1. Airway and Oxygen
System Orientation

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

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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. 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

11. 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.

12. 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.

13. Airway Obstruction
Causes of Airway Obstruction

14. Airway Obstruction
Causes
Tongue
Epiglottis
Foreign objects

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

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

17. Mouth-to-Mask Ventilation

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

19. 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

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

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

22. Aids to Resuscitation
Oropharyngeal Airways

23. Aids to Resuscitation
Select Oropharyngeal Airway

24. Aids to Resuscitation
Another Way to Measure

25. Aids to Resuscitation
Nasopharyngeal Airway

26. Aids to Resuscitation
Determine Proper Size

27. Aids to Resuscitation
Gently Advance Airway

28. 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.

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

30. Suction Systems
Positioning a Rigid Pharyngeal (Throat) Tip

31. 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.

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

33. An oxygen delivery system
Oxygen Therapy
An oxygen delivery system

34. Nasal cannula properly placed
Oxygen Therapy
Nasal cannula properly placed

35. Oxygen Therapy
Non-rebreather mask

36. 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?

37. 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.

38. Questions?

39. CPR/AED & Cardiac Arrest

40. CPR/AED

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

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

48. 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.

49. 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

50. Questions?