EMT: Ch 10 - Module #2: Airway

Used study guide and review sheet to make study cards - should still look at lesson plan, notes, textbook, and adaptive tests

T/F: a BiPAP allows you to set different airway pressures for inspiration and expiration.

true

what is the formula to calculate how long an oxygen cylinder will last?

- replace .28 with the cylinder constant (depends on type of cylinder) - e.g D, G, E, M, etc.

T/F: when using a BVM, select the appropriate size and use only enough volume to cause the chest to rise.

true

disadvantages of mouth-to-mask ventilations

• The mask is perceived by some EMT s as having an increased risk of infection.

• The EMT providing ventilation may fatigue.

• Doesn’t allow for the highest possible concentration of oxygen to be delivered.

advantages of mouth-to-mask ventilations

• A single EMT can maintain a good seal.

• Eliminates direct contact with the patient.

• One-way valve.

• Provides adequate tidal volume.

• Supplemental oxygen can be administered.

how much oxygen does mouth-to-mouth/mouth-to-nose deliver?

16%

what is Paradoxical chest wall movement?

chest wall segment moves in during inspiration and out during expiration, which is the reverse of normal

If breathing is inadequate, the brain begins to die within

4-6 minutes

T/F: Breathing can be adequate, but if the patient is working harder to breathe, he is in respiratory distress.

true

how should you insert a NPA?

bevel toward the septum or base of tonsil

T/F: Use an infant or child mask with your bag-mask device to make a seal over the stoma.

true

contraindications for CPAP

• Patient is in respiratory arrest or has agonal respirations.

• Patient is hypoventilating.

• Patient cannot speak.

• Patient is unresponsive or otherwise unable to follow verbal commands.

• Patient cannot protect his or her own airway.

• Patient has hypotension. 

• Signs and symptoms of pneumothorax or chest trauma

• Patient who has a tracheostomy

• Active gastrointestinal bleeding or vomiting

• Patient has experienced facial trauma.

• Patient is in cardiogenic shock.

• Patient cannot sit upright.

• CPAP system mask and strap cannot properly fit.

• Patient cannot tolerate the mask.

• Always reassess the patient for signs of deterioration and/or respiratory failure.

• patient is under the age of 12

what is minute volume vs tidal volume?

minute: the amount of gas inhaled/exhaled in one minute (product of respiratory rate + tidal volume)

tidal: the amount of gas inhaled/exhaled in one breath

contraindication for OPA

the patient has gag/cough reflex

what does it mean when a patient’s skin is diaphoretic?

the patient is excessively sweating

common causes of respiratory arrest

• stroke

• myocardial infarction (heart attack)

• drug overdose (especially opiates and other CNS depressants)

• toxic inhalation

• electrocution and lightning strike

• suffocation

• traumatic injuries to head, spine, chest, or abdomen

• infection to the epiglottis

• airway obstruction by a foreign body

what two things = minute volume?

tidal volume x respiration rate

4 things you should look for to see if patient is adequately breathing

1. rate

2. rhythm

3. quality

4. depth (tidal volume)

soft catheter AKA:

french catheter or whistle-tip or nonrigid plastic

rigid catheter AKA:

hard catheter or Yankauer “tonsil tip” or “tonsil sucker”

Airway anatomy in children vs adults

child:

• chest wall more pliable

• rely more on diaphragm

• more likely to overinflate lungs when giving ventilations

• nose and mouth are smaller

• epiglottis is U-shaped and protrudes into the pharynx

• cricoid cartilage is less rigid and less developed

• trachea is narrower, softer, and more flexible

• larger tongue takes up more space in the pharynx

what is edema?

swelling

while you are transporting a patient with altered mental status, he suddenly vomits and partially digested food along with large blood clots. the vomitus is too big for the rigid suction catheter. the EMT should immediately place the patient on his side and:

perform a finger sweep

when a person’s diaphragm contracts and the intercostal muscles pull the ribs upward, what will occur relative to the exchange of air and/or gases?

air will flow into the lungs

respiratory distress vs respiratory failure vs respiratory arrest

• distress: abnormal (increased/decreased) respiratory rate/effort

  • includes: increased work of breathing, inadequate respiratory effort (e.g hypoventilation or bradypnea), and irregular breathing.

  • respiratory distress —> (leads to) —> respiratory failure

• failure: there is an inadequate blood oxygenation/ventilation/both to meet the metabolic demands of the body tissues

  • job of the lungs is to ventilate and oxygenate. when it doesn’t do any of that, it is failing

• arrest: absence of breathing

T/F: a mask with an oxygen inlet provides oxygen during mouth-to-mask ventilation

true

should you use caution with patients with potentially low BP when using a CPAP? Why?

yes because CPAP causes a drop in cardiac output (mount of blood pumped by the heart)

T/F: you should take a helmet off a motorcycle driver after an accident to see the condition of his face/head

false - only take the helmet off if you need to do something for his airway

purpose of mucous membranes in notaris (in the nose)

to warm, moisten, and filter air

what is external respiration?

gas exchange process that occurs between the alveoli and the surrounding pulmonary capillaries

• Referred to as alveoli/capillary gas exchange

• serves to oxygenate the blood and eliminate carbon dioxide from the lungs

what is internal respiration

gas exchange process that occurs between the cells and systemic capillaries

• AKA cell/capillary gas exchange

• responsible for delivering oxygen to the cells and removing carbon dioxide from the cell

disadvantage of using a BVM

can be hard to maintain a tight seal - for best results, it requires two people

what is the epiglottis?

• small, leaf shaped flap of cartilaginous tissue that protects the trachea

• valve that closes over the opening to the larynx while food and drink are being swallowed

what is ventilation?

passage of air in/out of the lungs

• referred to as breathing, pulmonary ventilation

• mechanical process, involves movement of air

• creates pressure changes in the lungs to draw air in/out (inhalation, exhalation)

what is respiration?

gas exchange in the alveoli (external respiration) and in the cells (internal respiration)

• physiologic

• the exchange of oxygen and carbon dioxide

when using a BVM, check for:

bilateral chest rise and fall

what is the trachea?

passageway for air entering the lungs

• AKA the windpipe

• extends for the larynx to the carina

what is the carina?

the point at which the trachea splits into right and left mainstem bronchi

what is oxygenation?

the process by which the blood and cells become saturated with oxygen

• process of leading oxygen molecules onto hemoglobin in the bloodstream

• required for internal respiration

• does not gaurantee that internal respiration is taking place

what is a Bag-Valve Mask (BVM)?

a manual device used to provide positive pressure ventilation

what does a BVM consist of?

• self-inflating bag

• one-way nonrebreather valve

• face mask

• intake/oxygen reservoir valve

• oxygen reservoir

• pop off valve

standard respiration rate for adult

12-20 breaths/min (can fall within 8-24)

standard respiration rate for adolescent

12-20 breaths/min

standard respiration rate for for school aged children

15-30

standard respiration rate for preschooler

20-30 breaths/min

standard respiration rate for infant

25-40 breaths/min

standard respiration rate for newborn

30-60 breaths/min

the most effective way to use a BVM is by:

connecting it to high flow concentrated oxygen

abnormal upper airway sounds

• snoring

• crowing

• gurgling

• stridor

snoring description

• upper airway partially obstructed by the tongue or by relaxed tissues in the pharynx

• obstruction can be corrected by performing a head-tilt, chin-lift maneuver

• in a patient with suspected spinal injury, a jaw-thrust maneuver should be used

crowing description

• like a crow cawing that occurs when the muscles around the larynx spasm and narrow the opening into the trachea

• air rushing through the restricted passage causes the sound

gurgling description

• usually indicates the presence of blood, vomits, secretions, or other liquid in the airway

• immediately suction the substance from the airway

stridor description

• high-pitched sound heard during inspiration

• characteristic of a significant upper airway obstruction from swelling in the larynx

• may also be heard if a mechanical obstruction by food or other objects is present

what is cellular respiration and aerobic metabolism?

• process that breaks down glucose in the presence of oxygen

• produces high amounts of energy in the form of ATP

• releases carbon dioxide and water as a by-product

• brain needs oxygen and glucose

what two things does the brain need?

oxygen and glucose

when alone, the preferred method for ventilations is to use

a pocket mask

what is a NPA?

Nasopharyngeal Airway

what is a NPA used for?

useful in patient with clenched teeth, some facial injuries and those unable to tolerate an OPA

what is a contraindication for NPA?

it shouldn’t be used in a patient with suspected fracture of the base of the skull or severe facial trauma

what is minute volume (minute ventilation)?

the amount of air moved in/out of lungs in one minute

what is a FROPVD?

Flow Restricted, Oxygen-Powered Ventilation Device

• manually triggered ventilation device

• used by 1 EMT, using 2-handed technique to seal mask

what % of oxygen does FROPVD deliver?

100%

T/F: FROPVD is only used for adult patients

true

what is the most common airway obstruction?

the tongue - when muscles controlling the tongue relax, it causes the tongue to fall back and block the airway

normal pulse oximeter reading

95%-100%

how much oxygen does a BVM without an oxygen source deliver?

21%

how much oxygen can a BVM deliver when connected to an oxygen source and reservoir?

close to 100% oxygen

why can snoring and obstructs can be corrected by performing a head-tilt, chin-lift maneuver?

because it lifts the base of the tongue from the back of the pharynx (throat)

what does fluid in the alveoli negatively effect?

gas exchange

what should you do if you don’t see chest rise and fall and use an adjunct (OPA/NPA)?

readjust the head and try ventilating again

patient falls 20 feet onto the ground. how should you open the airway?

jaw thrust maneuver

how should jaw thrust maneuver be performed?

the jaw is displaced forward by an EMT’s fingers

• this causes patient’s tongue to be pulled forward, away from the back of the airway

when should you use the head tilt, chin lift maneuver?

to open the airway in a patient with no suspected spinal injury

how should the head-tilt, chin-lift maneuver be performed?

• place 1 hand on patients forehead and apply firm, backward pressure with the palm of the hand to tilt the head back

• place the tips of fingers of other hand underneath the bony part of the lower jaw

• with head tilted backward, lift the jaw upward (do not compress the soft tissues underneath the chin; they might obstruct the airway

• lift the chin and jaw so that the teeth are brought nearly together (If necessary, you can use your thumb to depress or retract the lower lip; this keeps the patient’s mouth slightly open.)

• If the patient has loose dentures, hold them in position, making obstruction by the lips less likely. A seal is easier to form when the dentures are in place. If the dentures cannot be managed, remove them.

T/F: you should place the tips of the fingers of the hand underneath the soft tissues underneath the chin during the head tilt, chin lift maneuver

false - you should place the tips of the fingers of the hand underneath the bony part of the lower jaw

• do not compress soft tissues underneath the chin; they might obstruct the airway

T/F: you can use your thumb to depress or retract the lower lip when doing the head-tilt, chin-lift maneuver if necessary

true - it keeps the mouth slightly open

if the patient has loose dentures and you need to perform a head-tilt, chin-lift maneuver, what should you do?

hold them in position

• makes obstruction by the lips less likely

• a seal is easier to form when the dentures are in place

if dentures cannot be managed, remove them

what is a quick way to check a patient for proper circulation?

check if they are cyanotic

what is cyanosis?

bluish gray color - late sign of hypoxia

• may be found in and around several areas of the body

  • lips

  • mouth

  • nose

  • fingernail beds

  • conjunctive (eye)

  • oral membranes (mouth/gums)

T/F: you should place an OPA in patient in cardiac arrest before transport

true

if the patient is coughing and showing universal sign that they are choking, what should you encourage the patient to do?

continue coughing to unblock the airway

what does it mean when a person is struggling to breath and is diaphoretic?

they aren’t receiving enough oxygen

what does it mean when a patient is diaphoretic?

they are profusely sweating

what is the best technique for using a BVM?

2-person to obtain an adequate seal on patient

patient is hit in the throat. you will hear ______ sounds due to the significant upper airway obstruction from swelling in the larynx (vocal cords)

stridor

when an elderly patient is breathing irregularly but is unresponsive, what is it a sign of?

sign of stroke

a patient is not breathing but has a pulse after falling out of a car window. what kind of injury do they have?

spinal injury

if you hear gurgling sounds, what should you use to suction their airway?

rigid tip suction catheter

what is a rigid tip suction catheter?

used for suctioning the mouth and oropharynx

• used in unresponsive patients

• insert only as far as you can see into the mouth

• avoid touching the back of the oropharynx

what is a soft (french) tip catheter?

can be used to suction the nose or nasopharynx

• should not be inserted beyond the base of the tongue

• avoid inserting too far

T/F: the soft suction catheter should not be inserted beyond the base of the tongue

true

T/F: a rigid tip suction catheter should be inserted, touching the back if the oropharynx

false - avoid touching the back of the oropharynx and only insert as far as you can see into the mouth

if a patient hits their chest and bends the steering wheel in a car accident, what type of injury do they have?

a chest injury

what is a flail segment/flail chest?

type of motion seen when two or more adjacent ribs are fractured in two or more places

• interferes with effectiveness of chest wall movement

• alters negative pressure in chest

• causes alveoli to collapse

• thus reduces adequacy of breathing and oxygenation

what is PPV?

Positive Pressure Ventilation

• the process of forcing air into the lungs of a patient

what are disadvantages of PPV?

• airway walls are pushed outward, creating a larger space

  • requires higher volumes to fill larger space and ventilate patient effectively

• can overcome esophageal opening pressure

  • allows air to enter the esophagus and fills the stomach with air during ventilation (gastric distention and possibility of regurgitation)

• thorax becomes positive during inhalation phase as air is forced into lungs

  • with loss of negative air pressure generated during normal ventilation, vacuum effect is diminished and venous return decreases

  • decreases preload

  • reduces stroke volume, cardiac output, blood pressure, and perfusion

disadvantages of FROPVD or Manually Triggered Ventilation (MTV) device

• designed only for adult patient use

  • because it delivers oxygen at high pressure and high flow rate (can’t be used on infants/children)

• EMT is unable to feel the compliance of air being delivered during ventilation

T/F: FROPVD and MTV are the same thing

true - same thing, referred to as different names

what is compliance when using a BVM?

how easy/difficult it is to squeeze the BVM

what is the most common cause of cardiac arrest

hypoxia