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EMT- Airway, Respiration, and Ventilation

LimmerEducation
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Terms in this set (84)

Ventilation
The moving of air in and out of the lungs
Inhalation
The diaphragm and intracoastal muscles contract; infra thoracic pressure decreases; vacuum created. Energy required, this is the active part of ventilation.
Exhalation
No energy required, this is the passive part of ventilation. Muscles relax and air is expelled. Intrathoracic pressure exceeds atmospheric pressure during exhalation.
Most common air way obstruction(s)
Tongue, fluid, swelling, foreign bodies.
The primary methods for controlling oxygen delivery
Increasing or decreasing the rate of breathing and increasing or decreasing the tidal volume of breaths.
Hypoxia
Inadequate delivery of oxygen to the cells.
Early indications of hypoxia
Restlessness, anxiety, irritability, dyspnea, and tachycardia
Late indications of hypoxia
Altered or decreased level of consciousness, severe dyspnea, cyanosis, and bradycardia (especially in pediatric patients)
Carbon Dioxide Drive
The body's pro,are system for monitoring breathing status; monitored by the body through the CO2 levels in the blood and cerebrospinal fluid.
Hypoxic Drive
Backup system to the CO2 drive; monitors oxygen levels through plasma. This may be found in patients with end stage chronic obstructive pulmonary disease (COPD) with chronically high levels of CO2. They aren't used to being at above a 94% POX.
Oxygenation
Delivery of oxygen to the blood- ventilation required.
Surrounding/Atmospheric Air contains what percent of oxygen?
21%
Expelled/Exhaled air contains what percent of oxygen?
16%
Respiration
The exchange of oxygen and carbon dioxide.
How long can the brain go without oxygen?
The heart and brain become irritable due to lack of oxygen almost immediately. Brain damage begins within about 4 minutes. Permanent brain damage likely within 6 minutes. Irrecoverable injury is likely within 10 minutes.
Airway Assessment: What do you look, listen, and feel for?
Look- for chest rise and fall
Listen- for breathing, ability to speak, lung sounds.
Feel- for air movement, chest rose and fall. Place your ear near the victim's mouth and nose and place your hand on the victim's chest.
Normal respiratory rate and rhythm for: adults, children, and infants
Adults- 12-20 BPM
Children- 15-30 BPM
Infants- 25-50 BPM
Note that for the breathing to be adequate there should also be clear bilateral lung sounds, non-labored, and there should be adequate tidal volume (chest rise and fall).
Auscultation: Anterior and Posterior
The use of a stethoscope to listen for lung sounds.
Compare lung sounds from side to side, not top to bottom.
Wheezing
High pitched sounds usually heard during exhalation, sounds almost musical. The sound is created by air moving through narrowed air passages in the lungs. Common with asthmatic patients.
Rhonci
Low pitched sounds that resemble snoring or rattling. Caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when materials are aspirated (breathed) into the lungs. Usually louder than rales.
Rhonci
Low pitched sounds that resemble snoring or rattling. Caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when materials are aspirated (breathed) into the lungs. Usually louder than rales.
Rales
"Wet" or "crackling" sounds; otherwise known as crackles. Sound is caused by fluid in the alveoli or by the opening of closed alveoli.
Stridor
A high pitched sound indicating partial upper airway obstruction. Stridor is auscultation in the upper airway (neck), not in the lower lung fields. Indicated partial obstruction of the trachea or larynx. Usually audible without a stethoscope.
Pulse Oximetry
Monitoring of oxygen saturation (SaO2). Monitors the percentage of hemoglobin (red blood cells) that is saturated with oxygen.
Normal SaO2
98%. Below 94% indicates the need for supplemental oxygen.
Manuel Airway Techniques
Head tilt-chin lift
Jaw thrust maneuver
Head tilt-chin lift
Preferred Manuel method of opening the airway; indication- patients with altered or decreased level of consciousness, patients with suspected airway obstruction, or patients requiring auctioning. DO NOT USE if there is a suspected c-spine injury.
Oropharyngeal airway (OPA)
Used to prevent the tongue from obstructing the airway. Failure to size/insert correctly could cause the tongue to block the airway. Only use on unconscious patient without a gag reflex.
Jaw-thrust maneuver
Indication- patients with altered or decreased consciousness and have a suspected c-spine injury. DO NOT USE if patient I conscious.
Nasopharyngeal airway (NPA)
Used to prevent tongue from obstructing the airway in patients who may not be able to protect their own airway. Do not use if there is severe head injury or facial trauma.
Recovery Position
Patient positioned on his/her side, reduces the risk of aspiration. Unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position.
Indications of supplemental oxygen
Cardiac Arrest
Any patient receiving artificial ventilations
Any patient with hypoxia
Any patient with signs of shock (hypoperfusion)
SaO2 below 94%
Medical condition/injury that may benefit from O2
Any patient with altered/decreased level of consciousness
Simple face mask
Similar to the no rebreather mask but with no oxygen reservoir.
How to delivery oxygen to patients with a tracheostomy or a stoma
Patients with a tracheostomy ventilate through their stoma, not the mouth or nose. Supplemental oxygen should be supplied over the stoma using a NRB mask.
Oxygen toxicity
The alveoli can collapse due to long term exposure to high concentrations of oxygen, but this rarely occurs in the prehospital setting.
Respiratory depression
A risk for COPD patients on the hypoxia drive, typically requires long term exposure to high concentration oxygen, retinal damage can occur in newborns with long term exposure to high concentration oxygen.
Assisted/Artificial Ventilations
Or positive pressure ventilations (PPV) can be: mouth to mask, BVM, mouth to mouth, CPAP
Artificial Ventilation Indications
Any patient with inadequate spontaneous breathing leading to severe respiratory distress or respiratory failure... Possible causes of this: central nervous system injury, disease, or impairment; foreign body airway obstruction; chest trauma,a such as flail chest or sucking chest wound; or increased airway resistance due to bronchoconstriction, pulmonary edema, or inflammation.
Conscious patient artificial ventilation indications
Apnea: no spontaneous breathing
Atonal breaths: shallow, ineffective gasps
Bradypnea: slow breathing
Tachypnea: fast breathing
Hypoventilation: breathing too slow or too shallow
Any patient breathing less than 8 times/minute or more than 24 times/minute
Correct rate of artificial ventilations for: adults, infants/children, and newborns
Adults- one breath every 5-6 seconds (10-12/minute)
Peds- one breath every 3-5 seconds (12-20/minute)
Newborns- one breath every 1-1.5 seconds (40-60/minute)
CPR rates for: adults, peds, and newborns
Adults- 30:2
Peds- 15:2
Newborns- 3:1
Volumes for BVM devices for: adults, peds, and infants
Adults: 1,200-1,600 mL
Peds: 500-700 mL
Infants: 150-240 mL
Continuous Positive Airway Pressure (CPAP)
Consists of a mask and a means of blowing oxygen or air into the mask at relatively low pressures. Blowing oxygen or air continuously at a low pressure into the airway prevents the alveoli from collapsing at the end of exhalation, and it can also push fluid out of the ale oil and back into the capillaries that surround them.
Used to improve spontaneously breathing patients in respiratory distress; often used for patients with sleep apnea and has proven effective for patients with COPD or pulmonary edema.
Indications AND Contraindication of CPAP
Indications- conscious patients in moderate to severe respiratory distress, tachypnic patients with reduced respiratory efficiency, pulse oximetry below 90%; ex. Pulmonary edema, drowning, Athens, COPD, or in general respiratory failure.

Contraindications- apneic patients, patients unable to follow verbal commands, patients unable to sit up, chest trauma, pneumothorax, patients with tracheostomy, vomiting, suspected gastrointestinal bleeding/recent surgery, hypotension, or anything that would prevent there being a good mask seal (facial trauma/deformities).
Why is the pediatric airway more easily obstructed?
The mouth and nose are smaller, and the pediatric tongue is larger in proportion to the airway.
Does hypoxia develop faster or slower in pediatric patients?
Faster; infants and children have less oxygen reserves and a higher metabolic rate that adults, bradycardia is common in pediatric patients experiencing hypoxia.
Signs of respiratory failure in pediatric patients
Bradycardia, altered level of consciousness, head bobbing and grunting on inhalation, seesaw breathing (chest and abdomen moving in opposition).
Indications of airway obstruction (FBAO)
Inability to cough, speak, or breath
Clutching throat
Inability of EMT to ventilate patient despite repositioning airway and managing the tongue.
How to manage FBAO (foreign body airway obstruction)
Abdominal thrusts until obstruction is relieved or until patient loses consciousness; for Fanta administer a series of 5 back blows and 5 chest thrusts until obstruction is relieved or patient loses consciousness.
For unconscious patients, initiate CPR
Before attempting ventilations, inspect the airway for visible foreign bodies and remove if possible.
Oropharynx
Area directly posterior to the mouth
Nasopharynx
Area directly posterior to the nose
Pharynx
The area directly posterior to the mouth and nose, made up of nasopharynx and Oropharynx
Epiglottis
Leaf shaped structure that prevents food and foreign matter from entering the trachea
Trachea
The wind pipe; structure that connects the pharynx to the lungs
Cricoid cartilage
The ring shaped structure that forms the lower portion of the larynx
Larynx
Voice box
Bronchi
The two large sets of branches that come off the trachea and enter the lungs. There are right and left bronchi.
Lungs
The organs where exchange of atmospheric oxygen and waste carbon dioxide take place.
Alveoli
The microscopic sacs of the lungs where gas exchange with the bloodstream takes place.
Pneumothorax
Lungs collapse;
Asthma
Airflow mainly restricted in one direction; when the student inhales the expanding lungs exert and outward pull increasing the diameter of the airway and allowing air to flow into lungs. However during exhalation the opposite occurs and the stale air becomes trapped in the lungs. This requires the patient to exhale the air forcefully, producing the characteristic wheezing sounds.
Bronchitis
Type of COPD, the bronchial lining is inflamed and excess mucus is formed. R bronchioles that normally clear away accumulations of mucus are not able to do so. The sweeping apparatus on these cells, the cilia, have been damaged or destroyed.
Emphysema
Type of COPD, the walls of the alveoli break down, greatly reducing the surface area of respiratory exchange. The lungs begin to lose elasticity. Those factors combine to allow stab,e air laden with carbon dioxide to be trapped in the lungs, reducing the effectiveness of normal breathing efforts.
Pulmonary edema
May occur in patients with CHF because of fluid that accumulates in the lungs, preventing them from breathing adequately. Typically this occurs because the left side of the heart has been damaged, often by a myocardial infarction or chronic hypertension.
Pneumonia
Infection of one or both lungs caused by bacteria, viruses, or fungi. Results from inhalation of certain microbes that grow in the lungs and cause inflammation. Common signs and symptoms are coughing, fever, chest pain, and severe chills. Most complain of shortness of breath, chest pain, headache, are pale and sweaty, fatigued, and confused. Auscultation may result in crackles.
Spontaneous pneumothorax
When a lung collapsed without injury or any other obvious cause. Usually a result of the rupture of a bleb (a small section of the lung that is weak). Once the rupture occurs the lung collapses and air leaks into the thorax. Signs may be sharp, pleuritic chest pain and shortness of breath. He may also tire easily, be tachycardic, breathe fast, have low pulse ox, and exhibit cyanosis. Auscultation will reveal breath sounds that are decreased or absent but sometimes the breath sounds will be completely normal.
Pulmonary embolism
When something that is not blood- clot, air, plaque, or fat- tries to get through blood vessels, gets stuck and blocks an artery in the lungs. Difficult to detect; sudden onset of sharp chest pain, shortness of breath, anxiety, cough (maybe bloody), sweaty pale/cyanotic skin, and tachycardia/tachypnea. May also feel dizzy or light headed, with pain and swelling in both legs. Sometimes wheezing will be found upon auscultation. Patient may be hypotensive and go into cardiac arrest if the clot is large enough.
DVT
Deep vein thrombosis- e most common type of pulmonary embolism; a blood clot that starts in a vein often in the leg or pelvis. Commonly occurs in cancer patients (blood more prone to clotting). Patients who have been lying or sitting in one position for a long time also have a higher risk of developing this.
Epiglottitis
When an infection inflames the area around and above the epiglottis, the tissue swells. If it sweeps enough, it can actually occlude or close off the airway.
This disease used to be a disease of children but is now much more less common in children than it is in adults. Childhood vaccination keep kids from getting it anymore.
Symptoms include sore throat, and painful or difficult swallowing. Patient in tripod position, may look sick, have a muffled voice, fever, and drooling because of the pain/difficulty in swallowing. An alarming sign is Stridor, indicates the airway is already significantly obstructed.
Onset slow in adults but rapid in children.
Keep the patient calm, do not inspect the throat. Administered high flow oxygen and transport immediately.
Cystic fibrosis
Genetic disease that typically appears in childhood; causes thick, sticky mucus that accumulates in the lungs and digestive system. Mucus can cause life threatening lung infections and serious problems with digestion.
Signs and symptoms are coughing with lots of mucus, fatigue, frequent pneumonia, fever, shortness of breath, loss of appetite, abdominal pain and distention, coughing up blood, nausea, and weight loss.
Viral respiratory infection
Sore/scratchy throat with sneezing, runny nose, and fatigue; may be fever with chills. Infection can spread to the lugs and cause shortness of breath. Administer oxygen.
Diaphragm
The muscular structure that divides the chest cavity from the abdominal cavity, a major muscle of respiration.
Pneumothorax
Lungs collapse;
Asthma
Airflow mainly restricted in one direction; when the student inhales the expanding lungs exert and outward pull increasing the diameter of the airway and allowing air to flow into lungs. However during exhalation the opposite occurs and the stale air becomes trapped in the lungs. This requires the patient to exhale the air forcefully, producing the characteristic wheezing sounds.
Bronchitis
Type of COPD, the bronchial lining is inflamed and excess mucus is formed. R bronchioles that normally clear away accumulations of mucus are not able to do so. The sweeping apparatus on these cells, the cilia, have been damaged or destroyed.
Emphysema
Type of COPD, the walls of the alveoli break down, greatly reducing the surface area of respiratory exchange. The lungs begin to lose elasticity. Those factors combine to allow stab,e air laden with carbon dioxide to be trapped in the lungs, reducing the effectiveness of normal breathing efforts.
Pulmonary edema
May occur in patients with CHF because of fluid that accumulates in the lungs, preventing them from breathing adequately. Typically this occurs because the left side of the heart has been damaged, often by a myocardial infarction or chronic hypertension.
Pneumonia
Infection of one or both lungs caused by bacteria, viruses, or fungi. Results from inhalation of certain microbes that grow in the lungs and cause inflammation. Common signs and symptoms are coughing, fever, chest pain, and severe chills. Most complain of shortness of breath, chest pain, headache, are pale and sweaty, fatigued, and confused. Auscultation may result in crackles.
Spontaneous pneumothorax
When a lung collapsed without injury or any other obvious cause. Usually a result of the rupture of a bleb (a small section of the lung that is weak). Once the rupture occurs the lung collapses and air leaks into the thorax. Signs may be sharp, pleuritic chest pain and shortness of breath. He may also tire easily, be tachycardic, breathe fast, have low pulse ox, and exhibit cyanosis. Auscultation will reveal breath sounds that are decreased or absent but sometimes the breath sounds will be completely normal.
Pulmonary embolism
When something that is not blood- clot, air, plaque, or fat- tries to get through blood vessels, gets stuck and blocks an artery in the lungs. Difficult to detect; sudden onset of sharp chest pain, shortness of breath, anxiety, cough (maybe bloody), sweaty pale/cyanotic skin, and tachycardia/tachypnea. May also feel dizzy or light headed, with pain and swelling in both legs. Sometimes wheezing will be found upon auscultation. Patient may be hypotensive and go into cardiac arrest if the clot is large enough.
DVT
Deep vein thrombosis- e most common type of pulmonary embolism; a blood clot that starts in a vein often in the leg or pelvis. Commonly occurs in cancer patients (blood more prone to clotting). Patients who have been lying or sitting in one position for a long time also have a higher risk of developing this.
Epiglottitis
When an infection inflames the area around and above the epiglottis, the tissue swells. If it sweeps enough, it can actually occlude or close off the airway.
This disease used to be a disease of children but is now much more less common in children than it is in adults. Childhood vaccination keep kids from getting it anymore.
Symptoms include sore throat, and painful or difficult swallowing. Patient in tripod position, may look sick, have a muffled voice, fever, and drooling because of the pain/difficulty in swallowing. An alarming sign is Stridor, indicates the airway is already significantly obstructed.
Onset slow in adults but rapid in children.
Keep the patient calm, do not inspect the throat. Administered high flow oxygen and transport immediately.
Cystic fibrosis
Genetic disease that typically appears in childhood; causes thick, sticky mucus that accumulates in the lungs and digestive system. Mucus can cause life threatening lung infections and serious problems with digestion.
Signs and symptoms are coughing with lots of mucus, fatigue, frequent pneumonia, fever, shortness of breath, loss of appetite, abdominal pain and distention, coughing up blood, nausea, and weight loss.
Viral respiratory infection
Sore/scratchy throat with sneezing, runny nose, and fatigue; may be fever with chills. Infection can spread to the lugs and cause shortness of breath. Administer oxygen.
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