The document discusses respiratory physiology and the pathophysiology of ventilation and respiration. It covers the anatomy and mechanics of the respiratory system, describing the four components of respiration: pulmonary ventilation, external respiration, internal respiration, and cellular respiration. Disruptions to ventilation or respiration can lead to cellular hypoxia, anaerobic metabolism, and organ dysfunction. Impaired pulmonary ventilation can result from interruptions to nervous control, thoracic damage, increased airway resistance, or loss of airway patency.

1. PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
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Prehospital Emergency Care, 10th
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Mistovich | Karren
TENTH EDITION
Part I
Airway Management,
Artificial Ventilation,
and Oxygenation
10

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Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 202

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Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to pages 202 and 203 of
your text to view the objectives for this
chapter.

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Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 203 of your text to
view the key terms for this chapter.

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Part I
• Respiration and Respiratory System
Review
• Airway Assessment
continued on next slide

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Part II
• Breathing Assessment
• Deciding to Ventilate
• Techniques of Artificial Ventilation
• Special Considerations
• Oxygen Therapy

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Case Study IntroductionCase Study Introduction
EMTs Chris Frost and Brittany Sullivan
arrive on the scene of a call for a, "sick
person, unknown problem," where they
immediately see a man in his 40s lying
on his right side on the floor. There is a
makeshift tourniquet beneath the man's
arm, and a hypodermic syringe and
needle lying next to him.
continued on next slide

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Case Study IntroductionCase Study Introduction
The patient is pale, with cyanosis of his
lips. He has very shallow, slow breathing,
and he has vomited.

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Case StudyCase Study
• What threats to the patient's life are
apparent so far?
• What do Chris and Brittany need to do
to intervene in the life threats?
• What equipment will the EMTs need to
carry out those interventions?

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IntroductionIntroduction
• An open airway, adequate ventilation,
and sufficient oxygenation are
necessary to sustain life.
• You must recognize when to intervene
to open and maintain the airway,
provide artificial ventilation, and
administer supplemental oxygen.

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RespirationRespiration
• Four components
 Pulmonary ventilation
 External respiration
 Internal respiration
 Cellular respiration
continued on next slide

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RespirationRespiration
• Pulmonary ventilation
 Mechanical process
 Air moves in and out of the lungs.
continued on next slide

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RespirationRespiration
• External respiration
 Gas exchange between alveoli and
pulmonary capillaries
 Oxygenates and removes carbon dioxide
from the lungs
continued on next slide

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RespirationRespiration
• Internal respiration
 Gas exchange between systemic
capillaries and cells
 Delivery of oxygen to the cells and
removal of carbon dioxide
continued on next slide

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RespirationRespiration
• Cellular respiration and metabolism
 Aerobic metabolism requires oxygen to
break down glucose to produce ATP.
 By-products of aerobic metabolism are
water and carbon dioxide.
continued on next slide

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Respiratory System ReviewRespiratory System Review
• Upper airway extends from nose and
mouth to the cricoid cartilage at the
inferior edge of the larynx.
• The tongue can obstruct the upper
airway in patients with altered mental
status.
continued on next slide

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Anatomy of the upper airway.

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Respiratory System ReviewRespiratory System Review
• The epiglottis protects the larynx.
 May fail to close in unresponsive
patients
 In altered mental status, relaxation of
muscles can cause the epiglottis to
obstruct the larynx.
continued on next slide

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The larynx. (a) Anterior view. (b) Posterior view.
continued on next slide

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Respiratory System ReviewRespiratory System Review
• The lower airway extends from the
cricoid cartilage to alveoli.
continued on next slide

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Anatomy of the lower airway.
continued on next slide

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Respiratory System ReviewRespiratory System Review
• The trachea divides into two mainstem
bronchi at the carina.
• The bronchioles contain smooth
muscle, which can contract and narrow
the air passages.
continued on next slide

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Respiratory System ReviewRespiratory System Review
• The lungs are surrounded by the
visceral and parietal pleura.
• The seal between the layers of pleura
must remain intact for ventilation to
occur.
• The diaphragm provides 60% to 70%
of the effort of breathing.
continued on next slide

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Click to indicate which process below involves theClick to indicate which process below involves the
exchange of gases between the capillaries andexchange of gases between the capillaries and
tissue cells.tissue cells.
Pulmonary ventilation
External respiration
Internal respiration
Metabolism

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Mechanics of VentilationMechanics of Ventilation
• Inhalation
 Active process
 External intercostal muscles and
diaphragm contract.
 Chest cavity increases in size.
 Pressure in the chest cavity decreases.
 Air is drawn in through the nose and
mouth.
continued on next slide

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Mechanics of VentilationMechanics of Ventilation
• Exhalation
 Passive process
 External intercostal muscles and
diaphragm relax.
 Chest cavity decreases in size.
 Pressure in the chest cavity increases.
 Air is forced out through the nose and
mouth.
continued on next slide

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Mechanics of ventilation: (a) inhalation; (b) exhalation.
continued on next slide

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Mechanics of VentilationMechanics of Ventilation
• Control of respiration
 Respiratory centers in the brainstem
receive input from chemoreceptors
about the levels of oxygen, carbon
dioxide and pH.
 The primary stimulus to breathe is
increased carbon dioxide in arterial
blood.
 Some COPD patients rely on a hypoxic
drive.

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Respiratory PhysiologyRespiratory Physiology
• Respiration is the process of gas
exchange.
• Oxygenation and removal of carbon
dioxide occur as a result of external
and internal respiration.
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Hypoxemia is a low oxygen content in
arterial blood that may occur from:
 Inadequate ventilation of alveoli despite
adequate lung perfusion
 Inadequate lung perfusion despite
adequate ventilation
 Combination of poor ventilation and
perfusion
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Hypoxia means inadequate oxygen is
being delivered to the cells. It may
occur from:
 Airway obstruction
 Inadequate breathing
 Shock
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Signs of mild to moderate hypoxia
 Tachypnea
 Dyspnea
 Pale, cool, clammy skin
 Tachycardia
 Elevation in blood pressure
 Restlessness and agitation
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Signs of severe hypoxia
 Tachypnea
 Dyspnea
 Cyanosis
 Tachycardia, dysrhythmias, bradycardia
 Severe confusion
continued on next slide

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Cyanosis at the (a) conjunctiva, (b) mucosa, (c) fingernail beds, (d) circumoral area.

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Respiratory PhysiologyRespiratory Physiology
• Signs of severe hypoxia
 Loss of coordination
 Sleepy appearance
 Head bobbing
 Slow reaction time
 Altered mental status
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• In infants and children, hypoxia may
result in bradycardia, instead of
tachycardia.
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Alveolar/capillary exchange
 Gases move from areas of higher
concentration to areas of lower
concentration.
 Carbon dioxide diffuses from the
capillaries into the alveoli.
 Oxygen diffuses from the alveoli into the
blood and is bound to hemoglobin.
continued on next slide

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Respiratory PhysiologyRespiratory Physiology
• Capillary/cellular exchange
 Blood entering capillaries is high in
oxygen, which diffuses into cells.
 Cells are high in carbon dioxide, which
diffuses into the blood.
continued on next slide

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(a) Alveolar/capillary gas exchange. Oxygen moves from the lung alveolus into the capillary. Carbon dioxide
moves from the capillary into the lung. (b) Capillary/cell gas exchange. Oxygen and nutrients move from the
capillary into the cell. Carbon dioxide and other wastes move from the cell into the capillary.

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Pathophysiology of Ventilation andPathophysiology of Ventilation and
RespirationRespiration
• Disturbance in ventilation or respiration
can lead to cellular hypoxia.
 Anaerobic metabolism results in:
• Insufficient energy production
• Buildup of lactic acid
• Cell dysfunction
continued on next slide

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Pathophysiology of Ventilation andPathophysiology of Ventilation and
RespirationRespiration
• Pulmonary ventilation may be impaired
by:
 Interruption of nervous control
 Damage to thorax
 Increased airway resistance
 Loss of airway patency
continued on next slide

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Pathophysiology of Ventilation andPathophysiology of Ventilation and
RespirationRespiration
• Gas exchange may be impaired by:
 Decreased ambient oxygen content
 Lung disease, drowning
 Toxic gases
continued on next slide

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Pathophysiology of Ventilation andPathophysiology of Ventilation and
RespirationRespiration
• Poor perfusion also leads to cellular
hypoxia. It may be caused by:
 Obstructed forward movement of blood
 Hypovolemia

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Airway Anatomy in Infants andAirway Anatomy in Infants and
ChildrenChildren
• Chest wall is pliable.
• Increased reliance on diaphragm.
• Lungs are easily overinflated in artificial
ventilation.
continued on next slide

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Comparison of airways of adult and infant or child.

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Airway Anatomy in Infants andAirway Anatomy in Infants and
ChildrenChildren
• Limited oxygen reserves
• High metabolic rate and oxygen needs
• Hypoxia is the most common cause of
cardiac arrest.

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Airway AssessmentAirway Assessment
• The airway and respiratory tract are the
conduit that allows air movement in
and out of the lungs.
• The airway must remain patent at all
times.
continued on next slide
continued on next slide

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Airway AssessmentAirway Assessment
• Any obstruction of the airway results in
less air movement and potential
hypoxia.
• The degree of the obstruction directly
affects the amount of air available for
gas exchange.
continued on next slide

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Airway AssessmentAirway Assessment
• Patients with altered mental status are
susceptible to airway obstruction and
aspiration.
• The airway may be obstructed by
injuries.
continued on next slide

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The airway can be blocked by injuries such as (a) burns or (b) soft tissue trauma.
continued on next slide

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Table 10-1 Signs of an Open Airway
continued on next slide

52. Prehospital Emergency Care, 10th
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Table 10-2 Signs of a Blocked or Inadequate Airway
continued on next slide

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Airway AssessmentAirway Assessment
• Abnormal upper airway sounds
 Snoring
 Crowing
 Gurgling
 Stridor
continued on next slide

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Airway AssessmentAirway Assessment
• You must open the mouth of an
unresponsive patient to assess the
airway.
• Clear the airway of liquids or foreign
bodies.
continued on next slide

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Airway AssessmentAirway Assessment
• Opening the airway
 Manual maneuvers
 Suction
 Mechanical airways
continued on next slide

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Airway AssessmentAirway Assessment
• Head-tilt, chin-lift maneuver
 Used when no spinal injury is suspected
 Used in unresponsive patients, cardiac
arrest
 Must be supplemented with a
mechanical airway if ineffective on its
own
continued on next slide

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(c) Head-tilt, chin-lift maneuver in the adult: neutral starting position. (d) Head-tilt, chin-lift maneuver in the
adult: final tilted position.
continued on next slide

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Airway AssessmentAirway Assessment
• Head-tilt, chin-lift in children
 Avoid overextension of the neck.
 It may be necessary to pad beneath the
shoulders.
continued on next slide

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Head-tilt, chin-lift maneuver in the infant. Be sure to avoid overextension.
continued on next slide

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Head-tilt, chin-lift maneuver in the infant. Be sure to avoid overextension.
continued on next slide

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In the supine position, an infant’s or child’s larger head tips forward, causing airway obstruction.
continued on next slide

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Placing padding under the patient’s back and shoulders will bring the airway to a neutral alignment.
continued on next slide

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Airway AssessmentAirway Assessment
• Jaw-Thrust Maneuver
 Used when spinal injury is suspected
 Allows neck to remain in neutral, in-line
position
continued on next slide

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The jaw-thrust maneuver is used to open the airway in patients with suspected spinal injury.
continued on next slide

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Jaw-thrust maneuver in an infant.
continued on next slide

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Airway AssessmentAirway Assessment
• Recovery position
 Used if a patient has an altered mental
status and is at risk of aspiration
 Contraindicated in suspected spinal
injury and patients who need positive
pressure ventilation
continued on next slide

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The modified lateral (recovery) position is used to help prevent aspiration in patients who do not have suspected
spinal injury.
continued on next slide

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Airway AssessmentAirway Assessment
• Suction
 Gurgling indicates liquid in the airway.
 Use suction to remove blood, vomitus,
secretions, and any other liquids, food
particles, or objects from the mouth and
airway.
continued on next slide

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Airway AssessmentAirway Assessment
• Standard Precautions during suctioning
 Protective eyewear
 Mask
 Gloves
 N-95 or HEPA respirator for suspected
tuberculosis
continued on next slide

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On-board suction unit.
continued on next slide

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Airway AssessmentAirway Assessment
• Suction equipment
 May be mounted in the ambulance or
portable
 Must generate enough vacuum and
airflow to clear the airway
 Must have wide-bore, thick tubing, a
collection bottle, and water supply
continued on next slide

72. Prehospital Emergency Care, 10th
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A portable suction unit.
continued on next slide

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A hand-powered suction device.
continued on next slide

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Airway AssessmentAirway Assessment
• Suction catheters
 Rigid catheter for suctioning the mouth
and oropharynx
• Used in unresponsive patients
• Insert only as far as you can see into the
mouth.
• Avoid touching the back of the
oropharynx.
continued on next slide

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Airway AssessmentAirway Assessment
• Suction catheters
 Soft catheter
• Can be used to suction nose or
nasopharynx
• Avoid inserting too far.
continued on next slide

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Airway AssessmentAirway Assessment
• Suctioning technique
 Assemble and turn on the suction unit.
 Measure and insert the catheter.
 Suction on the way out only.
 If possible, do not suction for more than
15 seconds at a time (5 seconds in
infants and children).
 Rinse the catheter.
continued on next slide

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EMT SKILLS 10-1
Suctioning Technique
continued on next slide

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Make sure the suction unit is properly assembled.
continued on next slide

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Measure the catheter from the corner of the mouth to the earlobe.
continued on next slide

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Open the patient's mouth and insert the catheter.
continued on next slide

81. Prehospital Emergency Care, 10th
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Apply suction as you withdraw the catheter.
continued on next slide

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Airway AssessmentAirway Assessment
• Special considerations in suctioning
 If there is too much to suction quickly,
roll the patient onto his side and
manually sweep the mouth.
 Alternate 15 seconds of suction with 2
minutes of ventilation for copious, frothy
secretions.
continued on next slide

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Airway AssessmentAirway Assessment
• Special considerations in suctioning
 Suctioning removes residual volume and
causes hypoxia.
 Oxygenate the patient and monitor the
heart rate and oxygenation.

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Case StudyCase Study
Before moving the patient to a supine
position, Chris quickly grabs the portable
suction unit and uses a rigid suction
catheter to clear the patient's mouth. The
EMTs log roll the patient, and Chris uses
a head-tilt, chin-lift to open the airway.
The patient's respiratory rate is 6 per
minute and his tidal volume is very
shallow.
continued on next slide

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Case StudyCase Study
• As Chris prepares to provide positive-
pressure ventilation, what airway
adjunct should he consider to assist in
keeping the patient's airway open?
• What are the advantages and
disadvantages of that choice?

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Airway AssessmentAirway Assessment
• Airway adjuncts
 Used in conjunction with manual airway
maneuvers
 Includes oropharyngeal and
nasopharyngeal airways
continued on next slide

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Airway AssessmentAirway Assessment
• The adjunct must be clean and clear of
obstructions.
• The proper size airway adjunct must be
selected.
• Airway adjuncts do not protect from
aspiration into the lungs.
continued on next slide

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Airway AssessmentAirway Assessment
• If the patient becomes more responsive
or gags, remove the airway adjunct.
• A head-tilt, chin-lift or jaw-thrust
maneuver must still be maintained.
continued on next slide

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Airway AssessmentAirway Assessment
• Oropharyngeal airways are used in
patients who are unresponsive, without
a gag reflex.
• The device must be sized properly.
continued on next slide

90. Prehospital Emergency Care, 10th
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Oropharyngeal (oral) airways.
continued on next slide

91. Prehospital Emergency Care, 10th
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EMT SKILLS 10-2
Inserting an Oropharyngeal Airway
continued on next slide

92. Prehospital Emergency Care, 10th
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Measure to ensure correct size.
continued on next slide

93. Prehospital Emergency Care, 10th
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Insert with tip pointing up toward roof of mouth.
continued on next slide

94. Prehospital Emergency Care, 10th
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Advance while rotating 180°.
continued on next slide

95. Prehospital Emergency Care, 10th
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Continue until flange rests on the teeth.
continued on next slide

96. Prehospital Emergency Care, 10th
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Oropharyngeal airway that is properly placed. The tongue is kept from falling back to occlude the patient’s airway.
continued on next slide

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The preferred method of inserting the oropharyngeal airway in the infant or child is to use a tongue blade to hold
the tongue forward and down toward the mandible as the airway is inserted.
continued on next slide

98. Prehospital Emergency Care, 10th
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Airway AssessmentAirway Assessment
• Nasopharyngeal airway
 Useful in patients with clenched teeth,
some facial injuries, and those unable to
tolerate an oropharyngeal airway
 Should not be used in a patient with
suspected fracture of the base of the
skull or severe facial trauma
continued on next slide

99. Prehospital Emergency Care, 10th
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Airway AssessmentAirway Assessment
• Nasopharyngeal airway
 May cause gagging or vomiting
 Does not prevent aspiration
 May cause trauma to nasal mucosa;
must be lubricated
continued on next slide

100. Prehospital Emergency Care, 10th
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Nasopharyngeal (nasal) airways.
continued on next slide

101. Prehospital Emergency Care, 10th
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EMT SKILLS 10-3
Inserting a Nasopharyngeal Airway
continued on next slide

102. Prehospital Emergency Care, 10th
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Measuring the nasopharyngeal airway.
continued on next slide

103. Prehospital Emergency Care, 10th
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Lubricate it with water-soluble lubricant.
continued on next slide

104. Prehospital Emergency Care, 10th
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Insert with the bevel toward the septum or base of the tonsil.

105. Prehospital Emergency Care, 10th
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Case Study ConclusionCase Study Conclusion
Chris selects and inserts an
oropharyngeal airway, and begins
positive pressure ventilation. The patient
vomits again, and Chris immediately
stops ventilating, as Brittany helps him
turn the patient onto his left side.
continued on next slide

106. Prehospital Emergency Care, 10th
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Case Study ConclusionCase Study Conclusion
Chris removes the oropharyngeal airway
and suctions the patient's mouth. As
Chris begins ventilations again, a second
crew arrives to assist with packaging and
transport.
continued on next slide

107. Prehospital Emergency Care, 10th
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Case Study ConclusionCase Study Conclusion
Chris continues airway management en
route to the emergency department.
Soon after arriving, Chris's suspicion that
the patient suffered a heroin overdose is
confirmed when the emergency
department staff administers naloxone, a
drug to counteract the effects of
narcotics. Within minutes, the patient is
awake and talking.

108. Prehospital Emergency Care, 10th
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Lesson SummaryLesson Summary
• Without an open airway and adequate
ventilation, patients rapidly deteriorate
and die.
• EMTs must quickly recognize an
inadequate airway and breathing and
immediately intervene.

109. PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
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Prehospital Emergency Care, 10th
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TENTH EDITION
Part II
Airway Management,
Artificial Ventilation &
Oxygenation
10

110. Prehospital Emergency Care, 10th
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Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 202

111. Prehospital Emergency Care, 10th
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Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to pages 202 and 203 of
your text to view the objectives for this
chapter.

112. Prehospital Emergency Care, 10th
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Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 203 of your text to
view the key terms for this chapter.

113. Prehospital Emergency Care, 10th
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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Part I
• Respiration and Respiratory System
Review
• Airway Assessment
continued on next slide

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Part II
• Breathing Assessment
• Deciding to Ventilate
• Techniques of Artificial Ventilation
• Special Considerations
• Oxygen Therapy

115. Prehospital Emergency Care, 10th
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Case Study IntroductionCase Study Introduction
EMTs Carlos Rivera and Alan Abrams are
caring for Mrs. Elena Diaz, who is 63
years old. Mrs. Diaz has COPD and
presents today with shortness of breath.
She can speak only a few words at time
before gasping for breath.

116. Prehospital Emergency Care, 10th
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Case StudyCase Study
• How will the EMTs determine the
severity of patient's difficulty
breathing? What will they be looking
for?
• How will the EMTs decide what
interventions the patient requires?

117. Prehospital Emergency Care, 10th
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IntroductionIntroduction
• An open airway, adequate ventilation,
and sufficient oxygenation are
necessary to sustain life.
• You must recognize when to intervene
to open and maintain the airway,
provide artificial ventilation, and
administer supplemental oxygen.

118. Prehospital Emergency Care, 10th
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Assessment of BreathingAssessment of Breathing
• After establishing a patent airway,
assess the adequacy of the patient's
breathing.
• Inadequate breathing leads to poor gas
exchange in the alveoli inadequate
oxygenation.
• Focus on both the rate of breathing and
the volume of each breath.
continued on next slide

119. Prehospital Emergency Care, 10th
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Assessment of BreathingAssessment of Breathing
• The relationship between the volume of
air breathed in, the respiratory rate,
and the volume of air that reaches the
alveoli is critical in determining if the
patient is breathing adequately.
continued on next slide

120. Prehospital Emergency Care, 10th
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Assessment of BreathingAssessment of Breathing
• Minute volume
 A function of both respiratory rate and
tidal volume
 A change in either respiratory rate or
tidal volume affects minute volume.
continued on next slide

121. Prehospital Emergency Care, 10th
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Assessment of BreathingAssessment of Breathing
• Alveolar ventilation is the amount of air
breathed in that reaches the alveoli.
• Dead air space does not change when
tidal volume decreases.
• Rapid respirations can decrease the
tidal volume.
continued on next slide

122. Prehospital Emergency Care, 10th
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Assessment of BreathingAssessment of Breathing
• Alveolar ventilation = (tidal volume –
dead space air) × respiratory rate

123. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Assess the rate, rhythm, quality, and
depth by looking, listening, feeling, and
auscultating.
continued on next slide

124. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Look
 Inspect the chest.
 Observe the patient's general
appearance.
 Determine if the breathing pattern is
regular or irregular.
 Look for nasal flaring.
continued on next slide

125. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Listen
 How many words are spoken at a time?
 How much air is moving during
exhalation?
 If tidal volume is inadequate, ventilate
the patient.
continued on next slide

126. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Feel
 For unresponsive patients, place your
ear near the patient's nose and mouth.
 How much air do you feel being exhaled
with each breath?
 If the tidal volume is inadequate,
ventilate the patient.
continued on next slide

127. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Auscultate
 Place your stethoscope at the second
intercostal space at the midclavicular
line.
 Listen to one full inhalation and
exhalation bilaterally.
 Breath sounds should be full and equal
on both sides.
continued on next slide

128. Prehospital Emergency Care, 10th
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Auscultation landmarks on the anterior and lateral chest.
continued on next slide

129. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Assess the following:
 Rate
 Rhythm
 Quality
 Depth
continued on next slide

130. Prehospital Emergency Care, 10th
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Table 10-3 Signs of Adequate Breathing
continued on next slide

131. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Breathing can be adequate, but if the
patient is working harder to breathe, he
is in respiratory distress.
continued on next slide

132. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Inadequate breathing leads to hypoxia.
• If breathing remains inadequate, the
brain begins to die within 4 to 6
minutes.
• Inadequate breathing can be
categorized as respiratory failure or
respiratory arrest.
continued on next slide

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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Patients with respiratory failure or
arrest require immediate positive
pressure ventilation.
continued on next slide

134. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Causes of respiratory arrest
 Stroke
 Myocardial infarction
 Drug overdose
 Toxic inhalation
 Electrocution
continued on next slide

135. Prehospital Emergency Care, 10th
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Assessing for Adequate BreathingAssessing for Adequate Breathing
• Causes of respiratory arrest
 Suffocation
 Traumatic injuries
 Infection of the epiglottis
 Airway obstruction
continued on next slide

136. Prehospital Emergency Care, 10th
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Table 10-4 Signs of Inadequate Breathing
continued on next slide

137. Prehospital Emergency Care, 10th
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Signs of inadequate breathing and severe respiratory distress.
continued on next slide

138. Prehospital Emergency Care, 10th
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Table 10-5 Making a Decision: Should I Assist
Ventilation or Apply Oxygen?

139. Prehospital Emergency Care, 10th
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Case StudyCase Study
Mrs. Diaz is appears fatigued and drowsy.
She has cyanosis of her lips and nail
beds, and the EMTs can hear wheezing
when she breathes, even without using a
stethoscope. Mrs. Diaz is breathing about
30 times per minute, but she is not
moving very much air with each breath
and she is using accessory muscles.
continued on next slide

140. Prehospital Emergency Care, 10th
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Case StudyCase Study
• Is Mrs. Diaz breathing adequately or
inadequately? Explain your answer.
• What intervention should Mrs. Diaz
receive?

141. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• There are physiological differences
between spontaneous breathing and
positive pressure ventilation.
continued on next slide

142. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• PPV does not rely on negative
pressure; air is forced into the alveoli.
• PPV increases airway wall pressure.
continued on next slide

143. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• PPV can overcome esophageal opening
pressure, leading to gastric distention.
• Negative pressure from spontaneous
breathing assists blood return to the
heart; PPV decreases cardiac output.
continued on next slide

144. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Basic considerations
 You must be able to maintain a good
mask seal.
 The device must deliver an adequate
volume of air to inflate the lungs.
 There must be a connection to allow
oxygen delivery while artificially
ventilating.
continued on next slide

145. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Standard Precautions
 Gloves
 Eyewear
 Face mask, for large amounts of blood
or secretions
 HEPA or N-95 respirator for suspected
tuberculosis
continued on next slide

146. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Adequate ventilation
 Sufficient rate (patients with a pulse)
• Newborns
• 40 to 60 times per minute
• Infants and children
• 12 to 20 times per minute, or once every
3 to 5 seconds
• Adults
• 10 to 12 times per minute, or once every
5 seconds
continued on next slide

147. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Adequate ventilation
 Sufficient rate (patients with a pulse)
• Deliver each breath over 1 second.
continued on next slide

148. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Adequate ventilation
 Sufficient rate (cardiac arrest)
• Perform ventilations in conjunction with
chest compressions.
• Infants, children and adults
• Ratio of 30 compressions to 2 ventilations
• Newborns
• Ratio of 3 compressions to 1 ventilation
continued on next slide

149. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Adequate ventilation
 Consistent tidal volume, sufficient to
cause chest rise
 Heart rate returns to normal.
 Color improves.
continued on next slide

150. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Inadequate ventilation
 Ventilation rate is too fast or too slow.
 The chest does not rise and fall.
 The heart rate does not return to
normal.
 Color does not improve.
continued on next slide

151. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Cricoid pressure is not recommended
for routine use, but can be used in
some situations.
 Adult intubation
 Pediatric patient when an extra EMT is
available
continued on next slide

152. Prehospital Emergency Care, 10th
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(a) and (b) Cricoid pressure.
continued on next slide

153. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Mouth-to-mouth ventilation
 Allows delivery of 16% oxygen
 A barrier device must be used.
 Form a seal around the patient's mouth
and pinch the nose.
 Mouth-to-nose ventilation can be used if
the patient's mouth cannot be opened.
continued on next slide

154. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Mouth-to-mask and bag-valve
ventilation
 Adjust the rate and volume based on:
• The patient's age
• Whether the patient has a pulse
• Whether the patient has an advanced
airway in place
 Avoid overventilation.
 Refer to text Table 10-6.
continued on next slide

155. Prehospital Emergency Care, 10th
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Artificial VentilationArtificial Ventilation
• Avoid gastric inflation.
 Leads to regurgitation and aspiration,
and impaired ventilation
 Reduce the tidal volume delivered and
use supplemental oxygen to maintain
oxygenation with a smaller tidal volume.
continued on next slide

156. Prehospital Emergency Care, 10th
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Mouth-to-Mask VentilationMouth-to-Mask Ventilation
• Advantages
 A single EMT can maintain a good seal
with the mask.
 Eliminates direct contact with the
patient
 One-way valve prevents exposure to the
patient's exhaled air.
continued on next slide

157. Prehospital Emergency Care, 10th
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Pocket mask with one-way valve and oxygen connection. (© Laerdal Medical Corporation).

158. Prehospital Emergency Care, 10th
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Mouth-to-Mask VentilationMouth-to-Mask Ventilation
• Advantages
 Provides adequate tidal volume
 Supplemental oxygen can be
administered.
continued on next slide

159. Prehospital Emergency Care, 10th
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Mouth-to-Mask VentilationMouth-to-Mask Ventilation
• Disadvantages
 The mask is perceived by some EMTs as
having an increased risk of infection.
 The EMT providing ventilation may
fatigue.
 Doesn't allow for the highest possible
concentration of oxygen to be delivered
continued on next slide

160. Prehospital Emergency Care, 10th
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Mouth-to-Mask VentilationMouth-to-Mask Ventilation
• Technique
 Connect mask to oxygen.
 Position yourself at the patient's head.
 Use a "C-E" technique to seal the mask
and perform a head-tilt, chin-lift.
 Blow into the ventilation port.
continued on next slide

161. Prehospital Emergency Care, 10th
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Figure 10-30 Mouth-to-mask ventilation. The mask should be connected to oxygen at a flow of 15 liters per
minute (lpm).

162. Prehospital Emergency Care, 10th
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Mouth-to-Mask VentilationMouth-to-Mask Ventilation
• Technique
 Modify technique for suspected spinal
injury.
 Recognize and correct ineffective
ventilations.
continued on next slide

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Bag-Valve-MaskBag-Valve-Mask
• Select the appropriate size and use
only enough volume to cause the chest
to rise.
• Two-person technique is preferred.
• Can deliver close to 100% oxygen
• May allow medication administration
• May allow end-tidal CO2 sampling
continued on next slide

164. Prehospital Emergency Care, 10th
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(a) Bag-valve-mask unit with oxygen bag reservoir. Tubing-type reservoirs are also available. (b) Adult, child, and
infant bag-valve-mask units.
continued on next slide

165. Prehospital Emergency Care, 10th
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Always use the proper size mask. It should fit securely over the bridge of the nose and in the cleft above the chin.
continued on next slide

166. Prehospital Emergency Care, 10th
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Bag-Valve-MaskBag-Valve-Mask
• Technique
 Use a head-tilt, chin-lift.
 Select the correct-size mask and bag-
valve device.
 Position the mask, use an "E-C"
technique.
 A second EMT squeezes the bag.

167. Prehospital Emergency Care, 10th
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Adequate artificial ventilation with good alveolar ventilation.
continued on next slide

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Bag-Valve-MaskBag-Valve-Mask
• Technique
 Modify technique for suspected spinal
injury.
 Recognize and correct ineffective
ventilations.
continued on next slide

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Two-person bag-valve-mask method.
continued on next slide

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EMT SKILLS 10-5
In-Line Stabilization During Bag-Valve
Ventilation
continued on next slide

171. Prehospital Emergency Care, 10th
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Technique for one EMT to maintain in-line stabilization while performing one-person bag-valve-mask ventilation.

172. Prehospital Emergency Care, 10th
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Technique for two EMTs to maintain in-line stabilization while performing bag-valve-mask ventilation.

173. Prehospital Emergency Care, 10th
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Alternative technique for two EMTs to maintain in-line stabilization while performing bag-valve-mask ventilation.

174. Prehospital Emergency Care, 10th
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FROPVDFROPVD
• Flow-restricted, oxygen-powered
ventilation device
• A manually triggered ventilation device
• Delivers 100% ventilation
• Can be used by one EMT using a two-
handed technique to seal the mask
• Only for adult patients
continued on next slide

175. Prehospital Emergency Care, 10th
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FROPVDFROPVD
• Technique
 Check the unit and oxygen source.
 Open the airway and establish a seal
with the mask.
 Depress the trigger; release it as the
chest begins to rise.

176. Prehospital Emergency Care, 10th
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(a) A flow-restricted, oxygen-powered ventilation device on a patient with no suspected spine injury. (b) A flow-
restricted, oxygen-powered ventilation device on a patient with a suspected spine injury.

177. Prehospital Emergency Care, 10th
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Automatic Transport VentilatorAutomatic Transport Ventilator
• Advantages
 Can deliver consistent rate and tidal
volume
 Delivers 100% oxygen
 Lower risk of gastric distention
continued on next slide

178. Prehospital Emergency Care, 10th
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Automatic Transport VentilatorAutomatic Transport Ventilator
• Advantages
 EMT can use both hands to seal the
mask.
 Allows specific tidal volumes and rates
 Alarms indicate low pressure and
disconnection.
continued on next slide

179. Prehospital Emergency Care, 10th
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Automatic Transport VentilatorAutomatic Transport Ventilator
• Disadvantages
 Requires oxygen source to operate
 Some ATVs cannot be used in small
children.
 Inability to feel lung compliance
continued on next slide

180. Prehospital Emergency Care, 10th
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An automatic transport ventilator.

181. Prehospital Emergency Care, 10th
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Automatic Transport VentilatorAutomatic Transport Ventilator
• Technique
 Check the device.
 Seal the mask to the face.
 Select the tidal volume and rate.
 Observe for adequate chest rise and fall.
 Recognize and correct ineffective
ventilations.

182. Prehospital Emergency Care, 10th
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Ventilating a SpontaneouslyVentilating a Spontaneously
Breathing PatientBreathing Patient
• Recognize the need to ventilate a
patient who is breathing, but breathing
inadequately.
• Complications include uncooperative
patients, inadequate mask seal, and
overinflation of the lungs.
continued on next slide

183. Prehospital Emergency Care, 10th
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Ventilating a SpontaneouslyVentilating a Spontaneously
Breathing PatientBreathing Patient
• Explain the procedure to the patient.
• Ventilate to achieve the normal rate
and/or tidal volume.

184. Prehospital Emergency Care, 10th
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CPAPCPAP
• Continuous positive airway pressure
• A form of noninvasive positive pressure
ventilation
• Used in awake, spontaneously
breathing patients who need ventilatory
support
continued on next slide

185. Prehospital Emergency Care, 10th
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CPAP is a form of noninvasive positive pressure ventilation used in the awake and spontaneously breathing
patient who needs ventilatory support. CPAP on an adult. (Photo: © Ken Kerr).

186. Prehospital Emergency Care, 10th
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CPAP on a child.

187. Prehospital Emergency Care, 10th
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CPAPCPAP
• CPAP can help avoid the need for
endotracheal intubation in some
patients.
• Oxygen should be titrated to the
patient's SpO2 reading, and signs and
symptoms.
continued on next slide

188. Prehospital Emergency Care, 10th
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CPAPCPAP
• Positive pressure is measured in cmH2O.
• Positive pressure helps inflate collapsed
alveoli and improve oxygenation.
• Decreases the work of breathing
• Helps displace fluid in alveoli in left
ventricular failure
continued on next slide

189. Prehospital Emergency Care, 10th
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CPAPCPAP
• Delivered at 2 to 20 cmH2O, but most
orders do not exceed 10 cmH2O
• Begin at the lowest setting and titrate.
continued on next slide

190. Prehospital Emergency Care, 10th
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CPAPCPAP
• Patient criteria
 Awake and can obey commands
 Can maintain his airway
 Breathing on his own, respiratory rate
>25/min.
 Has signs and symptoms of moderate to
severe respiratory distress, or early
respiratory failure
continued on next slide

191. Prehospital Emergency Care, 10th
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CPAPCPAP
• Indications
 Congestive heart failure
 Pulmonary edema
 COPD
 Asthma
 Pneumonia
continued on next slide

192. Prehospital Emergency Care, 10th
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CPAPCPAP
• Contraindications
 Apnea or agonal respirations
 Inability to follow commands
 Inability to maintain an airway
 Unresponsive
 Shock with cardiac insufficiency
 Cardiac arrest
 Vomiting
continued on next slide

193. Prehospital Emergency Care, 10th
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CPAPCPAP
• Contraindications
 Upper GI bleeding
 Pneumothorax or chest trauma
 Tracheotomy
 Facial trauma
 Increased intrathoracic pressure
continued on next slide

194. Prehospital Emergency Care, 10th
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CPAPCPAP
• Procedure
 Inform and coach the patient.
 Minimize the patient's anxiety.
 Obtain vital signs and SpO2.
 Have an adequate oxygen supply.
 Place the patient in seated or semi-
Fowler's position.
continued on next slide

195. Prehospital Emergency Care, 10th
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CPAPCPAP
• Procedure
 Assemble and check the device.
 Secure the mask with straps.
 Increase pressure in increments of 2
cmH2O.
 Continue to coach the patient.
continued on next slide

196. Prehospital Emergency Care, 10th
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CPAPCPAP
• Procedure
 Do not discontinue CPAP unless
contraindications arise or you are
advised by medical direction.
 Notify the receiving facility so they can
prepare to transfer CPAP.
continued on next slide

197. Prehospital Emergency Care, 10th
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CPAPCPAP
• Assess effectiveness with these
measures:
 Respiratory rate
 Heart rate
 Systolic blood pressure
 Oxygen saturation
 End-tidal CO2
 Complaint of dyspnea
continued on next slide

198. Prehospital Emergency Care, 10th
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CPAPCPAP
• Monitor for:
 Pneumothorax
 Gastric distention
 Vomiting
 Worsening of respiratory distress or
failure
 Decreased mental status
 Intolerance of the device

199. Prehospital Emergency Care, 10th
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Hazards of OverinflationHazards of Overinflation
• Overinflation leads to serious
complications.
 In cardiac arrest, perfusion is
decreased.
 In spontaneously breathing patients,
return to the left ventricle can be
reduced.

200. Prehospital Emergency Care, 10th
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Case StudyCase Study
The EMTs quickly decide to assist Mrs.
Diaz's ventilations with a bag-valve-mask
device. Alan explains to her what they
are going to do as Carlos prepares the
equipment.
continued on next slide

201. Prehospital Emergency Care, 10th
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Case StudyCase Study
• What should be the goals for the depth
and rate of ventilation for Mrs. Diaz?
• What complications should the EMTs
anticipate?
• How will the EMTs know if the assisted
ventilations are effective?

202. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• A stoma may indicate a tracheostomy,
which may be temporary.
• A tracheostomy tube may be placed in
the stoma.
• A stoma also may indicate a partial or
total laryngectomy.
continued on next slide

203. Prehospital Emergency Care, 10th
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A stoma is a surgical opening in the front of the neck.
continued on next slide

204. Prehospital Emergency Care, 10th
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The neck breather's airway has been changed by surgery.
continued on next slide

205. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• A bag-valve device can connect to a
tracheostomy tube.
• If there is not a tracheostomy tube,
place a mask over the stoma to provide
bag-valve ventilations.
continued on next slide

206. Prehospital Emergency Care, 10th
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Artificial ventilation can be accomplished in the patient with a tracheostomy tube by attaching the bag-valve-mask
device directly to the tube.
continued on next slide

207. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• It may be necessary to suction the
stoma.
• It may be necessary to seal the mouth
and nose.
continued on next slide

208. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Infants and children
 Place the infant's head in a neutral
position.
 Avoid excessive volumes and pressures
with ventilation.
 Use a BVM with minimum 450 to 500
mL volume and without a pop-off valve.
continued on next slide

209. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Infants and children
 If manual airway maneuvers are not
effective, use an oropharyngeal or
nasopharyngeal airway.
 Ventilate at 12 to 20/min., or once every
3 to 5 seconds.
continued on next slide

210. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Facial injuries
 Swelling can occlude the airway.
 Use an airway adjunct if needed.
 Avoid a nasopharyngeal airway in
patients with mid-face trauma.
 Bleeding may require frequent
suctioning.
continued on next slide

211. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Foreign body airway obstruction
 If a patient is choking but is effectively
moving air, instruct him to cough;
administer high-concentration oxygen.
 If air exchange is poor, manage as for a
complete airway obstruction.
continued on next slide

212. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Foreign body airway obstruction
 For a child or adult, perform abdominal
thrusts for complete airway obstruction.
 For an infant, perform chest thrusts and
back blows for a complete airway
obstruction.
continued on next slide

213. Prehospital Emergency Care, 10th
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Special Considerations in AirwaySpecial Considerations in Airway
Management and VentilationManagement and Ventilation
• Dental appliances
 Manage in place when dentures are
secure.
 If dentures are loose, remove them.

214. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• 100% oxygen is stored in cylinders.
• Cylinder volume varies.
• Pressure in a full cylinder is 2,000 psi.
• For long transports, calculate the
duration of flow for the cylinder.
continued on next slide

215. Prehospital Emergency Care, 10th
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Table 10-7 Oxygen Duration

216. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Safety precautions
 Never allow combustible materials such
as oil or grease to touch the cylinder,
regulator, fittings, valves, or hoses.
 Never allow smoking near oxygen
cylinders.
 Store cylinders below 125°F.
continued on next slide

217. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Safety precautions
 Never use without a properly fitting
regulator.
 Keep all valves closed when the cylinder
is not in use.
 Keep cylinders secured.
 Do not place your body over the cylinder
valve.
continued on next slide

218. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Pressure regulators
 Reduce the pressure in the cylinder to a
safe range and control the flow of
oxygen.
 A therapy regulator delivers oxygen
from 0.5 to 25 lpm.
continued on next slide

219. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Oxygen humidifiers
 Oxygen leaving the cylinder is dry,
which can be irritating to the respiratory
tract.
 An oxygen humidifier can add moisture
to the oxygen.
 Generally used for long-term therapy
continued on next slide

220. Prehospital Emergency Care, 10th
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An oxygen humidifier.

221. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Indications for oxygen use
 Cardiac or respiratory arrest
 Any patient receiving positive pressure
ventilation
 Signs of hypoxia and adequate
respirations
 SpO2 of less than 94%
continued on next slide

222. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Indications for oxygen use
 Any medical condition that may cause
hypoxia
 Altered mental status or
unresponsiveness
 Injuries to a body cavity or the central
nervous system
 Multiple fractures or soft tissue injuries
continued on next slide

223. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Indications for oxygen use
 Severe external or internal bleeding
 Any evidence of shock
 Exposure to toxins
continued on next slide

224. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• When in doubt, give oxygen.
• Never withhold oxygen from a patient
who needs it!
continued on next slide

225. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Determine the patient's breathing
status to decide how to supply the
oxygen.
• If either the respiratory rate or tidal
volume is inadequate, provide positive
pressure ventilation.
• A mask or nasal cannula is used for
patients with adequate breathing.
continued on next slide

226. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Hazards
 Oxygen toxicity is rare, but can happen
over long periods of time.
 Damage to the retina can occur in
premature newborns with excessive
oxygen administration.
 Respiratory depression may occur in
some COPD patients.
continued on next slide

227. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Clinical decision making
 Too much oxygen can worsen conditions
such as ischemic stroke and acute
coronary syndrome.
 Such patients should only receive
oxygen if they have evidence of hypoxia
or dyspnea, or an SpO2 <94%.
 Begin administration at 2 to 4 lpm by
nasal cannula.
 Always follow protocols. continued on next slide

228. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Administer supplemental oxygen if any
of the following are present:
 SpO2 <94%
 Dyspnea or respiratory distress
 Signs of poor perfusion
 Signs of heart failure
 Suspected shock
 Whenever hypoxia or hypoxemia is
suspected
continued on next slide

229. Prehospital Emergency Care, 10th
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Click on the condition that is NOT an indicationClick on the condition that is NOT an indication
for the administration of supplemental oxygen.for the administration of supplemental oxygen.
Acute coronary syndrome
Severe bleeding
SpO2 of 90%
A patient with a stab
wound to the chest
continued on next slide

230. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Procedures for initiating oxygen
administration
continued on next slide

231. Prehospital Emergency Care, 10th
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EMT SKILLS 10-7
Initiating Oxygen Administration

232. Prehospital Emergency Care, 10th
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Identify the cylinder as oxygen and remove the protective seal.

233. Prehospital Emergency Care, 10th
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Crack the main cylinder for 1 second to remove dust and debris.

234. Prehospital Emergency Care, 10th
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Place the yoke of the regulator over the cylinder valve and align the pins.

235. Prehospital Emergency Care, 10th
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Hand-tighten the T-screw on the regulator.

236. Prehospital Emergency Care, 10th
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Open the main cylinder valve to check the pressure.

237. Prehospital Emergency Care, 10th
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Attach the oxygen delivery device to the regulator.

238. Prehospital Emergency Care, 10th
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Adjust the flowmeter to the appropriate liter flow.

239. Prehospital Emergency Care, 10th
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Apply an oxygen device to the patient.

240. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• When terminating oxygen therapy or
transferring from one oxygen source to
another, first remove the mask from
the patient before turning off the
oxygen or disconnecting the oxygen
tubing.
continued on next slide

241. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• A nonrebreather mask is used to
deliver a high concentration of oxygen.
• The flow rate is usually 15 lpm.
• Always keep the reservoir bag inflated.
continued on next slide

242. Prehospital Emergency Care, 10th
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Nonrebreather mask.
continued on next slide

243. Prehospital Emergency Care, 10th
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Cutaway view of nonrebreather mask.
continued on next slide

244. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• A nasal cannula is used to deliver a
lower concentration of oxygen.
• The flow rate is between 1 lpm and 6
lpm.
continued on next slide

245. Prehospital Emergency Care, 10th
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Nasal cannula.
continued on next slide

246. Prehospital Emergency Care, 10th
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Cutaway view of nasal cannula.
continued on next slide

247. Prehospital Emergency Care, 10th
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Oxygen TherapyOxygen Therapy
• Other oxygen delivery devices
 Simple face mask
 Partial rebreather mask
 Venturi mask
 Tracheostomy mask
continued on next slide

248. Prehospital Emergency Care, 10th
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Simple face mask.
continued on next slide

249. Prehospital Emergency Care, 10th
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Partial rebreather mask.
continued on next slide

250. Prehospital Emergency Care, 10th
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Venturi mask.

251. Prehospital Emergency Care, 10th
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Case Study ConclusionCase Study Conclusion
Carlos attaches supplemental oxygen to
the bag-valve-mask device at a flow rate
of 15 lpm. He assists Mrs. Diaz's
respirations 16 times per minute,
assisting every other breath with a tidal
volume of approximately 600 mL. En
route to the hospital, Mrs. Diaz's
respiratory rate and heart rate decrease,
and her SpO2 increases from 88% to
94%. continued on next slide

252. Prehospital Emergency Care, 10th
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Case Study ConclusionCase Study Conclusion
The EMTs release Mrs. Diaz to the care of
the emergency department staff.
Following stabilization in the ED, Mrs.
Diaz is admitted to the hospital for
treatment of the exacerbation of her
COPD.
The EMTs write their report, clean the
ambulance, and replace supplies in
preparation for the next call.

253. Prehospital Emergency Care, 10th
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Lesson SummaryLesson Summary
• Without an open airway and adequate
ventilation, patients rapidly deteriorate
and die.
• EMTs must quickly recognize an
inadequate airway and breathing and
immediately intervene.