Six Chapter Airway Management
<ul><li>Identifying and using body substance   isolation procedures for airway   techniques </li></ul><ul><li>Providing ar...
<ul><li>Identifying the need for and providing   suctioning to patients  </li></ul><ul><li>Identifying the need for and   ...
Respiratory System
Breathing  —  Inhalation/Exhalation
Adequate Breathing: Normal Rates <ul><li>Adults </li></ul><ul><li>Children </li></ul><ul><li>Infant </li></ul>12  –  20/mi...
Adequate Breathing <ul><li>Rhythm: </li></ul>Usually regular Breath sounds audible with stethoscope Minimal effort <ul><li...
Inadequate Breathing Shallow chest expansion <ul><li>Depth: </li></ul>Outside normal range <ul><li>Rate: </li></ul>(fast o...
Inadequate Breathing Abnormal breath sounds <ul><li>Quality: </li></ul>(noisy, diminished, or absent) Unequal chest expans...
Just before death <ul><li>Agonal </li></ul><ul><li>gasps: </li></ul>Pale, cyanotic, cool,  or clammy <ul><li>Skin: </li></...
<ul><li>Nasal flaring </li></ul><ul><li>See-saw breathing </li></ul>Inadequate Breathing: Infants and Children
P RECEPTOR  P EARL Inform new EMT-Bs that a common sign of a partial airway obstruction is a snoring noise. As an experime...
Differences between the Airways of Children and Adults <ul><li>Mouth and nose </li></ul><ul><li>Pharynx </li></ul><ul><li>...
Child vs. Adult Airway
<ul><li>Chest rises and falls. </li></ul><ul><li>Heart rate returns to normal. </li></ul><ul><li>Skin color may return to ...
<ul><li>No visible chest rise. </li></ul><ul><li>Ventilating too slowly or too fast. </li></ul><ul><li>Heart rate does not...
O PENING THE AIRWAY
Head-Tilt, Chin-Lift Maneuver
Jaw-Thrust Maneuver
T ECHNIQUES OF SUCTIONING
To remove blood, other liquids, and food from the airway. Purpose of Suctioning WHEN YOU HEAR GURGLING,  SUCTION!
Mounted Oxygen-Powered Battery-Powered   Manual Suction Types of Suction Units
Suction Catheters <ul><li>Hard </li></ul><ul><li>Usually does a good job </li></ul><ul><li>Soft </li></ul><ul><li>Useful f...
Body Substance Isolation Equipment
Inspect and test suction unit before you need it.
Position the patient and yourself properly.
Open the patient’s mouth while protecting your fingers.
Without suctioning, insert hard catheter to base of tongue.
Once tip of catheter is in right place, apply suction, move tip, and remove fluid in airway.
If using a soft catheter, insert it only as far as the distance from the lips to the earlobe or angle of the jaw.
(Less in children and infants) Suction for No More Than 15 Seconds at a Time
Patients Producing Frothy Sputum <ul><li>Remove it as fast as you can. </li></ul><ul><li>Suction for 15 seconds. </li></ul...
If necessary, rinse catheter and tubing  to prevent obstruction of tubing by dried material.
P RECEPTOR  P EARL Rather than counting out 15 seconds as the maximum amount of time for suctioning, just take a breath an...
T ECHNIQUES OF ARTIFICIAL VENTILATION
Techniques of Artificial Ventilation <ul><li>Mouth-to-mask </li></ul><ul><li>Two-person bag-valve mask </li></ul><ul><li>F...
Mouth-to-Mask Ventilation
Bag-Valve Mask
Open the airway with the head-tilt, chin-lift technique.
Select mask of correct size.
Position yourself behind the patient’s head.
Hold the mask with your thumbs over the top half and your index and middle fingers over the bottom half.
Place the top of the mask over the patient’s nose and lower the bottom half of the mask over the mouth and chin.
If the mask has a large round cuff around the ventilation port, center the port over the patient’s mouth.
Use your ring and little fingers to lift the chin and maintain the head tilt.
Have an assistant squeeze the bag once every 5–6 seconds (3–5 seconds for a child or infant).
Are You Ventilating? <ul><li>If no chest rise, reposition  head. </li></ul><ul><li>If air escapes, reposition fingers </li...
Bag-Valve Mask in Trauma <ul><li>Same as for medical applications,   EXCEPT: </li></ul><ul><li>Use jaw-thrust  technique. ...
Using a Bag-Valve Mask When Trauma Is Suspected
Flow-Restricted, Oxygen-Powered Ventilation Device <ul><li>Peak flow rate is 40 lpm. </li></ul><ul><li>Inspiratory pressur...
Open airway and apply mask just as with bag-valve mask. Trigger device until chest rises. Repeat every 5–6 seconds.
Are You Ventilating? <ul><li>If no chest rise, reposition  </li></ul><ul><li>If air escapes, reposition  </li></ul>(Contin...
Are You Ventilating? <ul><li>If chest still does not rise,  </li></ul>try a pocket mask or manually triggered device.
FROPVD in Trauma <ul><li>Same as for medical applications,   EXCEPT: </li></ul><ul><li>Use jaw-thrust  </li></ul><ul><li>D...
Ventilating through a Stoma or Tracheotomy Tube Opening
Use a pediatric pocket mask to ventilate a patient with a stoma.
Aspiration of Stoma Aspiration of Tube (insert 3 – 5 inches) If unable to ventilate, suction.
<ul><li>If air escapes from the mouth   </li></ul>and/or nose when ventilating via stoma, seal the mouth and nose. <ul><li...
A IRWAY ADJUNCTS
An oral airway can prevent the tongue from obstructing the airway of an unresponsive patient without a gag reflex.
Measure correct size. Open mouth and insert  airway upside down.
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 ...
NPA insertion:  Choose correct size. Lubricate airway.
Insert the airway posteriorly.  If it does not advance, try the other nostril.
O XYGEN ADMINISTRATION
<ul><li>Shock or hypoperfusion </li></ul><ul><li>Respiratory distress or arrest </li></ul><ul><li>Cardiac abnormality or a...
Supplemental Oxygen How many liters  are in the D, E, and jumbo D cylinders?
An Oxygen Delivery System
Position desired cylinder upright, stand to one side, and remove the wrapper.
If your system uses a replaceable washer, keep it, and crack the cylinder’s valve for 1 second.
Select appropriate regulator. Place washer on regulator  and turn flowmeter to zero.
Align pins or thread by hand.
Tighten screw by hand or with a wrench.
Oxygen Delivery Devices
Administering Oxygen <ul><li>Nonrebreather mask preferred. </li></ul><ul><li>Can deliver up to 90% oxygen. </li></ul><ul><...
<ul><li>To which patients should you </li></ul>give oxygen? <ul><li>Cyanotic </li></ul><ul><li>Cool, clammy </li></ul><ul>...
<ul><li>Use the proper mask size:  Adult, child,   or infant </li></ul><ul><li>Use a nasal cannula on a patient who   cann...
Explain procedures to patient and attach tubing to regulator.
Open valve, adjust flowmeter (fill bag of nonrebreather mask) . . .
. . . and place mask on patient.
Adjust flowmeter . . .
. . . and secure tank.
<ul><li>Avoid excessive hyperextension </li></ul>Infants and Children (neutral position for infant and just past neutral f...
<ul><li>Make sure pop-off valve on </li></ul>BVM is disabled. <ul><li>Gastric distention is more </li></ul>common in child...
<ul><li>Try a properly sized oral or   </li></ul>works. nasal airway when nothing else Infants and Children
<ul><li>There are many blood vessels  </li></ul>Facial Injuries <ul><li>Severe swelling from blunt  </li></ul><ul><li>Blee...
Foreign Body Airway Obstruction <ul><li>When FBAO is severe: </li></ul><ul><li>Perform CPR chest compressions per healthca...
Dentures <ul><li>Leave in place under ordinary    circumstances. </li></ul><ul><li>If a partial plate loosens, leave it in...
1. What BSI procedures should be taken when doing airway techniques? 2. When should ventilations be assisted? 3. How and w...
Upcoming SlideShare
Loading in...5
×

Airway Management

3,985

Published on

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,985
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
261
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

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.
  17. 17. O PENING THE AIRWAY
  18. 18. Head-Tilt, Chin-Lift Maneuver
  19. 19. Jaw-Thrust Maneuver
  20. 20. T ECHNIQUES OF SUCTIONING
  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!
  35. 35. T ECHNIQUES OF ARTIFICIAL VENTILATION
  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?
  59. 59. A IRWAY ADJUNCTS
  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.
  65. 65. O XYGEN ADMINISTRATION
  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
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×