NREMT AIRWAY

A nasal cannula can

-deliver 24 to 44% oxygen
-have a flow rate of 1-6L.
-Not preferred but can be used for comfort.

A nonrebreather mask is for patients who are

-Breathing adequately but are suspected of having or showing signs of hypoxia.
-Provides 90% O2
-flow rate is 10-15L per min

A person with hypoxia has what problems?

Appears initially disoriented, irritable, nervous, and rapid pulse

Accessory Muscles Include:

The neck muscles (sternocleidomastoid), the chest pectoralis major muscles, and the abdominal muscles

Acidosis

Buildup of acids because of excess glucose, poisoning, and stress.

Acidosis can cause what?

Rapid breathing

Adult Respiration Rate

12-20

Anaphylaxis

Flushed skin or hives
Generalized edema
Decreased BP
Laryngeal edema with dyspnea

Asthma

Wheezing on Inspiration/Expiration
Bronchospasm

Asthma is referred to as:

Bronchiospasm

Biot's respirations

Caused by damage to the pons of the brain stem and in this case, secondary to what we can safely assume is head/facial trauma

Bronchitis

Chronic cough
Wheezing
Cyanosis
Productive Cough

BVM's deliver...

600ml of O2

CAD

Narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart

Can you do chest thrusts with CPR?

Yes

Can you perform a blind finger sweep on a child or infant?

No

Can you use a BVM on a child?

True

Can you use suction of the nasopharynx and oropharynx?

Yes

Catheters should be measured so they do not go past what?

The tongue

Central neuorogenic hyperventiliation

Rapid and deep respirations in stroke victims or severe head injury

Chest thrusts are for...

bed patients, obese patients, and children under 1

Cheyne-Strokes respirations

A pattern of breathing in stroke/comatose patients. Periods of apnea with tachypena/rapid breathing

Child Respiration Rate

15-30

Chronic Bronchitis presents as what?

Lung Infections

Combitube

Airway device with two lumens and obturator cuffs at two points, used to ventilate the trachea after blind insertion, whether the device is placed in the trachea or the esophagus

Conditions that are associated with hypoxia:

Heart attack, asthma, smoke inhalation, drug overdose, shock and fluid in the lungs

Congestive Heart Failure (CHF)

Dependent Edema
Rales
Paroxysmal Nocturnal dyspnea

COPD can mean...

asthma, bronchitis, and emphysema

COPD is driven by

Low O2

Croup

Fever
Barking Cough
Mostly seen in ped patients

Cystic Fibrosis

Thickens mucus lining in lungs and other organs (primarly digestive). The thick mucus holds germs against cell walls and increases risk of infection.

Digital clubbing

Sign of chronic hypoxia in young people with congenital heart disease and older people with severe chronic lung disease

Emphysema

Barrel Chest
Pursed lip breathing
Dyspnea on exertion

Emphysema is caused by?

Deterioration of arterial walls

Emphysema is when there is...

decreased alveolar surface tension. It's a cause of wheezing

Four steps when inserting a nasopharyngeal airway

-Select the proper size airway and apply water soluble lubricant
-Place the airway in the larger nostril with the curvature following the curve of the floor of the nose
-Advance the airway gently
-Continue until the flange rests against the skin

FROPVD does what?

Provides ventilation without physical input

Hard catheters should be used for?

Oropharynx

How do you clear the airway of a pregnant woman?

Chest compressions

How do you do rescue breaths for infants?

Two gentle breaths

How do you suction in an infant?

Bulb syringe

How do you treat asthma?

Epinephrine

How does airway of an infant/child compare to an adult?

Airway is much smaller; softer cartilage and more elastic

How to open airway in infants and how much?

Blow-by and 6lpm

If SPO2 is less than 94%

Hypoxemic

If the head is hyperextended what do you not do?

Head-tilt-chin-lift

In a patient with a stoma, the nose and mouth may need...

To be covered during CPR to prevent air leakage

In ped patients an children- DO NOT

TWIST when inserting OPA

Infant Respirations

25-50

Infants breath between what months through their nose and are called?

2-4; Obligate Nose Breathers

Kussmaul respirations

Very deep and rapid respiratory pattern in an attempt to blow off excess CO2.

Late stage hypoxia includes what?

Labored breathing, chest pain, and the patient might be cyanotic

Manually Triggered Ventilation devices should have the following components:

-A peak flow rate of 100% OXYGEN at up to 40L/min
-A inspiratory pressure safety release valve that opens at approximately 60 cm of water and vents any remaining volume to the atmosphere or stops the flow of oxygen
-An audible alarm that sounds whenever you exceed the relief pressure valve
-The ability to operate satisfactory under normal and varying environmental conditions
-A trigger (or lever) positioned so that both your hands can remain on the mask to provide an airtight seal while supporting and tilting the patient's head and keeping the jaw elevated

Oxygen for a BVM can be delivered at what rate?

10-15lpm

Partial Rebreather Masks

-Like nonrebreathers but no one way valve between the mask and the reservoir.
-This means the patient rebreathes some of their own air. -This is good for hyperventilation.
-It increases CO2 levels.
-Delivers approximately 80 to 90% oxygen and 2% to 3% CO2

Patent

Open airway clear of obstructions

People who have asthma might do what?

Cough, wheeze, hypoxic, use accessory muscles to catch breath.

Pertussis (whooping cough)

Cough spells
"Whooping" sounds
Fever
Mostly seen in peds patients

Pneumonia

Dyspnea
Chills, fever
Cough
Dark sputum

Pneumothorax

Sudden chest pain with dyspnea
Decreased lung sounds/affected side

Pocket masks uses how many breathes per how many aseconds?

1 breath every 4/5 seconds

Pulmonary Embolus

Sharp, pinpoint pain
Dyspnea
Sudden onset
After childbirth or surgery

Pursed lip breathing:

Improves ventilation
Releases trapped air in the lungs
Keeps the airways open longer and decreases the work of breathing
Prolongs exhalation to slow the breathing rate
Improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs
Relieves shortness of breath
Causes general relaxation
Keeps bronchioles from collapsing

Rescue breathing for pediatric patients is how many breaths per how many seconds?

1 breath every 3 seconds

Severe brain damage occurs after how long?

4-6 minutes

Signs of Inadequate breathing in adults

-Respiratory rate of fewer than 12 breaths per min or more then 20 breaths per mi in the presence of shortness of breath (dyspnea)
-Irregular rhythm, such as a patient taking a series of deep breaths followed by periods of apnea
-Diminished, absent, or noisy auscultated breath sounds
-Reduced flow of expired air at the nose and mouth
-Unequal or inadequate chest expansion, resulting in reduced tidal volume
-Increased effort of breathing- use of accessory muscles
-Shallow depth (reduced tidal volume)
-Skin that is pale, cyanotic (blue), cool, or moist (clammy)
-Skin pulling in around the ribs or above the clavicles during inspiration (retractions)

Soft catheters should be used for?

Nasopharynx

Tension Pneumothorax

Progressive shortness of breath
Increasing altered lvl of consciousness
Neck vein distention (JVD)
Tracheal deviation

The blood cells absorb what?

Oxygen

The correct setting for an albuterol Nebulizer is ...

6-8L per min

The most likely cause of reduced tidal volume...

Is uneven chest expansion

Ventura Masks are

-specific and can deliver 24% to 40% oxygen
-Good when you need a specific amount

What causes Asthma?

Smooth muscle of the bronchioles contract

What do you do if the head-tilt-chin-lift maneuver doesnt work?

Repeat and begin rescue breathing

What does wheezing mean?

Lower airway problem maybe from asthma

What happens without oxygen?

Heartbeat becomes irregular

What if the jaw-thrust maneuver is unsuccessful?

Do the Head-tilt-chin-maneuver

What is a problem with a pocket mask?

Can create excessive pressure in thoracic cavity

What is a stoma?

A tracheostomy

What is Bradypnea?

Slow Regular Breathing

What is cricoid pressure?

Prevents gastric distention and vomiting during ventilation; downward pressure on ring of cricoid cartilage

What is crowning?

Swollen larynx and lower pitched noise

What is depth of breath?

Tidal Volume

What is Dyspnea?

Difficulty Breathing

What is gurgling?

Fluid or mucous in the upper airway

What is head-tilt-chin-lift maneuver and when is it used?

Used if patient has no signs of head, neck or back injury. Patient should be on their back.

What is Hyperpnea?

Fast Deep Breathing

What is Hypopnea?

Slow Deep Breathing

What is hypoxia?

When tissues are not receiving enough oxygen

What is nasal cannula?

Flow Rate is 1-6liters which is about 20-40% oxyen.

What is nonrebreather masks?

Flow rate is 10-15lpm which is about 70-100% oxygen.

What is one sign of inadequate breathing?

Skin is damp and clammy

What is rales?

Crackling sound in the alveoli in the lungs

What is rhonci?

Snoring-like sound from upper or lower airway; maybe from mucous

What is simple mask?

Flow rate of 6-10L which is about 40%-60%-Being phased out

What is Tachypnea?

Fast Breathing

What is the Jaw-thrust maneuver and when is it used?

Used when suspected head, neck, or back injury. Put them in supine position.

What is the problem with pulse oximeters?

They do not monitor CO2 levels

What is the problem with the nonrebreather mask?

One way valve prevents the patient from inhaling exhaled CO2

What might be the only possible oxygen delivery technique for conscious infants?

Blow-by