1. Airway and Respiratory Emergencies

2. Anatomy of the Respiratory System

3. Anatomy of the Upper Airway Nasopharynx –Formed by the union of facial bones –Warms and humidifies air as it enters the body

4. Anatomy of the Upper Airway

6. Ventilation, Oxygenation, and Respiration

7. Inspiration Exhalation

8. Respiration External respiration (pulmonary respiration) –Breathes fresh air into respiratory system –Exchanges oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries

9. Respiration Internal respiration –Exchange of oxygen and carbon dioxide between systemic circulatory system and cells

10. Respiration

11. Regulation of Ventilation Pulmonary Ventilation is simply the movement of air into and out of the lungs. Body is a constantly changing environment Chemoreceptors monitor bodies CO2 levels and adjust respirations to correct highs and lows. Hypoxic drive is back-up system if normal system breaks down. (COPD)

12. Chief Complaint SOB Common EMS Response Initial Assessment –Appearance –LOC –ABCs

13. Signs of Adequate Breathing Normal Rate 12 – 20 breaths/min Regular pattern, with smooth flow of air Clear and equal breath sounds bilaterally Regular and equal chest rise and fall Adequate depth (tidal Volume)

14. Signs of Inadequate Breathing Labored breathing Altered LOC Respiratory rate less than 12 or greater than 20 with dyspnea Irregular Rhythm (Cheyne Stokes, Kussmaul, Ataxic pattern) Unequal chest expansion. Shallow breathing Skin Condition Retractions

15. Factors Effecting Respiration External factors –Elevation –Oxygen levels –Toxic chemicals –Confined Spaces Internal Factors –Medical conditions –Non functioning Alveoli –Fluid in lungs –Circulatory problems –Metabolic problems

16. Foreign Body Obstruction Partial –If able to talk or cough forcefully allow person to attempt to relieve on their own. –If poor air exchange and weak cough provide immediate intervention Complete –Abdominal thrusts –If pulseless and apneic begin CPR. –Use tongue jaw lift and check back of oropharynx for foreign body –No blind finger sweeps

17. Other Obstructions Dental Appliances –If well fitting and in place leave in –If loose remove to prevent obstruction Facial injuries –Blood may need to be suctioned –Broken teeth removed

18. Oxygen Delivery Nasal Cannula –1- 6 lpm 24%-44% Non Rebreather –10 -15 lpm up to 90% Bag Mask with reservoir –15 lpm 100% Mouth to Mask –15 lpm 55%

19. Ventilation Rates Adults –1 breath every 5 - 6 seconds Children and Infants –1 breath every 3 - 5 seconds

20. CPAP Mechanism –Increases pressure in the lungs –Opens collapsed alveoli –Pushes more oxygen across the alveolar membrane –Forces interstitial fluid back into the pulmonary circulation –Therapy is delivered through a face mask held to the head with a strapping system. –Use caution with patients with potentially low blood pressure.

21. CPAP Indications –Awake & Alert –Over 12 –Patent airway GCS>10 –BP above 90 systolic –2 of following Retractions/Accessory muscle use Respiratory rate >24 Pulse Ox <92% Inability to speak in complete sentences Contraindications –GCS <11 –Respiratory Arrest –BP <90 Systolic –Suspected Pneumothorax –Tracheostomy –Foreign body obstruction –Facial deformity or trauma –Actively vomiting –Recent neuro, facial or gastric surgery –Chest head or face trauma

22. Airway Adjuncts Oropharyngeal Airway Nasopharyngeal Airway BVM Pocket Mask Combi-tube King Airway

23. Skills Practice

24. Respiratory Emergencies

25. Anatomy of the Respiratory System Function of lungs is respiration. –Exchange of oxygen and carbon dioxide Air travels through trachea into lungs, then on to: –Bronchi (larger airways) –Bronchioles (smaller airways) –Alveoli

26. Alveoli are microscopic air sacs. –Thin-walled –Actual exchange of oxygen and carbon dioxide occurs here. Anatomy of the Respiratory System

27. Physiology of Respiration

29. Upper and Lower Airway Infection

30. Acute Pulmonary Edema Heart muscle can’t circulate blood properly. Fluid builds up within alveoli and in lung tissue. –Referred to as pulmonary edema –Usually result of congestive heart failure –Common cause of hospital admission

31. Chronic Obstructive Pulmonary Disease (COPD) Slow process of dilation and disruption of airways and alveoli Caused by chronic bronchial obstruction Fourth leading cause of death Tobacco smoke can create chronic bronchitis.

32. Chronic Obstructive Pulmonary Disease (COPD) Emphysema is another type of COPD. –Loss of elastic material around air spaces –Causes include inflamed airways, smoking. Most patients with COPD have elements of both chronic bronchitis and emphysema.

33. Asthma is acute spasm of smaller air passages (bronchioles). Asthma

34. Spontaneous Pneumothorax Pneumothorax is accumulation of air in pleural space. Most often caused by trauma Vacuum-like pressure in pleural space is lost. When caused by medical conditions, is called “spontaneous.”

35. Spontaneous Pneumothorax

36. Pulmonary Embolism Passage of blood clot formed in vein into pulmonary artery –Circulation cut off partially or completely –Becomes lodged –Significantly decreases blood flow –If large enough, can cause sudden death

37. Pulmonary Embolism Cont. Signs and symptoms include: –Dyspnea –Acute chest pain –Hemoptysis (coughing up blood) –Cyanosis –Tachypnea –Hypoxia

38. Other Respiratory Emergencies Croup –Inflammation and swelling of pharynx, larynx, and trachea –Easily passed between children –Responds well to humidified oxygen Epiglottitis –Bacterial infection causing swelling of flap over larynx –Position comfortably and provide oxygen.

39. Other Respiratory Emergencies Pneumonia –Worldwide leading cause of death in children –Often a secondary infection –Will come on quickly and result in high fever. –Obtain a core temperature and treat with airway, ventilatory, and circulatory support.

40. Discuss Case Scenarios and Treatment Options