airway and oxygen system orientation. objectives breathing respiratory anatomy assessment rescue...
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Airway and OxygenAirway and Oxygen
System OrientationSystem Orientation
ObjectivesObjectives
BreathingBreathing
Respiratory AnatomyRespiratory Anatomy
AssessmentAssessment
Rescue breathingRescue breathing
Airway obstructionAirway obstruction
Oxygen delivery devicesOxygen delivery devices
SuctionSuction
BreathingBreathing
Why we breatheWhy we breatheTo bring oxygen into the bodyTo bring oxygen into the body
To expel carbon dioxide from the bodyTo expel carbon dioxide from the body
Breathing is automaticBreathing is automatic
Clinical Death—The moment the breathing and heartbeat stop
Brain Damage—within 4–6 minutes
Biological Death—within 10 minutes
BreathingBreathing
How We Breathe:How We Breathe:Inspiration:Inspiration:
Rib and diaphragm muscles contract.Rib and diaphragm muscles contract.
Chest cavity expands. Chest cavity expands.
The volume inside each lung increases.The volume inside each lung increases.
The pressure inside each lung decreases.The pressure inside each lung decreases.
When the pressure inside the lungs becomes When the pressure inside the lungs becomes less than the pressure in the atmosphere, air less than the pressure in the atmosphere, air rushes into the lungs.rushes into the lungs.
BreathingBreathingHow We Breathe:How We Breathe:
Inspiration is an active process.Inspiration is an active process.
Expiration is a passive process.Expiration is a passive process.
AssessmentAssessment
Signs of Normal Breathing:Signs of Normal Breathing:
Look for rise and fall of the chest.Look for rise and fall of the chest.
Listen for air moving:Listen for air moving:The sounds should be quiet like a soft breeze. The sounds should be quiet like a soft breeze. No unusual soundsNo unusual sounds
Feel for air moving. Feel for air moving.
Observe skin color: Observe skin color: Should not be pale or ashen Should not be pale or ashen Should not be tinted blue or grayShould not be tinted blue or grayLook at the lips, eyes, and nail bedsLook at the lips, eyes, and nail beds
AssessmentAssessmentSigns of Inadequate Breathing:Signs of Inadequate Breathing:
No chest movements, or uneven chest No chest movements, or uneven chest movementsmovements
No air heard or felt at the nose or mouthNo air heard or felt at the nose or mouth
Noisy breathing or gasping soundsNoisy breathing or gasping sounds
Breathing that is irregular, too rapid, or too slowBreathing that is irregular, too rapid, or too slow
Breathing that is too shallow, or deep and Breathing that is too shallow, or deep and laboredlabored
AssessmentAssessment
Signs of Inadequate Breathing:Signs of Inadequate Breathing:
Breathing that uses muscles in the upper chest Breathing that uses muscles in the upper chest and around the neckand around the neck
Nostrils that flare when breathing, especially in Nostrils that flare when breathing, especially in childrenchildren
Skin that is tinted blue, gray, or ashenSkin that is tinted blue, gray, or ashen
Sitting or leaning forward in a tripod positionSitting or leaning forward in a tripod position
Normal Respiratory RatesNormal Respiratory Rates
Respirations:Respirations:
The normal respiratory rate for adults is 12–20 The normal respiratory rate for adults is 12–20 breaths per minute.breaths per minute.> 28 or < 8 are considered serious.> 28 or < 8 are considered serious.
Newborn infants = 25–50 breaths per min.Newborn infants = 25–50 breaths per min.Up to 5 years old = 20–30 breaths per min.Up to 5 years old = 20–30 breaths per min.5 to 12 years of age = 15–30 breaths per min.5 to 12 years of age = 15–30 breaths per min.
Opening The AirwayOpening The Airway
Repositioning the Head:Repositioning the Head:
The The head-tilt, chin-lift maneuverhead-tilt, chin-lift maneuver, is used for ill or , is used for ill or injured patients with no possibility of spinal injured patients with no possibility of spinal injury. injury.
Used when no c-spine injury is suspectedUsed when no c-spine injury is suspected
The The jaw-thrust maneuverjaw-thrust maneuver, is used for patients , is used for patients who have a mechanism of injury that indicates who have a mechanism of injury that indicates possible spinal injury.possible spinal injury.
Used for those who have a suspected c-spine injury or Used for those who have a suspected c-spine injury or in those who are unresponsive with mechanism of injury in those who are unresponsive with mechanism of injury in which trauma is suspectedin which trauma is suspected
Airway ObstructionAirway Obstruction
Causes of Airway ObstructionCauses of Airway Obstruction
Airway ObstructionAirway Obstruction
CausesCausesTongueTongue
EpiglottisEpiglottis
Foreign objectsForeign objects
Airway ObstructionAirway Obstruction
SignsSignsSnoringSnoringGurglingGurglingCrowingCrowingStridorStridorCyanosisCyanosisAnxietyAnxietyLabored breathingLabored breathingInability to speakInability to speak
Rescue BreathingRescue Breathing
Use personal protective equipment and Use personal protective equipment and barrier barrier devices.devices.
One example of a barrier device is the pocketOne example of a barrier device is the pocket face face maskmask. .
Mouth-to-Mask VentilationMouth-to-Mask Ventilation
Mouth to MaskMouth to Mask
Most effective techniqueMost effective technique
Can be used with airway adjunctsCan be used with airway adjuncts
Mouth to MaskMouth to Mask
ProblemsProblemsFailure to maintain a tight sealFailure to maintain a tight seal
Failure to tilt the head back to open the Failure to tilt the head back to open the airwayairway
Failure to deliver enough breath to see Failure to deliver enough breath to see the chest risethe chest rise
Providing breaths too quicklyProviding breaths too quickly
Failure to recognize airway obstructionFailure to recognize airway obstruction
Bag-Valve-Mask (BVM) VentilatorBag-Valve-Mask (BVM) Ventilator
Pediatric and adult BVM ventilators
Bag-Valve-Mask (BVM) VentilatorBag-Valve-Mask (BVM) Ventilator
Hand positioning for using the BVM with a single rescuer
Oropharyngeal AirwaysOropharyngeal Airways
Aids to ResuscitationAids to Resuscitation
Select Oropharyngeal AirwaySelect Oropharyngeal Airway
Aids to ResuscitationAids to Resuscitation
Another Way to MeasureAnother Way to Measure
Aids to ResuscitationAids to Resuscitation
Nasopharyngeal AirwayNasopharyngeal Airway
Aids to ResuscitationAids to Resuscitation
Determine Proper SizeDetermine Proper Size
Aids to ResuscitationAids to Resuscitation
Gently Advance AirwayGently Advance Airway
Aids to ResuscitationAids to Resuscitation
Suction SystemsSuction Systems
Suctioning Techniques:Suctioning Techniques:
USE PERSONAL PROTECTIVE EQUIPMENT.USE PERSONAL PROTECTIVE EQUIPMENT.
Never suction for longer than 15 seconds at a time.Never suction for longer than 15 seconds at a time.
Measure the tip of the catheter from the patientMeasure the tip of the catheter from the patient’’s earlobe to the s earlobe to the corner of the mouth. corner of the mouth.
Suction only as you remove the tip or catheter.Suction only as you remove the tip or catheter.
REMAIN ALERT FOR THE PATIENTREMAIN ALERT FOR THE PATIENT’’S GAG REFLEX AND FOR SIGNS OF S GAG REFLEX AND FOR SIGNS OF VOMITING.VOMITING.
Suction SystemsSuction Systems
•Oxygen-powered suction unit•Electrically-powered suction unit
•Portable electrical suction unit
•Portable hand-operated suction unit
Suction SystemsSuction Systems
Positioning a Rigid Pharyngeal (Throat) TipPositioning a Rigid Pharyngeal (Throat) Tip
First ResponderFirst Responder’’s Roles Role
Dependent on local protocols:Dependent on local protocols:
May require direct ordersMay require direct ordersMay be written as a standing orderMay be written as a standing order
Do only what you have been trained to do.Do only what you have been trained to do.
Basic life support is possible without equipment. Basic life support is possible without equipment.
If you are allowed to use equipment, you must If you are allowed to use equipment, you must maintain it and train with it.maintain it and train with it.
Oxygen TherapyOxygen Therapy
Equipment for Oxygen Therapy:Equipment for Oxygen Therapy:
Oxygen cylinderOxygen cylinder
Pressure regulator Pressure regulator
FlowmeterFlowmeter
Delivery device Delivery device
Oxygen TherapyOxygen Therapy
An oxygen delivery system
Oxygen TherapyOxygen Therapy
Nasal cannula properly placed
Oxygen TherapyOxygen Therapy
Non-rebreather mask
Check Your UnderstandingCheck Your Understanding
You are called for a 20 year-old male You are called for a 20 year-old male patient, struck by a car. You find the patient, struck by a car. You find the
patient unresponsive. You do not see patient unresponsive. You do not see the patientthe patient’’s chest rise when he s chest rise when he
breathes, but you hear gurgling from his breathes, but you hear gurgling from his airway. airway.
What airway control measures might What airway control measures might you take for this patient?you take for this patient?
SummarySummary
BreathingBreathing
Respiratory Anatomy Respiratory Anatomy
AssessmentAssessment
Rescue BreathingRescue Breathing
Airway ObstructionAirway Obstruction
Aids to ResuscitationAids to Resuscitation
Suction SystemsSuction Systems
Questions?Questions?
CPR/AED & Cardiac CPR/AED & Cardiac ArrestArrest
CPR/AEDCPR/AED
CPR/AEDCPR/AED
““Hearts and Brains Hearts and Brains are going to dieare going to die””
Peter Safar MDPeter Safar MD
EMS has the most EMS has the most opportunity to opportunity to perform CPR, so we perform CPR, so we should be good at should be good at performing good, performing good, quality CPRquality CPR
CPR/AEDCPR/AED
Why is CPR ImportantWhy is CPR ImportantStudies have shown that the general Studies have shown that the general
population will start CPR only 1/3 of the population will start CPR only 1/3 of the time and only 15% of that total is done time and only 15% of that total is done correctlycorrectly
CPR/AEDCPR/AEDLets look at the basics:Lets look at the basics:
The first step is to determine The first step is to determine responsiveness, if no response open the responsiveness, if no response open the airway, check for breathing, and determine airway, check for breathing, and determine if a pulse is presentif a pulse is present
CPR/AEDCPR/AED
Not Breathing and No Pulse:Not Breathing and No Pulse:Give 2 breaths-enough to see the chest Give 2 breaths-enough to see the chest
riserise
Give 30 chest compressions-allow for Give 30 chest compressions-allow for chest recoil between compressionschest recoil between compressions
Give 5 cycles of 30:2 before rechecking a Give 5 cycles of 30:2 before rechecking a pulsepulse
CPR/AEDCPR/AEDChest compressions and breaths are the Chest compressions and breaths are the
same for adults, child, and infantsame for adults, child, and infantAdult age starts at the onset of puberty Adult age starts at the onset of puberty
(12-14 yoa)(12-14 yoa)
Child is age 1 – onset of pubertyChild is age 1 – onset of puberty
Infant is anyone under the age of 1, chest Infant is anyone under the age of 1, chest compressions are delivered using 2 fingers, and compressions are delivered using 2 fingers, and remember a full head tilt should not be given as remember a full head tilt should not be given as you may obstruct the airway you may obstruct the airway
CPR/AEDCPR/AED
The AED should be applied as soon as The AED should be applied as soon as possible to the patients bare chestpossible to the patients bare chest
Make sure the pads adhere to the skinMake sure the pads adhere to the skinRemove all clothing from the area where the Remove all clothing from the area where the
pads need to be placedpads need to be placedRemove any medication patches from the Remove any medication patches from the
areaareaShave any chest hair, the pads need to be on Shave any chest hair, the pads need to be on
as much bare skin as possibleas much bare skin as possibleIf the patient has an implanted Pacemaker, If the patient has an implanted Pacemaker,
place the pad at least an inch awayplace the pad at least an inch away
CPR/AEDCPR/AED
AEDs are set to correct the cardiac AEDs are set to correct the cardiac arrhythmias of V-Fib and V-Tacharrhythmias of V-Fib and V-Tach
CPR/AEDCPR/AED
While there are many styles of AEDs While there are many styles of AEDs they all work the same. The first step is they all work the same. The first step is to turn the unit on and follow the voice to turn the unit on and follow the voice prompts.prompts.
CPR/AEDCPR/AEDThere are some safety There are some safety
considerations with the AED and considerations with the AED and Children:Children:
If the unit has child pads use these If the unit has child pads use these on children between the ages of 1-8.on children between the ages of 1-8.Never use child pads on an adult, Never use child pads on an adult,
the energy delivered by child pads the energy delivered by child pads is not enough for an adult, since the is not enough for an adult, since the child pads reduce the energy from child pads reduce the energy from 200J to 50J200J to 50JAEDs should not be used on AEDs should not be used on
infantsinfants
Questions?Questions?