Paramedic

1. Airway Management
and
ventilation
Chapter 15
by
Michelle Prescott

2. Airway
Anatomy

3. Airway anatomy
Upper Airway

4. Airway anatomy
Pharynx
Pharynx

5. Airway anatomy
Larynx
Vocal
Cords
Upper
Airway
Lower
Airway

6. Airway anatomy
Glottic Opening

7. Airway anatomy
Epiglottis

8. Airway anatomy
Lower Airway

9. Airway anatomy
Cricoid Cartilage

10. Airway anatomy
Cricothyroid membrane

11. Airway anatomy
Trachea

12. Airway anatomy
Carina

13. Airway anatomy
Bronchus and Bronchi

14. Airway anatomy
Alveoli

15. Ventilation
oxygenation
Respiration

16. Ventilation Oxygenation Respiration
Physical Act of
moving air into
and out of the
lungs
Process of
Loading oxygen
molecules onto
hemoglobin
molecules
Process of
exchanging
oxygen and
carbon dioxide

17. Pathophysiology
of
Respiration

18. External
Pulmonary Respiration
Exchange of oxygen and
carbon dioxide between
the alveoli and blood in
the capillaries
Internal
Cellular Respiration
Exchange of oxygen and
carbon dioxide between
the circulation and cells
Respiration

19. Hypoxic Hystotoxic Stagnant
Not enough
oxygen entering
lungs
(Low FIO2)
Inability of the
oxygen to load
or unload from
hemoglobin
Hemoglobin are
not being
transported to
cells
Hypoxia

20. Ventilation Perfusion
Mismatch

21. Negative
and Postive
Pressure
Ventilation

22. Negative Pressure
Drawing Air into the
Lungs
Positive Pressure
Forcing air into the lungs
Types of Ventilation

23. Factors
Affecting
Ventilation

24. Intrinsic
*Infection
*allergic Reactions
*Obstructions
*Medications
*Head and spine Trauma
*Neuromuscular Disorder
*bronchoconstriction
Extrinsic
*Airway Trauma
*Blunt Trauma
*chest wall trauma
*Burns
Factors Affecting Ventilation

25. Tidal Volume Dead Space
Alveolar
Volume
Amount of air moved
into the respiratory
tract with one breath
Portion of Tidal Volume
that does not reach the
alveoli
How much tidal volume
that participates in gas
exchange
Respiratory
Rate
Alveolar
Volume
Alveolar
Minute Volume
The amount of time a
person breaths in one
minute
The amount of air
moved into the alveoli
during one breath
The amount of air that
participates in gas
exchange within one
minute

26. Hypoventilation
Builds up Carbon Dioxide
HyperVentilation
Blows off Carbon Dioxide
Factors Affecting Ventilation
CO2 (HyperCarbia) CO2 (hypocarbia)
If patient is alkalotic,
patient may hypoventilate
to Retain CO2
If patient is acidotic,
patient may
hyperventilate to
Blow off CO2

27. Factors
Affecting
Oxygenation and
Respiration

28. External
*Altitude
*Closed Spaces
*Toxic Gases
Internal
*Decreased Surface Area
*Nonfunctioning Alveoli
*Submersion
*Hypoglycemia
*Infection
*Hormonal Imbalances
Factors Affecting Oxygenation and Respiration

29. Factors Affecting Oxygenation and Respiration
Circulatory Compromise

30. Acid Base Balance
Respiratory System
Renal System

31. Acid Base Balance
Respiratory System
Hydrogen Ions Carbon Dioxide
H+ Acidosis pH (<7.35)
H+ PH (>7.45)Alkalosis

32. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Respiratory

33. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Metabolic

34. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Compensation

35. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Partial or Full Compensation
These Two are compensating

36. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Uncompensated Respiratory Acidosis

37. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Uncompensated Respiratory Alkalosis

38. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Uncompensated Metabolic Acidosis

39. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Uncompensated Metabolic Alkalosis

40. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Partially compensated Respiratory Acidosis

41. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Partially compensated Respiratory Alkalosis

42. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Partially compensated Metabolic Acidosis

43. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Partially compensated Metabolic Alkalosis

44. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Fully compensated Respiratory Acidosis

45. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Fully compensated Respiratory Alkalosis

46. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Fully compensated Metabolic Acidosis

47. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Fully compensated Metabolic Alkalosis

48. Acid Base Balance
7.35 7.45
7.40
p
H a B
C
O
2
35 45
aB
H
C
O
3-
22 26
a B
Your Turn

49. Adequate
Breathing

51. INAdequate
Breathing

52. Shallow breathing

53. Irregular breathing Pattern

54. Preferential Positioning

55. Opening the Airway

56. Pursed Lip Breathing

57. Chest Wall Movement

58. Retractions

59. Assessing
Breathing

60. Assessment
of
Breath Sounds

61. Where to place Stethoscope

62. Bronchial Vesicular Bronchovesicular
Trachea
or
sternum
bronchioles
softer
muffled
Alveoli
Air “Whooshing”
Breath Sounds

63. Respiratory Rate:
20 Breaths Per Min
I:E Ratio
0 Sec. 60 Sec.
3 Sec. 3 Sec. 3 Sec. 3 Sec. 3 Sec. 3 Sec. 3 Sec. 3 Sec. 3 Sec.3 Sec.

64. Respiratory Rate:
20 Breaths Per Min
I:E Ratio
0 Sec. 3 Sec.
Normal I:E Ratio
1:2

65. Respiratory Rate:
12 Breaths Per Min
I:E Ratio
0 Sec. 60 Sec.
5 Sec. 5 Sec. 5 Sec. 5 Sec.5 Sec. 5 Sec.

66. Respiratory Rate:
12 Breaths Per Min
I:E Ratio
0 Sec. 5 Sec.
Normal I:E Ratio
1:2
3 Sec.

67. Respiratory Rate:
12 Breaths Per Min
I:E Ratio
0 Sec. 5 Sec.
Asthma I:E Ratio
1:4

68. Respiratory Rate:
30 Breaths Per Min
I:E Ratio
0 Sec. 60 Sec.
Each Breath is
2 seconds

69. Respiratory Rate:
30 Breaths Per Min
I:E Ratio
0 Sec. 2 Sec.
Tachypnea I:E Ratio
1:1

70. Adventitious Airway Sounds
Upper Airway Lower Airway
Stridor Crackles
Ronchi
Wheezing
Snoring (No audio)
Gurgling (No Audio)

71. Quantifying
Ventilation and
Oxygenation

72. Quantifying Respiration
Capnography
Gold standard to confirm
Tube placement

73. Capnography
Terminology
Capnogram
A real-time waveform record of the
concentration of carbon dioxide in the
respiratory gases
Capnograph
Capnogram waveform plus numerical Value

74. Capnography
Terminology
etco2 or End tidal co2
the measurement of exhaled co2 in the breath
Normal range- 35-45mmhg

75. Capnography
Terminology
Sidestream
an indirect method of measuring exhaled CO2 in
non-intubated patients
Mainstream
Direct method of measuring exhaled co2 with
intubated patients

76. Capnography
Normal Waveform
Co2
Time
A B
C
D
E
A-b= Clearing of Dead SpaceB-C= Exhalation phasec-D= Expiratory PhaseD-E= New Breath

77. Capnography
Common Waveforms
48
mmhm
8
RR
Hypoventilation
24
mmhm
35
RR
Hyperventilation

78. Capnography
Abnormal Waveforms
36
mmhm
20
RR
Asthma
0
mmhm
0
RR
Esophageal Tube
0
mmhm
0
RR
Esophageal Tube

79. Airway
Management

80. Positioning
The
Patient

81. Manual
airway
maneuvers

82. SUCTIONING

83. BLS
AIRWAY
DEVICES

84. AIRWAY
Obstructions

85. Supplemental
Oxygen

86. Supplemental
Oxygen
DEVICES

87. VENTILATORY
SUPPORT

88. CONTINUOUS
POSITIVE
AIRWAY
PRESSURE

89. GASTRIC
DISTENTION

90. SPECIAL
PATIENT
CONSIDERATIONS

91. ADVANCED
AIRWAY
MANAGEMENT

92. PREDICTING
THE
DIFFICULT
AIRWAY

93. PHARMACOLOGIC
ADJUNTS

94. ALTERNATIVE
AIRWAY
DEVICES

95. CRICOTHYROTOMY