8 Airway Management and Ventilation
Media Slide 8 Breathing Sounds Animation Slide 17 Lung Anatomy Labeling Exercise
Topics • Breathing • Respiratory System Anatomy • Signs of Normal Breathing • Signs of Abnormal Breathing
Breathing • Respiration: act of breathing; exchange of oxygen and carbon dioxide takes place in lungs. • Body uses oxygen to produce energy. • Respiratory compromise: patient not breathing adequately. • Hypoxia: insufficient level of oxygen in blood and tissues.
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Breathing • Respiratory arrest: absence of breathing. • Causes of respiratory compromise: • Asthma • Bronchitis • Heart attack • Severe allergic reactions • Exposure to toxic substances • Inhalation of super-heated air
Breathing • Respiratory system plays role in normal acid-base balance. • Without proper pH, brain functions cease. • Apnea: absence of breaths.
Breathing • Respiratory arrest: absence of breathing. • Cardiac arrest: absence of heartbeat. • Clinical death: both heartbeat and respirations stop. • Biological death: too many brain cells die (irreversible death).
Breathing • How we breathe: It's Automatic! • Lungs elastic and expandable. • Diaphragm primary breathing muscle. • Simple law: as volume increases, pressure decreases. • Inhalation (breath taken in). • Exhalation (breathing out).
Respiratory System Anatomy • Major Structures • Nose; mouth • Throat; epiglottis • Trachea • Larynx • Bronchial tree • Lungs • Alveoli • Lung Anatomy
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Respiratory System Anatomy • Respiratory Cycle • Air flows through mouth and nose, into throat, past epiglottis, into trachea. • Air flows into left/right main stem bronchi, through smaller bronchioles to alveoli. • Oxygen/carbon dioxide exchange takes place. • Oxygen travels through walls of alveoli, into blood, delivers it to cells. • Carbon dioxide travels from blood through alveoli walls, where eliminated when exhaled. (continued)
Respiratory System Anatomy • An Open and Clear Airway • Airway: nose, mouth, throat, trachea. • Patent: open and clear airway. • Causes of obstruction • Patient's own tongue • Foreign object • Swelling of tissues **Differences between the airway of an adult and the airway of a child.
Think About It You respond to the home of a 62-year-old male complaining of shortness of breath. He cannot speak in complete sentences, so you can tell his breathing is not adequate. Considering the respiratory cycle; what is happening inside his body?
Signs of Normal Breathing • Look for adequate tidal volume. • Listen for air entering and leaving nose and mouth. • If unresponsive, feel for air moving into and out of nose and mouth. • Observe skin color. • Observe level of responsiveness. • Normal Breathing
Signs of Abnormal Breathing • Signs and Symptoms • Increased work of breathing. • Absent or shallow rise and fall of chest. • Little or no air heard or felt at nose or mouth. • Noisy breathing or gasping sounds. • Breathing that is irregular, too rapid, or too slow. • Breathing that is too deep or labored. (continued)
Signs of Abnormal Breathing • Signs and Symptoms (continued) • Use of accessory muscles in chest, abdomen, and around neck. • Nostrils that flare when breathing. • Skin that is pale or cyanotic. • Sitting or leaning forward in tripod position. • Agonal respirations: slow, sporadic gasps of air from unresponsive patient. • Crackles • Wheezing (continued)
Signs of Abnormal Breathing • Stridor: Indication of obstruction of the upper airway. Remember: • Upper Airway includes nose, nasal passages, paranasal sinuses, the pharynx and a portion of the larynx above vocal cords. • Lower Airway includes the portion of the larynx below the vocal cords, trachea, bronchi, and bronchioles.
Think About It You respond to find an unresponsive 23-year-old male with a history of narcotic abuse. He is making snoring-like breathing sounds with periods of apnea. What are these respirations called?
Summary • Respiratory compromise caused by asthma, bronchitis, drowning, choking. • Clinical Death occurs the moment that both breathing and heartbeats stop. • Biological(irreversible) Death occurs approximately four to six minutes following clinical death.
Summary • Patent airway is clear and open. • Air contains approximately 21% oxygen. • Signs of inadequate breathing: • Increased work of breathing. • Shallow, rapid, noisy, or gasping breathing.