Airway management + ventilation, respiratory system

Pearson chapter 9

respiratory compromise

general term used to describe when a patient is not breathing adequately. 

clinical vs biological death

clinical is when heartbeat and ventilations stop (cause can be apnea - not breathing)

biological is when too many brain cells die

(ONLY CONSIDERED DEAD WHEN WARM AND DEAD)

respiratory system anatomy

Medulla (in brain) controls when you breathe

nose and mouth: air enters

larynx: at top of trachea, holds vocal cords, epiglottis prevents food from entering

Pharynx: tube that extends from nasal cavity to esophagus and to top of trachea

Trachea: bring air to lungs

Bronchial tree: continuous air to lungs

Lungs: contains air

Diaphragm: main muscle that makes ribs expand to breathe

patent airway signs

talking normally

breathing

alert

inadequate vs adequate breathing signs

tidal volume

sound of air entering and exiting (noisy means partial obstruction)

feel for movement

skin color (too pale or blue means not enough air)

breaths per minute (too many or few is bad)

regular or irregular (shallow deep normal)

flared nostrils (BAD)

positive pressure vetilation

rescue breaths (your lung air has 16% oxygen, but BVM has 21%)

good ventillations

tight seal

head tilted back

patent airway

breaths given at correct rate

airway management for kids w/ BVM

1. kneel behind patient’s head (ensure unresponsiveness)

2. open airway w/ correct maneuver (jaw thrust, or head tilt
   a, towel under should can be useful (if no spine injury)

3. with barrier device, give 1-2 breaths every 3 seconds

4. gentle but full enough breaths (chest should rise, but not OVER expanding)

airway management for adults and elderly

1. kneel behind patient’s head (ensure unresponsiveness)

2. open airway w/ correct maneuver (jaw thrust, or head tilt
   with barrier device, give 1-2 breaths every 6 seconds

3. gentle but full enough breaths (chest should rise, but not OVER expanding)

finger sweeps

only do if you can see foreign object and victim is unresponsive. 

care for a patient with partial and complete airway obstruction CHILDREN + ADULTS

abdominal thrusts

care for a patient with partial and complete airway obstruction INFANTS

2 back blows, then 5 chest thrusts

ALWAYS support infant’s neck

oropharyngeal airway insertion (OPA)

Use ONLY on unresponsive patients without gag reflex

1. open airway manually

2. measure it from corner of mouth to tip of earlobe (on same side of face) to see what size (use larger one if person is between two sizes)

3. insert device, tip pointing towards roof of mouth and slide it along roof of mouth

4. once halfway in, rotate it 180 degrees so tip is at base of tongue

5. flange on lips

6. check often

7. ventilate

nasopharyngeal airway insertion (NPA)

1. measure the size from nose to earlobe tip

2. use water based lubricant on outside of NPA

3. insert device straight in (if it is bendy, the bendy part should face the midline)

indications for oral and nasal suctioning

vomiting

bleeding in the mouth/nose

fluids

Oral suctioning

1. position at victim’s head, if possible turn victim on their side

2. measure catheter

3. insert catheter only as far as you can see, then activate it and twist and turn it from side to side to prevent grabbing of soft tissue
   a. only suction for max of 15 seconds (RECOMMENDED 10 OR LESS)

4. don’t insert over back of tongue - causes gag reflex

5. concentrate on back corners of mouth

head tilt/chin lift maneuver

no spine injury

place one hand on the patient’s forehead and two fingers of your other hand on the bony part of the patient’s chin. Gently tilt the head back while lifting the chin.

jaw thrust maneuver (with or without pocket mask)

suspected spine injury

Position yourself at the top of the patient’s head. Reach forward and place the index and middle fingers of each hand on either side at the angles of the jaw. You may press your thumbs against the cheekbones for leverage. Lift the jaw forward.

normal ventilation ranges per minute

10 - 20 for adult

18 - 34 for children (age 1-18)

30-60 for infant less than a year old

stoma

surgically created opening from an area inside the body to the outside.

use infant mask 

how long to suction

5 seconds for infants

10 seconds for children

15 seconds for adults

how much should the reservoir bag deflate by?

never deflate more than 1/3.