Airway Chapter 6

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. 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. 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. 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 Not enough oxygen for metabolic needs Develops when patient is: –Breathing inadequately –Not breathing Not enough oxygen for metabolic needs Develops when patient is: –Breathing inadequately –Not breathing

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

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

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

Normal Respiration Rates Adults12 to 20 breaths/min Children15 to 30 breaths/min Infants25 to 50 breaths/min Adults12 to 20 breaths/min Children15 to 30 breaths/min Infants25 to 50 breaths/min

Recognizing Inadequate Breathing Fast or slow rate Irregular rhythm Abnormal lung sounds Reduced tidal volumes Use of accessory muscles Cool, damp, pale or cyanotic skin Fast or slow rate Irregular rhythm Abnormal lung sounds Reduced tidal volumes Use of accessory muscles Cool, damp, pale or cyanotic skin

Head Tilt–Chin Lift Kneel beside patient’s head. Place one hand on forehead. Apply backward pressure. Place tips of finger under lower jaw. Lift chin. Kneel beside patient’s head. Place one hand on forehead. Apply backward pressure. Place tips of finger under lower jaw. Lift chin.

Jaw-Thrust Maneuver Kneel above patient’s head. Place fingers behind angle of lower jaw. Use thumbs to position the lower jaw. Kneel above patient’s head. Place fingers behind angle of lower jaw. Use thumbs to position the lower jaw.

Assessment of the Airway

Assess whether breathing has returned using look, listen, and feel technique. –Listen by placing your ear about 10 inches above patient’s nose and mouth. –Feel and listen for movement of air. –Watch the patient’s chest and abdomen. –Place a hand on patient’s chest to feel for movement. Assess whether breathing has returned using look, listen, and feel technique. –Listen by placing your ear about 10 inches above patient’s nose and mouth. –Feel and listen for movement of air. –Watch the patient’s chest and abdomen. –Place a hand on patient’s chest to feel for movement.

Severe Airway Obstruction There will be no movement of air. Chest and abdomen may rise and fall with patient’s attempts to breathe. Chest wall movement alone does not indicate breathing. Always use three-part approach: look, listen, and feel for movement of air. There will be no movement of air. Chest and abdomen may rise and fall with patient’s attempts to breathe. Chest wall movement alone does not indicate breathing. Always use three-part approach: look, listen, and feel for movement of air.

Basic Airway Adjuncts

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 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

Inserting an oropharyngeal airway Select the proper size airway. Open the patient’s mouth. Hold the airway upside down and insert it in the patient’s mouth. Rotate the airway 180° until the flange rests on the patient’s lips. Inserting an oropharyngeal airway Select the proper size airway. Open the patient’s mouth. Hold the airway upside down and insert it in the patient’s mouth. Rotate the airway 180° until the flange rests on the patient’s lips.

Nasopharyngeal airways –Conscious patients who cannot maintain airway –Can be used with intact gag reflex –Should not be used with head injuries or nosebleeds Nasopharyngeal airways –Conscious patients who cannot maintain airway –Can be used with intact gag reflex –Should not be used with head injuries or nosebleeds

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. 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.

Suctioning

Suctioning Equipment

Suctioning Technique Check the unit and turn it on. Select and measure proper catheter to be used. Open the patient’s mouth and insert tip. Suction as you withdraw the catheter. Never suction adults for more than 15 seconds. Check the unit and turn it on. Select and measure proper catheter to be used. Open the patient’s mouth and insert tip. Suction as you withdraw the catheter. Never suction adults 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. 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 combustible gas –Available in several sizes –H, A, K –G –M –E –Super D –D –Pin-indexing safety system –Oxygen regulators –Humidified oxygen Oxygen cylinders –Available as a compressed combustible gas –Available in several sizes –H, A, K –G –M –E –Super D –D –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 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 Inspect cylinder and markings. “Crack” the cylinder. Attach the regulator/flowmeter. Open the cylinder. Attach proper delivery device to flowmeter. Adjust flowmeter to desired flow rate. Apply the oxygen device to the patient. When done, discard the delivery device. Turn off the flowmeter. Inspect cylinder and markings. “Crack” the cylinder. Attach the regulator/flowmeter. Open the cylinder. Attach proper delivery device to flowmeter. 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 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 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

Methods of Ventilation Mouth to mask Two-person BVM device Flow-restricted, oxygen-powered device One-person BVM device Mouth to mask Two-person BVM device Flow-restricted, oxygen-powered device One-person BVM device

Rate of Artificial Ventilations Adult — 1 breath every 5-6 seconds Children — 1 breath every 3-5 seconds Infants — 1 breath every 3-5 seconds Adult — 1 breath every 5-6 seconds Children — 1 breath every 3-5 seconds Infants — 1 breath every 3-5 seconds

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

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

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

One-Person BVM Technique

Flow-Restricted, Oxygen-Powered Devices

Ongoing Assessment of Ventilation Adequate Ventilation –Equal chest rise and fall –Ventilating at appropriate rate –Heart rate returns to normal Inadequate Ventilation –Minimal or no chest rise and fall –Ventilations too fast or slow –Heart rate does not return to normal Adequate Ventilation –Equal chest rise and fall –Ventilating at appropriate rate –Heart rate returns to normal Inadequate Ventilation –Minimal or no chest rise and fall –Ventilations too fast or slow –Heart rate does not return to normal

Sellick Maneuver Also referred to as cricoid pressure. Use on unconscious patients to prevent gastric distention. Place pressure on cricoid with thumb and index finger. Also referred to as cricoid pressure. Use on unconscious patients to prevent gastric distention. Place pressure on cricoid with thumb and index finger.

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 and increase risk of aspiration 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 and increase risk of aspiration

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. 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 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 mild or severe. Is patient able to speak or cough? If patient is unconscious, attempt to deliver artificial ventilation. Perform Heimlich maneuver. Use suction if needed. If attempts to clear the airway are unsuccessful, transport rapidly. Obstruction may be mild or severe. Is patient able to speak or cough? If patient is unconscious, attempt to deliver artificial ventilation. Perform Heimlich maneuver. Use suction if needed. If attempts to clear the airway are unsuccessful, transport rapidly.