Airway and Oxygen System Orientation

Objectives Breathing Respiratory Anatomy Assessment Rescue breathing Airway obstruction Oxygen delivery devices Suction

Breathing Why we breathe To bring oxygen into the body To expel carbon dioxide from the body Breathing is automatic

Clinical Death—The moment the breathing and heartbeat stop Brain Damage—within 4–6 minutes Biological Death—within 10 minutes Without oxygen, brain cells begin to die within 10 minutes. Cell death may begin in as little as 4 minutes.

Breathing How We Breathe: Inspiration: Rib and diaphragm muscles contract. Chest cavity expands. The volume inside each lung increases. The pressure inside each lung decreases. When the pressure inside the lungs becomes less than the pressure in the atmosphere, air rushes into the lungs. Diaphragm the dome-shaped muscle that separates the chest and abdominal cavities. It is the major muscle used in breathing. Inspiration refers to the process of breathing in.

Breathing How We Breathe: Inspiration is an active process. Expiration is a passive process. The volume of the chest cavity is increased by muscle contraction. This may sound backwards because contractions usually make things smaller. However, as the muscles between the ribs contract, they pull the front of the ribs up and out. When the diaphragm contracts, it flatten downward. Both actions result in an increase in the size and volume of the chest cavity.

Assessment Signs of Normal Breathing: Look for rise and fall of the chest. Listen for air moving: The sounds should be quiet like a soft breeze. No unusual sounds Feel for air moving. Observe skin color: Should not be pale or ashen Should not be tinted blue or gray Look at the lips, eyes, and nail beds As you approach a patient and form a general impression, you can quickly determine if he is comfortable and breathing normally or if he is distressed and having trouble breathing. As you perform an initial assessment of the patient, you will: • Look for the even and effortless rise and fall of the chest associated with normal breathing. • Listen for air entering and leaving the nose or mouth. The sounds should be quiet like a soft breeze (no gurgling, gasping, wheezing, or other unusual sounds). • Feel for air moving into and out of the nose or mouth. • Observe skin color. While every person's skin is a different color, the skin should not be pale or ashen or tinted blue or gray. Look for these signs especially around the lips and eyes and in the nail beds, where they will be obvious if the patient is not ventilating properly.

Assessment Signs of Inadequate Breathing: No chest movements, or uneven chest movements No air heard or felt at the nose or mouth Noisy breathing or gasping sounds Breathing that is irregular, too rapid, or too slow Breathing that is too shallow, or deep and labored A patient who has inadequate breathing will have the following signs and symptoms

Assessment Signs of Inadequate Breathing: Breathing that uses muscles in the upper chest and around the neck Nostrils that flare when breathing, especially in children Skin that is tinted blue, gray, or ashen Sitting or leaning forward in a tripod position

Normal Respiratory Rates Respirations: The normal respiratory rate for adults is 12–20 breaths per minute. > 28 or < 8 are considered serious. Newborn infants = 25–50 breaths per min. Up to 5 years old = 20–30 breaths per min. 5 to 12 years of age = 15–30 breaths per min.

Opening The Airway Repositioning the Head: The head-tilt, chin-lift maneuver, is used for ill or injured patients with no possibility of spinal injury. Used when no c-spine injury is suspected The jaw-thrust maneuver, is used for patients who have a mechanism of injury that indicates possible spinal injury. Used for those who have a suspected c-spine injury or in those who are unresponsive with mechanism of injury in which trauma is suspected Simply repositioning the head may be enough to open the airway. If the patient is lying down with his head on several pillows or up against some object with head flexed forward, tilt the head back slightly by removing pillows or repositioning him so that the head is not flexed forward. You may place one flat pillow beneath the patient's shoulders to help maintain the airway. A large fluffy pillow may open the airway too far (that is, it may hyperextend it). Patients under the influence of alcohol or drugs often have trouble holding a head position that will keep the airway open.

Airway Obstruction Causes of Airway Obstruction

Airway Obstruction Causes Tongue Epiglottis Foreign objects

Airway Obstruction Signs Snoring Gurgling Crowing Stridor Cyanosis Anxiety Labored breathing Inability to speak

Rescue Breathing Use personal protective equipment and barrier devices. One example of a barrier device is the pocket face mask.

Mouth-to-Mask Ventilation

Mouth to Mask Most effective technique Can be used with airway adjuncts

Mouth to Mask Problems Failure to maintain a tight seal Failure to tilt the head back to open the airway Failure to deliver enough breath to see the chest rise Providing breaths too quickly Failure to recognize airway obstruction

Bag-Valve-Mask (BVM) Ventilator Pediatric and adult BVM ventilators

Bag-Valve-Mask (BVM) Ventilator Hand positioning for using the BVM with a single rescuer

Aids to Resuscitation Oropharyngeal Airways

Aids to Resuscitation Select Oropharyngeal Airway

Aids to Resuscitation Another Way to Measure

Aids to Resuscitation Nasopharyngeal Airway

Aids to Resuscitation Determine Proper Size

Aids to Resuscitation Gently Advance Airway

Suction Systems Suctioning Techniques: USE PERSONAL PROTECTIVE EQUIPMENT. Never suction for longer than 15 seconds at a time. Measure the tip of the catheter from the patient’s earlobe to the corner of the mouth. Suction only as you remove the tip or catheter. REMAIN ALERT FOR THE PATIENT’S GAG REFLEX AND FOR SIGNS OF VOMITING.

Suction Systems Oxygen-powered suction unit Electrically-powered suction unit Portable hand-operated suction unit Portable electrical suction unit

Suction Systems Positioning a Rigid Pharyngeal (Throat) Tip

First Responder’s Role Dependent on local protocols: May require direct orders May be written as a standing order Do only what you have been trained to do. Basic life support is possible without equipment. If you are allowed to use equipment, you must maintain it and train with it.

Oxygen Therapy Equipment for Oxygen Therapy: Oxygen cylinder Pressure regulator Flowmeter Delivery device

An oxygen delivery system Oxygen Therapy An oxygen delivery system

Nasal cannula properly placed Oxygen Therapy Nasal cannula properly placed

Oxygen Therapy Non-rebreather mask

Check Your Understanding You are called for a 20 year-old male patient, struck by a car. You find the patient unresponsive. You do not see the patient’s chest rise when he breathes, but you hear gurgling from his airway. What airway control measures might you take for this patient?

Summary Breathing Respiratory Anatomy Assessment Rescue Breathing Airway Obstruction Aids to Resuscitation Suction Systems We breathe to bring in oxygen, remove carbon dioxide, and help regulate the pH level of our blood, a process called respiration. The major muscle of breathing, the diaphragm, and the muscles between our ribs contract to increase the volume of the chest cavity. Increased volume decreases the pressure in the chest cavity and allows the lungs to expand. As the lungs expand, the pressure inside decreases and allows air to fill the lungs. When we exhale, changes in chest size and pressure cause air in the lungs to flow out. All this is an involuntary, automatic process, which is mainly controlled by the respiratory centers of the brain. Clinical death occurs when an individual stops breathing and the heart stops beating. Biological death occurs when the brain cells start to die. Without oxygen, lethal changes take place in the brain cells within 4 to 6 minutes. Brain death may start within 10 minutes.

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CPR/AED & Cardiac Arrest

CPR/AED

CPR/AED “Hearts and Brains are going to die” Peter Safar MD EMS has the most opportunity to perform CPR, so we should be good at performing good, quality CPR

CPR/AED Why is CPR Important Studies have shown that the general population will start CPR only 1/3 of the time and only 15% of that total is done correctly

CPR/AED Lets look at the basics: The first step is to determine responsiveness, if no response open the airway, check for breathing, and determine if a pulse is present

CPR/AED Not Breathing and No Pulse: Give 2 breaths-enough to see the chest rise Give 30 chest compressions-allow for chest recoil between compressions Give 5 cycles of 30:2 before rechecking a pulse

CPR/AED Chest compressions and breaths are the same for adults, child, and infant Adult age starts at the onset of puberty (12-14 yoa) Child is age 1 – onset of puberty Infant is anyone under the age of 1, chest compressions are delivered using 2 fingers, and remember a full head tilt should not be given as you may obstruct the airway

CPR/AED The AED should be applied as soon as possible to the patients bare chest Make sure the pads adhere to the skin Remove all clothing from the area where the pads need to be placed Remove any medication patches from the area Shave any chest hair, the pads need to be on as much bare skin as possible If the patient has an implanted Pacemaker, place the pad at least an inch away

CPR/AED AEDs are set to correct the cardiac arrhythmias of V-Fib and V-Tach

CPR/AED While there are many styles of AEDs they all work the same. The first step is to turn the unit on and follow the voice prompts.

CPR/AED There are some safety considerations with the AED and Children: If the unit has child pads use these on children between the ages of 1-8. Never use child pads on an adult, the energy delivered by child pads is not enough for an adult, since the child pads reduce the energy from 200J to 50J AEDs should not be used on infants

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