Emergency Care in the Streets Chapters 15 and 16

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
*

27. 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

28. Factors
Affecting
Oxygenation and
Respiration

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

30. Factors Affecting Oxygenation and Respiration
Circulatory Compromise

32. Acid Base Balance
Respiratory System
Renal System

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

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
Respiratory

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
Metabolic

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
Compensation

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
Partial or Full Compensation
These Two are compensating

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 Respiratory 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 Respiratory 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
Uncompensated Metabolic 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
Uncompensated Metabolic 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 Respiratory 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 Respiratory 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
Partially compensated Metabolic 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
Partially compensated Metabolic 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 Respiratory 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 Respiratory 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
Fully compensated Metabolic Acidosis

49. 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

50. 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

51. C
O
2
Acid Base Balance
p
H
H
C
O
3-
Your Turn

52. Adequate
Breathing

54. INAdequate
Breathing

55. Shallow breathing

56. Irregular breathing Pattern

57. Preferential Positioning

58. Opening the Airway

59. Pursed Lip Breathing

60. Chest Wall Movement

61. Retractions

62. Assessing
Breathing

63. Assessment
of
Breath Sounds

64. Where to place Stethoscope

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

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

67. 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.

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

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

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

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

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

73. 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

90. Quantifying
Ventilation and
Oxygenation

91. Quantifying Respiration
Capnography
Gold standard to confirm
Tube placement

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

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

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

95. 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

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

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

98. Airway
Management

99. Positioning
The
Patient

100. Manual
airway
maneuvers

101. SUCTIONING

102. BLS
AIRWAY
DEVICES

103. AIRWAY
Obstructions

104. Supplemental
Oxygen

105. Supplemental
Oxygen
DEVICES

106. VENTILATORY
SUPPORT

107. CONTINUOUS
POSITIVE
AIRWAY
PRESSURE

108. GASTRIC
DISTENTION

109. SPECIAL
PATIENT
CONSIDERATIONS

110. ADVANCED
AIRWAY
MANAGEMENT

111. PREDICTING
THE
DIFFICULT
AIRWAY

112. PHARMACOLOGIC
ADJUNTS

113. ALTERNATIVE
AIRWAY
DEVICES

114. CRICOTHYROTOMY

115. RESPIRATORY
EMERGENCIES
Chapter 16
by
Michelle Prescott

116. Airway
Anatomy
REVIEW

117. Airway anatomy
Bronchus and Bronchi

118. Airway anatomy
MEDIASTINUM

119. Airway anatomy
PULMONARY BLOOD FLOW

120. Airway anatomy
Pulmonary Embolus

121. Airway anatomy
Pulmonary Embolus

122. Hypoventilation

123. 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

124. 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

125. Hyperventilation

126. Patient
Assessment

127. Scene
Size up

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

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

130. Primary
Assessment

131. Primary Assessment
General impression

132. Primary Assessment
General impression

133. Primary Assessment
General impression

134. Primary Assessment
General impression

135. Primary Assessment
General impression

136. Primary Assessment
General impression

137. Primary Assessment
General impression