1. The Airway CHAPTER 7

2. The Respiratory System Respiratory Anatomy

3. Respiratory System Anatomy

4. The Larynx Thyroid cartilage Cricoid ring Cricothyroid membrane

5. Trachea and Bronchi Trachea Right Bronchus Left Bronchus

6. C4-20 The Alveoli Alveoli Bronchiole

7. P5-11 Alveolar-Capillary Interface Alveolus Capillary

8. The Respiratory System Respiratory Physiology

9. In the lungs, the alveoli and capillaries exchange oxygen and carbon dioxide.

10. Alveolar-capillary interface Cellular-capillary interface Gas exchange occurs at the: O2O2 Body cells Capillary CO 2 O2O2 Alveolus

11. Adequate Breathing

12. Respiratory rate: The number of breaths in one minute.

13. Normal Respiratory Rates  Adult:12 - 20/minute  Children:15 - 30/minute  Infants:25 - 50/minute

14. Tidal volume: The amount of air exchanged in one breath. Also considered “depth” of respiration.

15. Breathing InhalationExhalation Chest contracts Chest relaxes

16. Inadequate Breathing

17. Quickly recognizing inadequate breathing is one of the most important skills to master as an EMT.

18. Inadequate Breathing  Difficulty breathing, shortness of breath  Rate that is too fast or too slow  Rhythm that is irregular  Diminished or absent breath sounds

19. Inadequate Breathing continued  Unequal or inadequate breath sounds  Increased effort of breathing  Inadequate tidal volume, shallow breathing  Cyanotic, pale, or cool & clammy skin

20. Inadequate Breathing continued  Use of accessory muscles  Retractions  Nasal flaring  “See-saw” breathing in children

21. Considerations for Infants and Children Considerations for Infants and Children

22. Comparison of the diameter of the child’s trachea versus the adult’s. Adult (20 mm) Infant (4 mm)

23. Adult vs Child Respiratory Anatomy  Proportionately larger tongue  Narrower and shorter trachea  Trachea easily kinked by improper positioning  Chest-wall very pliable  Larynx is more anterior  Weaker intercostal muscles  Requires more use of diaphragm

24. OxygenOxygen Oxygen Sources

25. Common Sizes of Oxygen Cylinders Size D Size E Size M

26. Sizes of Oxygen Cylinders CYLINDERCAPACITY (L) D350 Liters E625 Liters M3000 Liters G5300 Liters H6900 Liters

27. Equipment for Oxygen Delivery

28. Three Types of Oxygen Regulators

29. Attaching the Regulator

30. Attaching the Regulator continued

34. Oxygen Masks

35. Nonrebreather Mask Mask reservoir

36. Any patient in respiratory distress should receive high-concentration oxygen.

37. Indications for the NRB Mask  Any adequately breathing patient with signs or symptoms of respiratory distress  Any patient with potential or actual shock (hypoperfusion)  Any other patients that would benefit from high-flow oxygen

38. Nasal Cannula Use a cannula if NRB mask cannot be tolerated.

39. Indications for the Nasal Cannula  Patients who will not tolerate a mask  Medical patients without respiratory compromise  Stable cardiac patients without signs or symptoms of an acute myocardial infarction  Patients with chronic pulmonary disease who are not in respiratory distress

40. Opening the Airway Manual Positioning

41. Anything that compromises the continuous flow of air in and out of the lungs is an immediate life-threat.

42. The tongue may obstruct the airway in unresponsive patients.

43. Head-tilt, Chin-lift Maneuver Done in the absence of spinal injury.

44. Jaw Thrust Done when spinal injury is suspected.

45. Airway Adjuncts

46. Oral Airway

47. Gag reflex: A reflex that causes the patient to retch when the back of the throat is stimulated. This reflex helps unresponsive patients protect the airway.

48. The oral airway displaces the tongue.

49. Oral Airway Insertion in Adults Select proper size.

50. Oral Airway Insertion in Adults continued Insert with tip aimed at roof of patient’s mouth.

51. Insert gently while turning 180 o Oral Airway Insertion in Adults continued

52. Flange should rest on patient’s teeth. Oral Airway Insertion in Adults continued

53. Alternative Method for Insertion Use tongue blade and insert with tip facing floor of patient’s mouth.

54. Nasal Airway Nasopharyngeal airways come in different types and sizes.

55. Nasal Airway Insertion in Adults Determine proper size.

56. Nasal Airway Insertion in Adults continued Lubricate with a water-soluble gel.

57. Insert with bevel towards septum. Nasal Airway Insertion in Adults continued

58. Advance until flange rests at nostril. Nasal Airway Insertion in Adults continued