Airway Management


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Airway Management

  1. 1. Six Chapter Airway Management
  2. 2. <ul><li>Identifying and using body substance isolation procedures for airway techniques </li></ul><ul><li>Providing artificial ventilation and assisted ventilations </li></ul><ul><li>Using airway adjunct devices </li></ul>CORE CONCEPTS Six Chapter (Continued)
  3. 3. <ul><li>Identifying the need for and providing suctioning to patients </li></ul><ul><li>Identifying the need for and administering oxygen to patients </li></ul>CORE CONCEPTS Six Chapter
  4. 4. Respiratory System
  5. 5. Breathing — Inhalation/Exhalation
  6. 6. Adequate Breathing: Normal Rates <ul><li>Adults </li></ul><ul><li>Children </li></ul><ul><li>Infant </li></ul>12 – 20/min. 15 – 30/min. 25 – 50/min. (Continued)
  7. 7. Adequate Breathing <ul><li>Rhythm: </li></ul>Usually regular Breath sounds audible with stethoscope Minimal effort <ul><li>Quality: </li></ul>Chest expands <ul><li>Depth: </li></ul>
  8. 8. Inadequate Breathing Shallow chest expansion <ul><li>Depth: </li></ul>Outside normal range <ul><li>Rate: </li></ul>(fast or slow) Regular or irregular <ul><li>Rhythm: </li></ul>(Continued)
  9. 9. Inadequate Breathing Abnormal breath sounds <ul><li>Quality: </li></ul>(noisy, diminished, or absent) Unequal chest expansion Increased breathing effort (Continued)
  10. 10. Just before death <ul><li>Agonal </li></ul><ul><li>gasps: </li></ul>Pale, cyanotic, cool, or clammy <ul><li>Skin: </li></ul>Above clavicles, between/below ribs <ul><li>Retractions: </li></ul>(Continued) Inadequate Breathing
  11. 11. <ul><li>Nasal flaring </li></ul><ul><li>See-saw breathing </li></ul>Inadequate Breathing: Infants and Children
  12. 12. P RECEPTOR P EARL Inform new EMT-Bs that a common sign of a partial airway obstruction is a snoring noise. As an experiment, they can simply hyperextend the neck of a snoring person (if they can do so without waking up the person) and listen as the snoring stops!
  13. 13. Differences between the Airways of Children and Adults <ul><li>Mouth and nose </li></ul><ul><li>Pharynx </li></ul><ul><li>Trachea </li></ul><ul><li>Cricoid cartilage </li></ul><ul><li>Diaphragm </li></ul>
  14. 14. Child vs. Adult Airway
  15. 15. <ul><li>Chest rises and falls. </li></ul><ul><li>Heart rate returns to normal. </li></ul><ul><li>Skin color may return to normal. </li></ul><ul><li>Rate is about 12 for adults and </li></ul>about 20 for children and infants. Signs of Adequate Ventilation
  16. 16. <ul><li>No visible chest rise. </li></ul><ul><li>Ventilating too slowly or too fast. </li></ul><ul><li>Heart rate does not return to </li></ul>Signs of Inadequate Ventilation normal.
  18. 18. Head-Tilt, Chin-Lift Maneuver
  19. 19. Jaw-Thrust Maneuver
  21. 21. To remove blood, other liquids, and food from the airway. Purpose of Suctioning WHEN YOU HEAR GURGLING, SUCTION!
  22. 22. Mounted Oxygen-Powered Battery-Powered Manual Suction Types of Suction Units
  23. 23. Suction Catheters <ul><li>Hard </li></ul><ul><li>Usually does a good job </li></ul><ul><li>Soft </li></ul><ul><li>Useful for nasopharynx and </li></ul><ul><li>when hard catheter won’t work </li></ul>
  24. 24. Body Substance Isolation Equipment
  25. 25. Inspect and test suction unit before you need it.
  26. 26. Position the patient and yourself properly.
  27. 27. Open the patient’s mouth while protecting your fingers.
  28. 28. Without suctioning, insert hard catheter to base of tongue.
  29. 29. Once tip of catheter is in right place, apply suction, move tip, and remove fluid in airway.
  30. 30. If using a soft catheter, insert it only as far as the distance from the lips to the earlobe or angle of the jaw.
  31. 31. (Less in children and infants) Suction for No More Than 15 Seconds at a Time
  32. 32. Patients Producing Frothy Sputum <ul><li>Remove it as fast as you can. </li></ul><ul><li>Suction for 15 seconds. </li></ul><ul><li>Ventilate for 2 minutes and repeat. </li></ul><ul><li>Transport promptly and consult </li></ul><ul><li>medical direction. </li></ul>
  33. 33. If necessary, rinse catheter and tubing to prevent obstruction of tubing by dried material.
  34. 34. P RECEPTOR P EARL Rather than counting out 15 seconds as the maximum amount of time for suctioning, just take a breath and hold it as you begin to suction. When you need a breath, so does the patient. Stop suctioning and ventilate. In the excitement of a serious call, you will need to breathe more often than four times a minute!
  36. 36. Techniques of Artificial Ventilation <ul><li>Mouth-to-mask </li></ul><ul><li>Two-person bag-valve mask </li></ul><ul><li>Flow-restricted, oxygen-powered ventilation device </li></ul><ul><li>One-person bag-valve mask </li></ul>
  37. 37. Mouth-to-Mask Ventilation
  38. 38. Bag-Valve Mask
  39. 39. Open the airway with the head-tilt, chin-lift technique.
  40. 40. Select mask of correct size.
  41. 41. Position yourself behind the patient’s head.
  42. 42. Hold the mask with your thumbs over the top half and your index and middle fingers over the bottom half.
  43. 43. Place the top of the mask over the patient’s nose and lower the bottom half of the mask over the mouth and chin.
  44. 44. If the mask has a large round cuff around the ventilation port, center the port over the patient’s mouth.
  45. 45. Use your ring and little fingers to lift the chin and maintain the head tilt.
  46. 46. Have an assistant squeeze the bag once every 5–6 seconds (3–5 seconds for a child or infant).
  47. 47. Are You Ventilating? <ul><li>If no chest rise, reposition head. </li></ul><ul><li>If air escapes, reposition fingers </li></ul><ul><li>If chest still does not rise, try a </li></ul>pocket mask or manually triggered device. and mask.
  48. 48. Bag-Valve Mask in Trauma <ul><li>Same as for medical applications, EXCEPT: </li></ul><ul><li>Use jaw-thrust technique. </li></ul><ul><li>Do not tilt head or neck. </li></ul>
  49. 49. Using a Bag-Valve Mask When Trauma Is Suspected
  50. 50. Flow-Restricted, Oxygen-Powered Ventilation Device <ul><li>Peak flow rate is 40 lpm. </li></ul><ul><li>Inspiratory pressure relief valve </li></ul>opens at 60 cm water. <ul><li>Alarm is audible when relief valve </li></ul>pressure is exceeded.
  51. 51. Open airway and apply mask just as with bag-valve mask. Trigger device until chest rises. Repeat every 5–6 seconds.
  52. 52. Are You Ventilating? <ul><li>If no chest rise, reposition </li></ul><ul><li>If air escapes, reposition </li></ul>(Continued) head. and mask. fingers
  53. 53. Are You Ventilating? <ul><li>If chest still does not rise, </li></ul>try a pocket mask or manually triggered device.
  54. 54. FROPVD in Trauma <ul><li>Same as for medical applications, EXCEPT: </li></ul><ul><li>Use jaw-thrust </li></ul><ul><li>Do not tilt head or neck. </li></ul>technique.
  55. 55. Ventilating through a Stoma or Tracheotomy Tube Opening
  56. 56. Use a pediatric pocket mask to ventilate a patient with a stoma.
  57. 57. Aspiration of Stoma Aspiration of Tube (insert 3 – 5 inches) If unable to ventilate, suction.
  58. 58. <ul><li>If air escapes from the mouth </li></ul>and/or nose when ventilating via stoma, seal the mouth and nose. <ul><li>If still unable to ventilate, seal </li></ul><ul><li>the stoma and mouth and </li></ul><ul><li>attempt via the nose. </li></ul>Are You Ventilating?
  60. 60. An oral airway can prevent the tongue from obstructing the airway of an unresponsive patient without a gag reflex.
  61. 61. Measure correct size. Open mouth and insert airway upside down.
  62. 62. When airway is in mouth as far as it will go, turn it right-side up. You can also insert an oral airway right side up, IF you use a tongue depressor to press the tongue down and forward.
  63. 63. NPA insertion: Choose correct size. Lubricate airway.
  64. 64. Insert the airway posteriorly. If it does not advance, try the other nostril.
  66. 66. <ul><li>Shock or hypoperfusion </li></ul><ul><li>Respiratory distress or arrest </li></ul><ul><li>Cardiac abnormality or arrest </li></ul><ul><li>Smoke or toxic fume inhalation </li></ul><ul><li>Multiple-system trauma </li></ul><ul><li>Stroke, seizure, or diabetic emergency </li></ul>Indications for Oxygen Therapy
  67. 67. Supplemental Oxygen How many liters are in the D, E, and jumbo D cylinders?
  68. 68. An Oxygen Delivery System
  69. 69. Position desired cylinder upright, stand to one side, and remove the wrapper.
  70. 70. If your system uses a replaceable washer, keep it, and crack the cylinder’s valve for 1 second.
  71. 71. Select appropriate regulator. Place washer on regulator and turn flowmeter to zero.
  72. 72. Align pins or thread by hand.
  73. 73. Tighten screw by hand or with a wrench.
  74. 74. Oxygen Delivery Devices
  75. 75. Administering Oxygen <ul><li>Nonrebreather mask preferred. </li></ul><ul><li>Can deliver up to 90% oxygen. </li></ul><ul><li>Must fill bag before placing </li></ul><ul><li>Bag must not collapse when patient </li></ul><ul><li>inhales. </li></ul>mask on patient. (Continued)
  76. 76. <ul><li>To which patients should you </li></ul>give oxygen? <ul><li>Cyanotic </li></ul><ul><li>Cool, clammy </li></ul><ul><li>Short of breath </li></ul>(Continued) Administering Oxygen
  77. 77. <ul><li>Use the proper mask size: Adult, child, or infant </li></ul><ul><li>Use a nasal cannula on a patient who cannot tolerate a nonrebreather mask, even with coaching and reassurance. THIS SHOULD BE A RARE EVENT. </li></ul>Administering Oxygen
  78. 78. Explain procedures to patient and attach tubing to regulator.
  79. 79. Open valve, adjust flowmeter (fill bag of nonrebreather mask) . . .
  80. 80. . . . and place mask on patient.
  81. 81. Adjust flowmeter . . .
  82. 82. . . . and secure tank.
  83. 83. <ul><li>Avoid excessive hyperextension </li></ul>Infants and Children (neutral position for infant and just past neutral for child) . <ul><li>Avoid excessive pressure </li></ul><ul><li>when ventilating </li></ul>(ventilate only until chest rises) . (Continued)
  84. 84. <ul><li>Make sure pop-off valve on </li></ul>BVM is disabled. <ul><li>Gastric distention is more </li></ul>common in children. (Continued) Infants and Children
  85. 85. <ul><li>Try a properly sized oral or </li></ul>works. nasal airway when nothing else Infants and Children
  86. 86. <ul><li>There are many blood vessels </li></ul>Facial Injuries <ul><li>Severe swelling from blunt </li></ul><ul><li>Bleeding into the airway </li></ul>the face. This can lead to in two problems: injuries
  87. 87. Foreign Body Airway Obstruction <ul><li>When FBAO is severe: </li></ul><ul><li>Perform CPR chest compressions per healthcare provider procedures. </li></ul><ul><li>Transport as soon as possible. </li></ul>
  88. 88. Dentures <ul><li>Leave in place under ordinary circumstances. </li></ul><ul><li>If a partial plate loosens, leave it in place unless it causes a problem. </li></ul>
  89. 89. 1. What BSI procedures should be taken when doing airway techniques? 2. When should ventilations be assisted? 3. How and when are the OPA and NPA used? 4. How and when is suctioning provided? 5. When should oxygen be administered? R EVIEW QUESTIONS