    • 68. Reviewing Suctioning
      • BSI – Scene Safety
      • Equipment
        • Suction device
        • Rigid or Soft Tip
      • Insert with Suction Off
      • Withdraw while Suctioning
      • No more than 15 seconds before ventilating!
    • 69. Oh, That Sucks!
      • Vomitus
        • Food
        • Protein dissolving enzymes
        • Hydrochloric Acid
      • Aspiration damage
        • Alveolar Damage
        • Increased fluid
        • Obstruction
        • Aspiration Pneumonia
    • 70. Oh, Go Spit on It
      • Saliva
        • Digestive enzymes
        • Bacteria
      • Aspiration Damage
        • Fills alveoli
        • Pneumonia
    • 71. Food
      • Clogs airways
      • Interferes with ventilation
      • Pneumonia
    • 72. Blood
      • Contents
        • Protein
        • Fibrin
        • Water
        • Electrolytes
      • Aspiration Damage
        • Clog small airways
        • Creates chemical reaction
    • 73. Suction Catheters
      • Rigid
      • Advantages
      • Disadvantages
      • Indications
      • Contraindications
      • Methods of Use
      • Flexible
      • Advantages
      • Disadvantages
      • Indications
      • Contraindications
      • Methods of Use
    • 74. Lesson 6 Dual-Lumen Airway Devices
    • 75. Combitube ©
    • 76. Description
      • Other Similar Devices
        • Pharyngeal tracheal lumen airway (PTLA)
        • EGTA
        • EOA
      • What we use
        • Combitube ©
    • 77. Indications for Combitube ©
      • Respiratory Arrest
      • Cardiac Arrest
      • Unconscious, without a gag reflex
    • 78. Contraindications for Combitube ©
      • Gag Reflex
      • Conscious
      • Breathing Adequately
      • Caustic Ingestion
      • Known esophageal disease or varices
      • Under 16 y/o
      • Under 5 feet or over 6 feet 8inches
    • 79. Advantages for Combitube ©
      • Rapid Insertion
      • Limits regurgitation, aspiration & distention
      • Blind insertion
      • High oxygen delivery
      • Less training required
      • Inserted in neutral position
    • 80. Disadvantages for Combitube ©
      • Patient must be unresponsive without gag reflex
      • Some are difficult to obtain adequate seal
      • Some do not totally protect against aspiration
      • Most responsive patients will vomit when removed
      • May damage esophagus
    • 81. Demonstration
    • 82. When Can I Remove the Combitube?
      • Patient returns to full consciousness
      • Patient able to maintain own airway
      • Orders from OLMC
    • 83. Procedure for Removing
      • SUCTION READY!
      • Deflate Tube #2
      • Deflate Tube #1
      • Tell patient to exhale
      • Pull out quickly and in-line
      • SUCTION
    • 84. Demonstration
    • 85. Skills Labs
      • Basic Airway Management
        • Manual Maneuvers and Simple Adjuncts
        • Supplemental Oxygen
        • Ventilation
        • Suctioning
      • Advanced Airway Management
        • Combitube
    • 86. Questions?