Airway, Respiration, & Ventilation

How does oxgyen reach the body?

circulation and breathing

How many processes are there for oxygenation of the body to occur?

2

How is the airway divided?

upper and lower airway

what are the structures that help us breathe?

chest wall, diaphragm, and nerves from the brain and spinal cord

Anatomy of the Upper airway

Nasopharynx—>Oropharynx(suction here)—→ larynx

Where does the upper airway end and the lower airway begin?

trachea

The trachea divides into the two sides in the thoracic cavity, what are these structures called?

bronchi

what is the lung tissue covered in?

pleura

Bronchioles

thin tubelike structures, they dilate or constrict to various stimuli

ventilation

process of moving air in and out of the lungs

Hypoxia

when body is deprived of oxygen, can cause severe tissue damage

early signs of hypoxia

irritability, anxiety, restlessness, tachycardia, apprehension

late signs of hypoxia

difficulty forming full sentences, weak pulse, mental status changes, shortness of breath(dyspnea), cyanosis

dyspnea

shortness of breath

Intrinsic factors affecting pulmonary ventilation

infections(swelling of upper airway), allergic reactions, tongue obstruction in unresponsive patient, pulmonary edema: fluid in the lungs, COPD

COPD

chronic obstructive pulmonary disease

extrinsic factors affecting pulmonary ventilaiton

foreign airway obstructions, trauma

metabolic respiration

cells take energy from nutrients through a chemical process

what is another name for metabolic respiration

metabolism

fresh air composition

21% oxygen, 78% nitrogen gas, 0.3% CO2

aerobic repsiration

with the use of oxygen cells convert glucose into energy

anaerobic respiration

w/o adequate amounts of oxygen, cells are unable to completely convert glucose to energy

pathophysiology of respiration

chemoreceptors detect changes in pH, hydrogen ion concentration, and oxygen levels in the CSF

what happens when a patient is without oxygen

0-1 min: cardiac irritability

4 min: brain damage not likely

4-6 min: brain damage is possible

6-10 min: brain damage likely

10+ min: irreversible brain damage

what conditions can compromise circulation

hemothorax, pneumothorax, heart failure, cardiac tamponade, blood loss and anemia

Hemothorax

blood collection in the pleural space

pneumothorax

collapsed lung

blood loss and anemia

makes it hard for oxygen transport throughout the body

cardiac tamponade

buildup of blood in the pericardium

respiratory rate in adults

12-20 BPM

Labored Breathing

requires effort of accessory muscles in children

agonal gasps

gasping, do not provide high flow oxygen

treatment should consist of ventilatory support and chest compressions

cheyne stroke respirations

common in patients with stroke and head injuries

characterized by period of apnea followed by a period of breathing with increasing depth and rate

ataxic respirations

irregular and have no identifiable pattern, they are also common in patients with head injuries

kussmaul respirations

characterized by deep rapid respirations

common in patients experiencing metabolic or toxic disorder

pulse oximetry

device that provides a reliable indication of oxygenation levels

what indicates hypoxia

pulse oximetry reading under 94%

Performing pulse oximetry

1) stick the patients middle or index finger in the pulse oximeter after cleaning it, record the reading

2) Palpate the radial pulse to make sure it correlates with the LED reading

How to position an unconscious patient to check for respiration and airway obstructions

patient must be placed in the supine position

1) stabilize the patients head while your partner straightens the legs

2) Have your partner place their hand on the patients far shoulder and hip

3) move on a count of three (EMT who is supporting the patients counts)

4) open and assess the patients airway and breathing

Managing obstructions in unconscious patients with no suspected spinal injury

head-tilt chin maneuver

managing airway obstruction in unconscious patient with suspected spinal injury

jaw-thrust maneuver

head-tilt chin maneuver

1) kneel by the patients head

2) press heel of hand flat to the patients forehead and push back

3) place finger tips under the bony part of the chin and push the jaw upward

4) this motion should move the tongue out of the airway

jaw-thrust maneuver

1) kneel above the patients head

2) place fingers behind the angles of the lower jaw and move the jaw upward

3) assess whether breathing has returned

4) open the mouth by placing the tips of your index finger and thumb over the patients teeth and pushing on the teeth with slight force

what do when hearing gurgling or gurgling respirations?

suctioning

requirments for suction

• must generate 300 mm Hg power when the tubing is clamped

• must generate airflow of 40L/min

• do not suction for more than 10-15s in adults, 10s in children, and more than 5s in infants

steps for suctioning patients airway

1) make sure the unit generates 40L/min of airflow, and 300 mm Hg

2) measure the catheter from the corner of the mouth to the angle of the jaw

assessing breathing

• equal rise and fall of the chest

• equal breath sounds

• lungs sounds

• assess chest

respiratory distress

difficulty breathing causing increased RR and respiratory effort

respiratory failure

inadequate oxygenation or poor ventilation

characterized by inadequate perfusion of oxygen throughout the body

respiratory arrest

result of respiratory failure if left untreated

Managing the airway

OPEN, CLEAR, KEEP, VENTILATE

ventilation

ventilate patient with BVM at 15L/min airflow

signs of airway obstruction in an unresponsive patient

noisy breathing(stridor, snoring, gurgling), shallow or absent breathing, obvious trauma, blood or other obstruction

what does oxygen treat?

hypoxia

what does inadequate breathing require

ventilation assistance

adequate breathing

smooth lung sounds, equal rise and fall of the chest, RR is 12-20 BPM

inadequate breathing

too fast, too shallow, unequal chest rise

crackles

fine, coarse, popping sounds, usually at the end of an inspiration

indicates fluid in alveoli

wheezing

high pitched, musical sounds when exhaling

indicates airway obstruction

ronchi

low pitched wheezing, causes difficulty in exhalation

secretion of fluid in the lungs

Nasal Cannula Oxygen treatment

administered to patient with SPO2 in normal range, but in moderate respiratory distress

non rebreather

administer to patient with SPO2 below normal levels, moderate to severe respiratory distress

albuterol

bronchodilator, used in the presence of wheezing 2.5 mg given through metered dose inhaler

xopenex

bronchodilater, use when there is wheezing

1.25 mm Hg HHN