EMT Chapter 10: Airway Management

apnea
lack of spontaneous breathing
oxygen saturation
measure of the percentage of hemoglobin molecules bound in arterial blood. Because hemoglobin delivers 97% of the oxygen delivered to the body’s tissues, oxygen saturation is an excellent indication of the amount of oxygen available to the end organs.
oropharyngeal airway
two principal purposes: keeps tongue fro blocking the upper airway and to make it easier to suction the oropharynx if necessary
hypoxia
inadequate oxygen to the tissues and cells
nasal cannula
delivers oxygen through two small, tubelike prongs that fit into the patient’s nostrils. provides 24% to 44% inspired oxygen when flowmeter is set at 1 to 6 L/m. only used in prehospital setting if patient cannot tolerate nonrebreathing mask
postive pressure ventilation
generated by a BVM (and other tools) and forces air into the chest cavity fro the external environment, rather than based on pressure changes. More air is needed to achieve the same oxygenation and ventilatory effects of normal breathing.
effects of positive pressure ventilation
the increase in airway wall pressure causes the walls of the chest cavity to push out of their normal anatomic shape. As a result, there is an increase in the overall inthrathoracic pressure within the chest cavity. This pressure increase affects the venous return of blood back to the heart. The blood flow is decreased due to the increased pressure in the chest. This causes poor venous return to the heart, and the amount of blood pumped out of th eheart is reduced. (drop in cardiac output aka, amount of blood ejected by left ventricle in 1 minute)
CPAP (continuous positive airway pressure)
noninvasive means of providing ventilatory support for patients experiencing respiratory distress. Nowadays used for obstuctive pulmonary disease and acute pulmonary edema
where does the actual exchange of oxygen and carbon dioxide occur?
alveolar sacs
an adult at rest should have a respiratory rate that ranges between?
12 and 20 breaths/min
what is the most serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face?
penetrating the cranium
the purpose of the pin-indexing system for compressed gas cylinders?
ensure that the correct regulator is used for the cylinder (oxygen vs. CO2)
what is oxygen toxicity?
condition in which cellular tissue damage occurs from excessive oxygen levels in the blood
what should you do for a 66 y/o man who is conscious but is unable to follow simple verbal commands, and his breathing is severely labored and oxygen saturation is 80%
*assist* his ventilations with a bag-valve mask
CPAP is indicated for patients who:
have pulmonary edema and can follow verbal commands
hypercarbia
when carbon dioxide levels in the bloodstream increase as an effect of impaired ventilation
ventilation
the physical act of moving air into and out of the lungs
oxygenation
the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream. required for INTERNAL respiration to take place. requires air used for ventilation contains an adequate percentage of oxygen
respiration
the actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body.
external respiration (pulmonary respiration)
the process of breathing fresh air into the respiratory system and exchanging oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries
internal respiration
exchange of oxygen and carbon dioxide between the systemic circulatory system and the cells of the body
aerobic metabolism
in presence of oxygen, cells convert glucose into energy through this process. With out this lactic acid will accumulate in the cell (anaerobic metabolism) if this is not corrected, cells die. this is why perfusion (circulation of blood within organ or tissue) & external ventilation must be present for aerobic internal respiration to take place. during this process, CO2 accumulates in the cell and is then transported through circulation back to lungs for exhalation
VQ
air and blood flow must be directed to the same place at the same time. In other words, ventilation (air flow, V) and perfusion (blood flow, Q) must be matched. **failure to match these two lies behind most abnormalities in oxygen and carbon dioxide exchange**
pulse oximeter
provides rapid, reliable, noninvasive, real-time indication of a patient’s oxygenation status. It measures the percentage of hemoglobin saturation (oxygen saturation or Spo2) under normal conditions the Spo2 should be 98% – 100%. lower than 96 may mean hypoxemia. used on a finger. *can’t tell difference between O2 and CO2 so doesn’t catch CO2 poisoning*
nonrebreathing mask
preferred way of giving oxygen in prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia. with good mask to face seal, capable of providing up to 90% inspired oxygen
tracheostomy masks
cover tracheostomy hole and have a strap that goes around the neck
what are the two treatment options for when a patient is in severe respiratory distress or respiratory failure and not breathing adequately?
assisted ventilation and CPAP (continuous positive airway pressure)
what are the signs and symptoms of a patient needing assisted ventilation?
signs of altered mental status and inadequate minute volume. in addition, excessive accessory muscle use and fatigue from labored breathing are signs of potential respiratory failured
Artificial ventilation
the act of breathing FOR a patient
when do you use artificial ventilation?
once you determine someone is not breathing
what do you use for artificial ventilation?
mouth-to-mask technique, one or two-person BVM, and the manually triggered ventilation device
barrier device
a protective item that features a plastic barrier placed on a patient’s face with a one-way valve to prevent the backflow of secretions, vomitus, and gases
BVM (Bag Valve Mask) – what is it and when is it used?
delivers a very high concentration of oxygen. used when you need to deliver high concentrations of oxygen to patients who are not ventilating adequately. Also used for patients in respiratory arrest, cardiopulmonary arrest, and respiratory failure. May be used with or with out oxygen
what do you have to be aware of when using a BVM or any other ventilation device?
gastric distention (inflation of the stomach with air)
what is passive ventilation and when do you use it?
it is air movement in and out of the chest cavity passively as a result of compressions. use it during cardiac arrest
manually triggered ventilation device
allows a single rescuer to use both hands to maintain a mask-to-face seal while providing positive-pressure ventilation. Also reduces rescuer fatigue associated with using a BVM on extended transports
automatic transport ventilator (ATV)
essentially a manually triggered ventilation device attached to a control box that allows the variables of ventilation to be set