Michelle Prescott

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

96. RESPIRATORY
EMERGENCIES
Chapter 16
by
Michelle Prescott

97. Airway
Anatomy
REVIEW

98. Airway anatomy
Bronchus and Bronchi

99. Airway anatomy
MEDIASTINUM

100. Airway anatomy
PULMONARY BLOOD FLOW

101. Airway anatomy
Pulmonary Embolus

102. Airway anatomy
Pulmonary Embolus

103. Hypoventilation

104. Impaired
lung function
Atelectasis
Pneumonia
Pulmonary Edema
Asthma
Cold
Hypoventilation
Causes
Impaired
mechanics of breathing
Flail Chest
Diaphragmatic rupture
severe retractions
distended abdomen
abdominal binding
chest binding

105. Impaired
neuromuscular function
Head trauma
intracranial infections
brain tumors
spinal cord injury above c5
guillain-barre syndrome
ALS or Lou Gehrig disease
botulism
Hypoventilation
Causes
Reduced
Respiratory Drive
alcohol intoxication
narcotics
toxins
head injury
hypoxic drive
asphyxia

106. Hyperventilation

107. Patient
Assessment

108. Standard
Precautions
Minimum protection:
Exam gloves
eye protection
*if suspicion of respiratory infection
you should wear a face shield and
gown*
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Dangerous
situations
Reduced oxygen concentration
Carbon monoxide
toxic gases
highly contagious illness

109. Impaired ventilation,
perfusion, or diffusion
acute bronchospasm
anaphylaxis
pulmonary embolism
pneumothorax
Paroxysmal nocturnal dyspnea
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Rapid onset
dyspnea
Inadequate ventilation
hypoxia
hypercarbia