emt 6/26
OPA indications and contraindications
to create or maintain a patent airway in an unconscious patient with no gag reflex any patient who has a gag reflex
two types of tips of suction
tonsil tip/rigid tip/Yankauers (measure like OPA) french/whistle tip catheter
assisted ventilation
usually for hyperventilations patients sync ventilations with inhalations after 5-10 breaths, deliver an appropriate tidal volume maintain adequate volume
types of regulaters/flow meters and requirements
yoke-type prssure reducing guage Bourdon guage pressure compensated flowmeter 2-25 L/min (usually we do 15)
side effects of albuterol
Hypertension, tachycardia, anxiety, restlessness
air we breathe in vs out concentration
In: 78% N 21% O2 1% other Out: 78% N 16% O2 5% CO2 1% other
NPA indications and contraindications
Indications: to create or maintain a patent airway in a semi conscious or unconscious patient with a gag reflex Contraindications: less than 12 mos of age (infants)
what do we change for OPQRST for resp. distress
Q: is it harder to breateh in or out R: observe rate, rhythm quality S: mild, moderate, or severe resp distress (ask and listen)
methods of ventilation in order of preference
mouth to mask when alone 2-person bmv device flow-restricted, oxygen powered device 1-person BMV technique
structure of upper airway
nasopharynx, oropharynx, laryngopharynx larynx epiglottis
we can assist with
nitroglycerin, metered dose inhaler, epi pen (LA and DOT)
indications for NBM
patients with adequate tidal volume and rate but actual or impending resp. failure patients with expected or confirmed exposure to toxins
COPD-E
pink puffers polycythemia - excess RBC (flush color) Barrel chest- air trapping + accessory muscle use pursed lip breathing - loss of lung elasticity and to avoid atelectasis (alveoily collapse) prone to spontaneous pneumo
inhalor administration instructions
room temp or warmer shake stop O2 exhale deeply hold as long as possible (or 10 sec) exhale through pursed lips check lung sounds 3 minutes after
Asthma vs. Anaphylaxis
skin signs! asthma- normal, just wheezing anaphylaxis - tachycardia, tachypnea, decreased BP, flush, hot, urticaria, wheezing, pruritis (itch), edema
what 5 things cause pulmonary edema
superheated gases, chemicals, pneumonia, left-sided heart problems, near-drowning
Measurement of NPA
measure from ant tragus/earlobe to side/tip/septum of nose eyeball nostril diameter or diameter of pinkey
Venturi mask
medium flow, blend ambient air, 24-40% O2, works on venturi principle
what is recovery position
modified left lateral w/leg up
COPD bronchitis
1. Blue Bloaters (cyanotic) 2. Large quantity of sputum 3. Productive cough 4. Destruction of cilia 5. Tend to be overweight Wheezing and rhonchi give high flow O2 and assist with inhaler if available
non rebreather mask textbook flow rate? delivers? putting on?
10-15 L/min up to 90% O2 inflate reservoir bag first
how long to suction
15 sec for adult 10 sec for pediatric 5 sec for infants
Nasal Canulla O2? flow rate? how to put on?
24-44% 1-6 L/min prongs point down (toward lungs)
normal breathing rates
Adult: 12-20 breaths per minute Child: 15-30 breaths per minute Infant: 25-50 breaths per minute
Albuterol: indications and contraindications
Asthma/difficulty breathing with wheezing patient unable to help coordinate inhalation, max dose prescribed per episode has been given
causes of blood clots mnemonic
BADPLRS Birth control, atrial fibrillation, deepn vein thrombrosis prolonged immobiloization, recent surgery long bone fracture sickle cell anemia
Wheezing: Rales: Rhonchi: Stridor: sound + causes
Wheezing: bronchial constrict-- anaphylaxis, asthma, COPD bronchitis Rales: pulmonary edema, fluid in base Rhonchi: infection of lower airway (course bubbling) Stridor: upper airway obstruction. Either mechanical or croup or epiglottitis
other drugs
activated charcoal narcan ASA epinephrine glucometer
pulmonary embolism signs and symptoms
acute dyspnea acute pleuritic pain (pinpoint) hemoptysis cyanosis tachypnea hypoxia
3 types of irregular breathing
ataxis (biot's) Cheyne-stokes (regularly irregular) Kussmaul breathing (deep, rapid breath) (DKA) (diabetics)
3 types of COPD
chronic bronchitis (air passages obstructed) , emphysema (alveoli damage), asthma (bronchial contriction)
cpap stands for
continuous positive airway pressure for pulmonary edema or severe brocho spasm
pleural effusion
diminished lung sound at base, clear up top collection of fluid on pleura causes dyspnea no moi normal skin signs
DICCE
drug/doctor/dose, integrity, clarity, color, expiration date
3 types of infections of airway and S+S
epiglottitis: 6mos-3years, bacterial, makes stridor sound, fever, chills, nausea, vomiting, drooling croup: 6mos-3y, viral. stridor, fever, chills, nausea, vomiting, barking seal (lower) pneumonia: bacteria, virus, fungi, parasites
3 ways to measure OPA
from angle of jaw to middle of mouth from anterior portion of tragus to corner of mouth from anterior portion of earlobe to corner of mouth
we can administer
glucose, oxygen
how to set up BMV
green end hooks to butt end red portion hooks up to christmas tree set 15 L/min hook mask to front end point part over nose, round end under lips CE grip with head hand
how do you try to open an airway
head tilt chin lift modified jaw thrust neutral sniffing
how to put in
hold it upside down and put in mouth rotate airway 180 degrees until flange rests on patients lips (or 90degree method) peds/infants goes straight in
how to put in
lubricate airway (lubricant or patient's saliva) open bigger nostril always have bevel side toward septum, insert twist if you get resistance have patient swallow during
