Lesson 14: Airway and Ventilation You Are the Emergency Medical Responder Your medical emergency response team has been called to the fitness center by building security on a report that an employee complained of having difficulty breathing. You and your partner arrive and find the man conscious but in distress. The patient’s chief complaint is difficulty breathing. He says he just “overdid it” on the treadmill. He appears to be out of breath and is having trouble speaking in full sentences. You begin a primary assessment and determine that the patient is in respiratory distress.
An Open Airway is the Priority • Ensuring an open airway is the most important step you can take in caring for a patient because a person cannot breathe without an open airway • A patient who can speak or cry is conscious, has an open airway, is breathing and has a pulse
Respiratory System Overview • Upper airway tract • Begins at the mouth • Includes the nose, pharynx and larynx • Lower airway tract • Begins below the level of the vocal cords • Includes the trachea, bronchi, bronchioles and alveoli
Pathophysiology • Breathing difficulties for various reasons • Low-oxygen environment • Infections • Choking • Unconscious, altered LOC, poisoning • Diseases • COPD • Emphysema • Oxygenation – the amount of oxygen in the blood
Respiratory Emergencies • Respiratory distress: • When someone has difficulty breathing • Respiratory arrest: • The cessation of breathing • By recognizing respiratory distress and taking immediate action, you may prevent respiratory arrest
Causes of Respiratory Distress • A partially obstructed airway • Illness • Chronic conditions, such as asthma • Electrocution • Heart attack • Injury to the head, chest, lungs or abdomen • Allergic reactions • Drugs • Poisoning • Emotional distress
Signs and Symptoms of Respiratory Emergencies • Slow or rapid breathing • Unusually deep or shallow breathing • Gasping for breath • Wheezing, gurgling or high-pitched noises • Unusually moist or cool skin • Flushed, pale, ashen or bluish skin color • Shortness of breath • Dizziness or light-headedness • Pain in the chest or tingling in the hands, feet or lips • Apprehensive or fearful feelings
Activity You and your partner are summoned to a local conference center in response to an emergency call. A person who was scheduled to speak at a conference began complaining of difficulty breathing about 10 minutes before he was scheduled to speak. On arrival at the scene, you find the patient sitting on the floor, breathing rapidly. The patient states that all of sudden he began to feel dizzy and his lips started tingling.
Specific Respiratory Emergencies • Chronic Obstructive Pulmonary Disease (COPD) • Asthma • Pneumonia • Acute pulmonary edema • Hyperventilation • Pulmonary embolism • Emphysema • Blue bloater • Pink puffer
Signs of an Open Airway • Two methods for opening an airway • Head tilt / chin lift • Jaw thrust • Chest is rising and falling • Air is heard and felt coming out of patient’s mouth and nose with exhalation • The conscious patient is able to speak in full sentences without distress • The conscious patient is speaking in normal tones
Signs of an Inadequate Airway • Visibly unable to catch breath • Gasping for air • Abnormal breath sounds - www.easyauscultation.com • Grunting / gurgling • Stridor – harsh, high-pitched noise • Snoring • Wheezing • Apnea – complete absence of breathing
Causes of Airway Obstruction • Mechanical • Foreign body • Solid object, such as food, in adults • Large chunks of food and small objects (toy parts or balloons) in children younger than 4 years • Anatomical • Tongue – most common • Swelling due to trauma, infection, asthma, emphysema or anaphylaxis
Techniques to Clear Airway Obstruction • Back blows • Abdominal thrusts • Chest thrusts • Modified CPR for unconscious patients
Techniques to Remove Foreign Material from the Upper Airway • Finger sweeps • Only for an unconscious patient • Only when foreign matter is seen in a patient’s mouth • Use the index finger for an adult or child and the little finger for a smaller child and an infant • Suctioning • H.A.IN.E.S. – High Arm in Endangered Spine
Signs of Inadequate Breathing Rib muscles pulling in on inhalation Pursed lip breathing Nasal flaring Fatigue or sweating Excess use of abdominal muscles Tripod position Deviated trachea • Abnormal breath sounds (stridor, wheezing, crackles/rales) • Inadequate depth of breathing • Too slow or too rapid rate • Paradoxical breathing • Irregular respiratory patterns
Signs of Inadequate Oxygenation Cyanosis Pale, cool, ashen, clammy skin Mottling Altered mental state, such as restlessness, agitation, confusion or anxiety
Artificial Ventilation Methods Various mechanical means to help patients breath Just enough to see chest rise, about 1 second Gastric distention Why does artificial ventilations increase an individuals chance of survival? The air we breath is composed of many substances, the most important is oxygen, which accounts for 21% of the air we breath Exhaled air is composed of 16%, more than enough to sustain life
Artificial Ventilation Methods cont • Mouth-to-mouth • Mouth-to-mask • Mouth-to-nose breathing • Mouth-to-stoma breathing • Bag-Valve-Mask resuscitator (BVM)
BVM Resuscitator Ventilations Three-part device: a bag, a valve and a mask Advantages: Increased oxygen blood levels Ability to be connected to emergency oxygen Increased effectiveness of ventilations when used correctly by two rescuers Protection against disease transmission and inhalation hazards Useful with advanced airway adjuncts Disadvantage?
Ventilation Rates and Patient Age 30 to 60 breaths per minute: 1 ventilation about every 1 to 2 seconds for a newborn (0 to 1 month) 12 to 20 breaths per minute: 1 ventilation about every 3 seconds for a child or an infant 8 to 10 breaths per minute: 1 ventilation about every 5 seconds for an adult
You Are the Emergency Medical Responder While waiting for emergency medical services personnel to arrive, you complete a SAMPLE history and secondary assessment. You have helped the patient into a position of comfort for breathing when he suddenly loses consciousness and stops breathing. He has a pulse.
EnrichmentAssessing Breath Sounds Use a stethoscope to listen to lungs In the front, listen along the midclavicular line at the second intercostal space On the sides, listen along the midaxillary line between the fourth and fifth intercostal spaces In the back, listen along the midclavicular line below the scapula Compare sounds heard on both sides Suspect obstruction if abnormal sounds, such as wheezing, rales, rhonchi or stridor, are heard
EnrichmentSellick’s Maneuver Also known as cricoid pressure Appropriate during positive pressure ventilation situations when a patient requires intubation Two rescuers needed: one to perform the maneuver, another to perform the intubation Application of pressure on both sides of cricoid cartilage using the thumb and index finger, with pressure applied firmly toward the back of the neck
EnrichmentAsthma Medications Long-term control medications Quick-relief medications (rescue medications) Medications for allergy-induced asthma Read Enrichment pages 247 - 250
Asthma Medication Delivery Systems Metered-dose inhaler Dry powder inhaler Small-volume nebulizer Pill or liquid Injection
Peak Flow Meter • Measurement of person’s ability to push air out of lungs in one quick breath • Tool for evaluating response to treatment and for warning if asthma is worsening
Common Side Effects of Asthma Medications • Increased heart rate • Palpitations • Nausea or vomiting • Nervousness • Sleepiness • Dry mouth • Cough • Hoarseness • Headache • Throat irritation