Section 2: Airway

Chapter 6 Airway

Objectives (1 of 6) Name and label the major structures of the respiratory system. Describe the steps in performing the head tilt-chin maneuver. Relate mechanism of injury to opening the airway. Describe the techniques of suctioning.

Objectives (2 of 6) Describe how to artificially ventilate a patient with a pocket mask. Describe how to measure and insert an oropharyngeal (oral) airway. Describe how to measure and insert a nasopharyngeal (nasal) airway. Define the components of an oxygen delivery system.

Objectives (3 of 6) Identify a nonrebreathing face mask and state the oxygen flow requirements needed for its use. Describe the indications for using a nasal cannula versus a nonrebreathing face mask. Explain the rationale for basic life support, artificial ventilation, and airway protective skills taking priority over most other basic life support skills.

Objectives (4 of 6) Demonstrate the steps in performing the head tilt-chin lift maneuver. Demonstrate the steps in performing the jaw-thrust maneuver. Demonstrate the techniques of suctioning. Demonstrate the steps in providing mouth-to-mouth artificial ventilation with body substance isolation (barrier shields).

Objectives (5 of 6) Demonstrate how to use a pocket mask to artificially ventilate a patient. Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask device for one and two rescuers. Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask device while using the jaw-thrust maneuver.

Objectives (6 of 6) Demonstrate the correct operation of oxygen tanks and regulators. Demonstrate the use of a nonrebreathing face mask and state the oxygen flow requirements needed for its use. Demonstrate the use of a nasal cannula and state the flow requirement needed for its use.

Anatomy Review

Breathing Process: Inhalation Active part of breathing Diaphragm and intercostal muscles contract, allowing the lungs to expand. The decrease in pressure allows lungs to fill with air. Air travels to the alveoli where exchange of gases occurs.

Breathing Process: Exhalation Does not normally require muscular effort Diaphragm and intercostal muscles relax. The thorax decreases in size, and ribs and muscles assume their normal positions. The increase in pressure forces air out.

The Body’s Need for Oxygen

Gas Exchange Inhalation delivers oxygen-rich air to alveoli. Oxygen diffuses into the blood. Breathing is primarily adjusted by the level of carbon dioxide in the blood.

Hypoxia Signs: Nervousness, irritability, and fear Tachycardia Mental status changes Use of accessory muscles for breathing Difficulty breathing, possible chest pain

Conditions Resulting in Hypoxia Stroke Chest injury Shock Lung disease Asthma Myocardial infarction Pulmonary edema Acute narcotic overdose Smoke inhalation

Recognizing Adequate Breathing Normal rate and depth Regular pattern Regular and equal chest rise and fall Adequate depth

Normal Respiration Rates Adults 12 to 20 breaths/min Children 15 to 30 breaths/min Infants 25 to 50 breaths/min

Recognizing Inadequate Breathing Labored breathing Use of accessory muscles Pale or blue skin Cool, clammy skin Irregular respirations Abnormal lung sounds

Positioning an Unconscious Patient (1 of 3) Kneel beside the patient. Provide in-line cervical stabilization.

Positioning an Unconscious Patient (2 of 3) Turn patient by pulling the distant hip and shoulder. Control the head and neck so they move as a unit with the torso.

Positioning an Unconscious Patient (3 of 3) Roll onto backboard if available. Open patient’s airway and assess breathing.

Opening the Airway Head tilt-chin lift Nontrauma patients, medical patients Jaw-thrust Suspected spinal injury Head tilt-chin lift

Basic Airway Adjuncts (1 of 6) Oropharyngeal airways: Keep the tongue from blocking the upper airway Allow for easier suctioning of the airway Used in conjunction with BVM device Used on unconscious patients without a gag reflex

Basic Airway Adjuncts (2 of 6) Inserting an oropharyngeal airway 1. Select the proper size airway. 2. Open the patient’s mouth. 3. Hold the airway upside down and insert it in the patient’s mouth. 4. Rotate the airway 180° until the flange rests on the patient’s lips.

Basic Airway Adjuncts (3 of 6) 1 2 3

Basic Airway Adjuncts (4 of 6) Nasopharyngeal airways: Used on conscious patients who can’t maintain an airway Can be used on patients with a gag reflex Should not be used on patients with possible skull fractures

Basic Airway Adjuncts (5 of 6) Inserting a nasopharyngeal airway: 1. Select the proper size airway. 2. Lubricate the airway. 3. Gently push the nostril open. 4. With the bevel turned toward the septum, insert the airway.

Basic Airway Adjuncts (6 of 6) 1 2 3 4

Suctioning Equipment (1 of 2)

Suctioning Equipment (2 of 2) Tonsil-tip catheter French, or whistle-tip, catheter

Suctioning Technique Check the unit and turn it on. Select and measure the proper catheter to be used. Open the patient’s mouth and insert the tip. Suction as you withdraw the catheter. Never suction for more than 15 seconds.

Recovery Position

Supplemental Oxygen All patients in cardiac arrest should get oxygen. Any patient with a respiratory or cardiac emergency needs oxygen. Never withhold oxygen from anyone who may benefit from it.

Supplemental Oxygen Equipment Oxygen cylinders Available as a compressed gas Available in several sizes Pin-indexing safety system Oxygen regulators Humidified oxygen

Oxygen Flowmeters Pressure-compensated flowmeter Affected by gravity; must be kept upright Bourdon-gauge flowmeter Not affected by gravity; can be used in any position

Using Supplemental Oxygen (1 of 2) Inspect cylinder and markings. “Crack” the cylinder. Attach the regulator/flowmeter. Use proper seal. Open the cylinder. Attach proper delivery device to flowmeter.

Using Supplemental Oxygen (2 of 2) Adjust flowmeter to desired flow rate. Apply the oxygen device to the patient. When done, discard the delivery device. Turn off the flowmeter.

Hazards of Oxygen Oxygen supports combustion. Keep possible ignition sources away from the area. Oxygen tanks are under high pressure.

Oxygen Delivery Equipment Nonrebreathing mask Provides up to 90% oxygen Used at 10 to 15 L/min Nasal cannula Provides 24% to 44% oxygen Used at 1 to 6 L/min

Pulse Oximetry Evaluates the effectiveness of oxygenation Probe is placed on finger or earlobe. Pulse oximetry is a tool. Does not replace good patient assessment.

Artificial Ventilation One- or two-person bag-valve-mask (BVM) device Mouth-to-mask ventilation Oxygen-powered ventilation device

Rate of Artificial Ventilations Adults 1 breath every 5 seconds Children 1 breath every 3 seconds Infants 1 breath every 3 seconds

Mouth-to-Mask Technique (1 of 2) Kneel at patient’s head and open airway. Place the mask on the patient’s face. Take a deep breath and breathe into the mask for 2 seconds. Remove your mouth and watch for patient’s chest to fall.

Mouth-to-Mask Technique (2 of 2)

Bag-Valve-Mask Device Can deliver more than 90% oxygen Delivers less tidal volume than mouth-to-mask ventilation Requires practice to be proficient May be used with advanced airways

Bag-Valve-Mask Components Disposable self-refilling bag No pop-off valve (or capability of disabling the pop-off valve) Outlet valve Oxygen reservoir One-way, no-jam inlet valve system Transparent face mask Ability to perform under extreme environmental conditions

Two-Person BVM Technique (1 of 2) Insert an oral airway. One caregiver maintains seal while the other delivers ventilations. Place mask on patient’s face. Squeeze bag to deliver ventilations.

Two-Person BVM Technique (2 of 2)

One-Person BVM Technique

Cricoid Pressure Use on unconscious patients to prevent gastric distention. Place pressure on cricoid with thumb and index finger.

Flow-Restricted, Oxygen-Powered Devices

Flow-Restricted, Oxygen-Powered Devices Should not be used on infants and children or patients with suspected chest or neck injuries. Cricoid pressure will help reduce gastric distension. Use requires training and considerable practice.

Gastric Distention Artificial ventilation fills stomach with air. Occurs if ventilations are too forceful or too frequent or when airway is blocked May cause patient to vomit

Stomas and Tracheostomy Tubes Ventilations are delivered through the stoma. Attach BVM device to tube or use infant mask. Stoma may need to be suctioned.

Causes of Foreign Body Obstruction Relaxation of the tongue Vomited stomach contents Blood clots, bone fragments, damaged tissue Swelling caused by allergic reactions Foreign objects

Recognizing an Obstruction Obstruction may be partial or complete. Is patient able to speak or cough? If patient is unconscious, attempt to deliver artificial ventilation.

Removing an Obstruction Perform Heimlich maneuver. Use suction if needed. If attempts to clear the airway are unsuccessful, transport rapidly.

Dental Appliances Can be a source of airway obstructions. If loose, remove. Intact appliances help provide facial structure to assure face-to-mask seals. Periodically re-asses dental appliance placement.

Facial Bleeding Can be a challenging situation. Control bleeding with pressure and suction as needed.