Lesson 10: Airway Management, Chapter 10 - EMT

Signs of normal (adequate) breathing for adult patients are as follows:

- A normal rate (between 12 & 20 breaths/min) - A regular pattern of inhalation & exhalation - Clear & equal lung sounds on both sides of the chest (bilateral). - Regular & equal chest rise & fall (chest expansion) - Adequate depth (tidal volume)

An inaccurate pulse oximetry reading may be caused by the following:

- Hypovolemia - Severe peripheral vasoconstriction (chronic hypoxia, smoking, or hypothermia). - Time delay in detecting respiratory insufficiency - Dark or metallic nail polish - Dirty fingers - Carbon monoxide poisoning

Hypoxic drive:

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases. - Hypoxic drive is typically found in end-stage COPD (Chronic Obstructive Pulmonary Disease).

Hypovolemic shock:

A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.

Hypoxia:

A dangerous condition in which the body's tissues & cells do not have enough oxygen.

Emphysema:

A disease of the lungs in which there is extreme dilation & eventual destruction of the pulmonary alveoli with poor exchange of oxygen & carbon dioxide; it is 1 form of chronic obstructive pulmonary disease (COPD).

Suction catheter:

A hollow, cylindrical device used to remove fluid from the patient's airway.

Surfactant:

A liquid protein substance that coats the alveoli in the lungs, decreases alveolar surface tension, & keeps the alveoli expanded; a low level in a premature infant contributes to respiratory distress syndrome.

Lactic acid:

A metabolic by-product of the breakdown of glucose that accumulates when metabolism proceeds in the absence of oxygen (anaerobic metabolism).

Which of the following conditions will affect the overall process of respiration? a) Environments with decreased amounts of ambient oxygen. b) A patient with a chronic lung condition, such as emphysema. c) A patient hiking at extremely high altitudes. d) All of these answers are correct.

d) All of these answers are correct.

Carina:

Point at which the trachea bifurcates (divides) into the left & right mainstem bronchi.

Signs of inadequate breathing in adult patients are as follows:

- Respiratory rate of fewer than 12 breaths/min or more than 20 breaths/min in the presence of shortness of breath (dyspnea). - Irregular rhythm, such as patient taking a series of deep breaths followed by periods of apnea (absence of spontaneous breathing). - Diminished, absent, or noisy auscultated breath sounds. - Reduced flow of expired air at the nose & mouth. - Unequal or inadequate chest expansion, resulting in reduced tidal volume. - Increased effort of breathing (use of accessory muscles). - Shallow depth (reduced tidal volume). - Skin that is pale, cyanotic (blue), cool, or moist (clammy). - Skin pulling in around the ribs or above the clavicles during inspiration (retractions).

Suctioning Equipment. A portable or fixed suctioning unit should be fitted with the following:

- Wide-bore, thick-walled, nonkinking tubing. - Plastic, rigid pharyngeal suction tips, called tonsil tips or Yankauer tips. - Nonrigid plastic catheters, called French or whistle-tip catheters. - A nonbreakable, disposable collection bottle. - Water for rinsing the tips. * Portable, hand-operated, & fixed (mounted) suctioning equipment is essential for resuscitation. * A fixed suctioning unit should generate airflow of more than 40 L/min & a vacuum of more than 300 mm Hg when the tubing is clamped.

Follow these general steps to operate the suction unit:

1. Check the unit for proper assembly of all its parts. 2. Turn on the suctioning unit & test it to ensure a vacuum pressure of more than 300 mm Hg. 3. Select & attach the appropriate suction catheter to the tubing. *NEVER suction the mouth or nose for more than 15 seconds for adult patients, 10 seconds for children, & 5 seconds for infants. *Suctioning removes oxygen from the airway along with the obstructive material & can result in hypoxia. Rinse the catheter & tubing with water to prevent clogging of the tube with dried vomitus or other secretions. Repeat suctioning ONLY after the patient has been adequately ventilated & reoxygenated. *Use extreme caution when suctioning a conscious or semiconscious patient. Put the tip of the suction catheter in only as far as you can visualize. Be aware suctioning may cause vomiting.

Normal respiratory rate ranges for children:

15 to 30 breaths/min

Normal respiratory rate ranges for infants:

25 to 50 breaths/min

Any time there are fluids in the airway, the risk of aspiration increases. Aspiration may increase the risk of mortality by _______ to ________.

30% to 70%

Homeostasis:

A balance of all systems of the body.

Pulmonary embolism:

A blood clot that breaks off from a large vein & travels to the blood vessels of the lung causing a sudden blockage of the pulmonary artery & an obstruction of blood flow.

Pulmonary edema:

A buildup of fluid in the lungs, usually as a result of congestive heart failure.

Hemothorax:

A collection of blood in the pleural cavity

Flail chest:

A condition in which 2 or more ribs are fractured in 2 or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage.

Capnography:

A noninvasive method to quickly & efficiently provide information on a patient's ventilatory status, circulation, & metabolism; effectively measures the concentration of carbon dioxide in expired air over time. - Capnography provides both a numerical reading & a graph, or real-time image, of the end-tidal carbon dioxide levels from breath to breath. - The digital display of end-tidal co2 is expressed in millimeters of mercury (mm Hg). - The normal range is 35 to 45 mm Hg. - Additionally, waveform capnography provides data that can be used to determine changes in cardiac output. It also offers the 1st indication of ROSC (Return Of Spontaneous Circulation) after a heart attack.

Superior:

Above a body part or nearer to the head.

Respiratory system:

All the structures of the body that contribute to the process of breathing, consisting of the upper & lower airways & their component parts.

Based on what you learned from the "Respiration 3D Medical Animation" video, where does diffusion take place?

Alveoli

Hypoglycemia:

An abnormally low blood glucose level.

Tension pneumothorax:

An accumulation of air or gas in the pleural space that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

Pulse oximetry:

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds. - The pulse oximeter provides a rapid, reliable, noninvasive, real-time indication of a patient's oxygenation status. - A pulse oximeter reading should NOT be the sole determinant of a patient's respiratory status. This value should be interpreted together with a full clinical assessment of the patient. - This device can be used to assess the adequacy of oxygenation during positive-pressure ventilation & assess the overall impact of interventions on your patient.

Pneumonia:

An infectious disease of the lung that damages lung tissue; its cause can be bacterial, viral, or fungal.

Open pneumothorax:

An open or penetrating chest wall wound through which air passes during inspiration & expiration, creating a sucking sound; also referred to as a sucking chest wound.

Pons:

An organ that lies below the midbrain & above the medulla & contains numerous important nerve fibers, including those for sleep, respiration, & the medullary respiratory center.

bronchoconstriction:

As the bronchioles constrict, air is forced through smaller lumens resulting in decreased ventilation.

Intrapulmonary shunting:

Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart.

Red blood cells:

Cells that carry oxygen to the body's tissues; also called erythrocytes.

Contraindications:

Conditions that make a particular medication or treatment inappropriate; for example, a condition in which a medication should not be given because it would not help or may actually harm a patient.

Kussmaul respirations:

Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin isn't available in the body. - Commonly seen in patients with metabolic acidosis.

Partial Pressure:

Describes the amount of gas in the air or dissolved in fluid, such as blood. - Partial pressure is measured in millimeters of mercury (mm Hg).

Ventilation:

Exchange of air between the lungs & the environment, spontaneously by the patient or with assistance from another person, such as an EMT.

Hypercarbia:

Increased carbon dioxide level in the bloodstream.

Ataxic respirations:

Irregular, ineffective respirations that may or may not have an identifiable pattern.

Tonsil tips:

Large, semirigid suction tips recommended for suctioning the pharynx; also called Yankauer tips. *Best kind of catheter for infants & children. The plastic tips have a large diameter & are rigid, so they don't collapse.

Chemoreceptors:

Monitor the levels of O2, CO2, hydrogen ions, & the pH of the cerebrospinal fluid & then provide feedback to the respiratory centers to modify the rate & depth of breathing based on the body's needs at any given time. - Central chemoreceptors in the medulla respond quickly to slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid. - Peripheral chemoreceptors, located in the carotid arteries & the aortic arch, are sensitive to decreased levels of oxygen in arterial blood as well as to low pH levels.

Agonal breaths:

Occasional, gasping breaths that occur after the heart has stopped; seen in dying patients. - They occur when the respiratory center in the brain continues to send signals to the respiratory muscles. These gasps do NOT provide adequate oxygen because they're infrequent, gasping respiratory efforts. - In patients with agonal gasps, you'll need to provide artificial ventilations &, most likely, chest compressions.

Lateral:

Parts of the body that lie farther from the midline; also called outer structures.

The actual exchange of oxygen & carbon dioxide in the alveoli as well as tissues of the body is called:

Respiration

Mottling:

Skin becoming marked with blotches of different colors.

Mediastinum:

Space within the chest that contains the heart, major blood vessels, vagus nerve, trachea, major bronchi, & esophagus; located between the 2 lungs.

Follow these steps to measure pulse oximetry:

Step 1: Clean patient's finger, & remove nail polish as needed. Place the index or middle finger into the pulse oximeter probe. Turn on the pulse oximeter, & note the LED reading of the Spo2. Step 2: Palpate the radial pulse to ensure that it correlates with the LED display on the pulse oximeter.

To position the unconscious patient in order to open the airway, follow these steps:

Step 1: Kneel beside patient. Make sure you kneel far enough away so that the patient, when rolled toward you, doesn't come to rest in your lap. Place your hands behind the patient's head & neck to provide in-line stabilization of the cervical spine as your partner straightens the patient's legs. Step 2: Have your partner place his/her hands on the patient's far shoulder & hip. Step 3: As you call the count to control movement, have your partner turn the patient toward you by pulling on the far shoulder & hip. Control the head & neck so that they move as a unit with the rest of the torso. In this way, the head & neck stay in the same vertical plane as the back. This single motion will minimize aggravation of any potential spine injury. At this point, apply a cervical collar. Place the patient's arms at his/her side. Step 4: Once the patient is positioned, maintain an open airway & check for breathing.

To properly suction a patient, follow these steps:

Step 1: Turn on the assembled suction unit. To test the suction, clamp the tubing, & make sure that the unit generates a vacuum of more than 300 mm Hg. Step 2: Measure the catheter to the correct depth by measuring the catheter from the corner of the patient's mouth to the edge of the earlobe or angle of the jaw. Step 3: Before applying suction, turn the patient's head to the side (unless you suspect cervical spine injury). Open the patient's mouth using the cross-finger technique or tongue-jaw lift, & insert the tip of the catheter to the depth measured. Do NOT suction while inserting the catheter. Step 4: Insert the catheter to the premeasured depth & apply suction in a circular motion as you withdraw the catheter. Do NOT suction an adult for more than 15 seconds.

Hemopneumothorax:

The accumulation of blood & air in the pleural space of the chest.

Inhalation:

The active, muscular part of breathing that draws air into the airway & lungs; also a medication delivery route.

Residual volume:

The air that remains in the lungs after maximal expiration.

Tidal Volume:

The amount of air (in mL) that is moved in or out of the lungs during 1 breath.

Vital capacity:

The amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible.

End-tidal CO2:

The amount of carbon dioxide present at the end of an exhaled breath. - Measured by capnometry & capnography devices.

Posterior:

The back surface of the body; the side away from you in the standard anatomic position.

metabolism (cellular respiration):

The biochemical processes that result in production of energy from nutrients within the cells.

Internal respiration:

The exchange of gases between the blood cells & the tissues.

External respiration:

The exchange of gases between the lungs & the blood cells in the pulmonary capillaries; also called pulmonary respiration.

Pulmonary circulation:

The flow of blood from the right ventricle through the pulmonary arteries & all of their branches & capillaries in the lungs & back to the left atrium through the venules & pulmonary veins; also called the lesser circulation.

Anterior:

The front surface of the body; the side facing you in the standard anatomic position.

The body's "backup system" of breathing is called:

The hypoxic drive

Alveolar minute volume:

The volume of air moved through the lungs in 1 minute minus the dead space; calculated by multiplying tidal volume (minus dead space) & respiratory rate.

Vasocontriction:

The narrowing of a blood vessel, such as with hypoperfusion or cold extremities.

Minute Volume:

The volume of air that moves in & out of the lungs per minute; calculated by multiplying the tidal volume & respiratory rate; also called minute ventilation.

Exhalation:

The passive part of the breathing process in which the diaphragm & the intercostal muscles relax, forcing air out of the lungs.

Respiration:

The physiologic process of exchanging oxygen & carbon dioxide, or, in the context of environmental emergencies, the loss of body heat as warm air in the lungs is exhaled into the atmosphere & cooler air is inhaled.

Diffusion:

The process in which molecules move from an area of higher concentration to an area of lower concentration

Oxygenation:

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs; the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream.

Alveolar ventilation:

The volume of air that reaches the alveoli; calculated by subtracting the amount of dead space air from the tidal volume.

Capillaries:

The small blood vessels that connect arterioles & venules; various substances pass through capillary walls, into & out of the interstitial fluid, & then on to the cells.

Visceral pleura:

Thin membrane that covers the lungs.

Parietal pleura:

Thin membrane that lines the chest cavity.

Based on what you learned from the "Respiration 3D Medical Animation" video, what is the function of the cartilage rings of the trachea?

To prevent the trachea from collapsing.

Cardiac arrest:

When the heart fails to generate effective & detectable blood flow; pulses aren't palpable in cardiac arrest, even if muscular & electrical activity continues in the heart.

Vasodilatory shock:

When the blood vessels suddenly relax, it results in vasodilation. In vasodilatory shock, the blood vessels are too relaxed leading to extreme vasodilation & blood pressure drops & blood flow becomes very low. Without enough blood pressure, blood & oxygen won't be pushed to reach the body's organs. - Also known as distributive shock. - In contrast to hypovolemic shock, vasodilatory shock is not determined by the amount of circulating blood, but by the size of the blood vessels. As the diameter of the blood vessels increases, the blood pressure in the circulatory system decreases. As the systemic blood pressure falls, oxygen isn't delivered effectively to the tissues.

The lungs consist of a mass of tissue. All of the following structures comprise that tissue EXCEPT: a) Pleura b) Bronchi c) Alveoli d) Bronchioles

a) Pleura

In the presence of oxygen, cells convert glucose into energy through a process known as:

aerobic metabolism

Emergency medical care includes:

airway management, supplemental oxygen, & ventilatory support.

Cheyne-Stokes respirations:

are an irregular respiratory pattern in which the patient breathes with an increasing rate & depth of respirations that's followed by a period of apnea, or lack of spontaneous breathing, followed again by a pattern of increasing rate & depth of respiration.

Based on what you learned from the "Respiration 3D Medical Animation" video, which of the following structures is the common passageway for air & food? a) Larynx b) Pharynx c) Nares d) Bronchi

b) Pharynx

Signs of adequate breathing in the adult include all of the following EXCEPT: a) Adequate depth b) Shallow chest rise c) A regular pattern of inhalation & exhalation d) A respiratory rate between 12 & 20 breaths/min.

b) Shallow chest rise

All of the following are INTRINSIC conditions that can cause significant restrictions to the ability to maintain an open airway, EXCEPT: a) Tongue obstruction. b) Allergic reaction. c) A broken jaw. d) Infections.

c) A broken jaw.

A respiratory range of 15 to 30 breaths/min is normal for ______________.

children.

Adult patients who are breathing slower (fewer than 12 breaths/min) than normal should be:

evaluated for inadequate breathing by assessing the depth of respirations. * Patients with shallow depth of breathing (reduced tidal volume) may require assisted ventilations, even if the respiratory rate is within normal limits.

Patients with a history of rheumatoid arthritis or Down syndrome are predisposed to instability of the cervical spine, specifically at the 1st & 2nd cervical vertebrae. The _____________________ maneuver should be avoided on these patients.

head tilt-chin lift - Excessive force or hyperextension of the neck can cause partial dislocation of the cervical spine, which can potentially lead to paralysis. It's often better to open the airway of these patients using a jaw-thrust maneuver.

Patients with inadequate breathing have inadequate minute volume & need to be treated _____________.

immediately. * This condition is most easily recognized in patients who are unable to speak in complete sentences when at rest or who have a fast or slow respiratory rate, both of which may result in a reduction in tidal volume.

Oxygen saturation (SpO2):

is the measure of the percentage of hemoglobin molecules that are bound in arterial blood.

When positioning an unconscious patient, you must make sure the patient is:

lying down, face up, on a firm, flat surface.

For proper respiration to take place at the cellular level, both:

oxygenation & perfusion need to function efficiently.

To open an airway obstruction caused by the tongue & throat muscles relaxing back into the airway, the EMT should:

perform the head tilt-chin lift maneuver.

A tonsil tip is best used for suctioning the:

pharynx

Nonrigid plastic catheters, sometimes called French or whistle-tip catheters, are used to:

suction the nose & liquid secretions in the back of the mouth & in situations in which you CANNOT use a rigid catheter, such as for a patient with a stoma.

Which structure prevents aspiration of food contents into the trachea?

the Epiglottis

The diaphragm & muscles of the chest wall are responsible for:

the regular rise & fall of the chest that accompany normal breathing.

Pleura:

the serious membranes covering the lungs & lining the thorax, completely enclosing a potential space known as the pleural space.

Pathophysiology:

the study of how disease processes affect the function of the body

Capnometry:

typically refers to a device that provides a digital numerical reading of the end-tidal co2 level - Also defined as: the use of a capnometer, a device that measures the amount of expired carbon dioxide.