airway

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AIRWAY MANAGEMEN

TStephen Schutts, Master Sergeant, WA ANG

National Registry Emergency Medical Technician - Paramedic

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ObjectivesObjectivesAnatomy reviewAnatomy reviewOpening the AirwayOpening the AirwayTechniques of Techniques of SuctioningSuctioning

Airway AdjunctsAirway AdjunctsOxygen Delivery Oxygen Delivery DevicesDevices

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Respiratory System

Nose and Nose and mouthmouth

PharynxPharynx OropharynxOropharynxNasopharynNasopharynxx

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Respiratory System

EpiglottisEpiglottisTrachea Trachea LarynxLarynxCricoid Cricoid cartilagecartilage

Bronchi Bronchi

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Respiratory System

Lungs Lungs DiaphragDiaphragmm

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The ProcessInhalation Inhalation (active)(active)Diaphragm Diaphragm contractscontractsIncreases the Increases the size of the size of the thoracic thoracic cavitycavity

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The ProcessExhalation Exhalation (passive)(passive)Diaphragm Diaphragm relaxesrelaxesDecreasing Decreasing the size of the the size of the thoracic cavitythoracic cavity

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Respiratory Physiology

Alveolar/Capillary Alveolar/Capillary exchangeexchangeOxygen rich air enters the Oxygen rich air enters the alveoli on inspiration alveoli on inspiration

Oxygen poor blood in the Oxygen poor blood in the capillaries passes to the capillaries passes to the alveolialveoli

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Respiratory Physiology

Alveolar/Capillary Alveolar/Capillary exchangeexchangeOxygen enters the Oxygen enters the capillaries as carbon capillaries as carbon dioxide enters the alveolidioxide enters the alveoli

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Respiratory Physiology

Capillary/Cellular Capillary/Cellular exchangeexchangeCells give up carbon Cells give up carbon dioxide to the capillariesdioxide to the capillaries

Capillaries give up oxygen Capillaries give up oxygen to the cellsto the cells

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Adequate Breathing

Normal rateNormal rateAdult 12-20/minAdult 12-20/minChild 15-30/minChild 15-30/minInfant 25-50/minInfant 25-50/min

RhythmRhythmRegularRegular

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Adequate BreathingQualityQuality

Breath soundsBreath soundsPresent and equalPresent and equal

Chest expansionChest expansionAdequate and equalAdequate and equal

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Adequate Breathing

QualityQualityEffort of breathingEffort of breathingDepth (Tidal Volume)Depth (Tidal Volume)

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Inadequate Inadequate BreathingBreathing

Rate Rate Outside the normal Outside the normal rangesranges

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Inadequate Inadequate BreathingBreathing

QualityQualityBreath soundsBreath sounds

Diminished or absentDiminished or absentChest expansionChest expansion

Unequal or inadequateUnequal or inadequateIncreased breathing effortIncreased breathing effort

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Inadequate BreathingDepthDepth

Skin Skin CyanoticCyanoticcool/clammycool/clammy

Muscle retractionsMuscle retractionsOften seen in childrenOften seen in children

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Inadequate BreathingNasal flaringNasal flaring

Often seen in childrenOften seen in childrenSee-saw respirations in See-saw respirations in infantsinfants

Agonal Respiration’sAgonal Respiration’sGasping respirationsGasping respirations

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Infant/Child Anatomy

Considerations

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Effective Artificial Ventilations

Rise and fall of chestRise and fall of chestRegular ventilation rateRegular ventilation rate

Adults-12/min Adults-12/min Children/Infants-20/minChildren/Infants-20/min

Heart rate returns to Heart rate returns to normalnormal

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Opening the AirwayBSIBSI

Head tilt, chin liftHead tilt, chin liftNo suspected neck No suspected neck injuriesinjuries

Jaw-thrustJaw-thrustSuspect spinal injuriesSuspect spinal injuries

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Head-Tilt, Chin-Lift Head-Tilt, Chin-Lift ManeuverManeuver

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Jaw-Thrust Jaw-Thrust ManeuverManeuver

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Suctioning Techniques

BSIBSIPurposePurpose

Remove blood, liquids Remove blood, liquids and food particles from and food particles from the airwaythe airway

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Suctioning Techniques

Types of Types of unitsunitsMountedMountedPortable Portable

ElectricElectricHand Hand operatedoperated

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Suctioning Suctioning TechniquesTechniques

Suction CathetersSuction CathetersHard/rigidHard/rigid

Used to suction Used to suction mouth/oropharynxmouth/oropharynx

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Hard/Rigid CatheterHard/Rigid Catheter

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Suctioning Suctioning TechniquesTechniques

Soft (French)Soft (French)Useful for suctioning Useful for suctioning nasopharynxnasopharynx

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Soft/French Soft/French CatheterCatheter

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30 This is one of them!This is one of them!

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Techniques of Techniques of Artificial VentilationArtificial Ventilation

Two-person Two-person BVMBVM

Mouth to Mouth to maskmask

One-One-person person BVMBVM

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Mouth-to-MaskMouth-to-Mask

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Mouth-to-MaskMouth-to-MaskShould be connected to Should be connected to oxygenoxygen

Provides 50% oxygen Provides 50% oxygen concentrationconcentration

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Bag-Valve-Mask Bag-Valve-Mask (BVM)(BVM)

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Bag-Valve-Mask Bag-Valve-Mask (BVM)(BVM)

Consists ofConsists ofSelf-inflation bagSelf-inflation bagOne way valveOne way valveOxygen reservoirOxygen reservoir

Delivers close to 100% Delivers close to 100% oxygenoxygen

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Bag-Valve-Mask Bag-Valve-Mask IssuesIssuesProvides less volume Provides less volume

than mouth-to-maskthan mouth-to-maskMore effective with two More effective with two peoplepeople

Available in infant, Available in infant, child, adult sizeschild, adult sizesRemember CPR?Remember CPR?

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Bag to Stoma or Bag to Stoma or Tracheostomy TubeTracheostomy Tube

Tracheostomy – an artificial Tracheostomy – an artificial permanent opening in the permanent opening in the tracheatrachea

If unable to ventilate, suctionIf unable to ventilate, suctionNeed to seal the mouth and Need to seal the mouth and nose when air is escaping nose when air is escaping during ventilationduring ventilation

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Bag to Stoma or Bag to Stoma or Tracheostomy TubeTracheostomy Tube

Bag-valve-mask to stomaBag-valve-mask to stomaUse infant or child size mask Use infant or child size mask to ventilateto ventilate

Technique very similar to Technique very similar to ventilating though mouthventilating though mouth

Head and neck position not Head and neck position not importantimportant

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Ventilating Through a Stoma or

Tracheotomy Tube

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Airway AdjunctsOropharyngeal AirwayOropharyngeal Airway

Used on all unconscious Used on all unconscious patient’s without a gag patient’s without a gag reflexreflex

Must be correctly sizedMust be correctly sizedCorner of mouth to Corner of mouth to bottom of the ear lobebottom of the ear lobe

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OP Airway

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Airway AdjunctsAirway AdjunctsNasopharyngeal AirwayNasopharyngeal Airway

Less likely to stimulate Less likely to stimulate gag reflexgag reflex

Select proper sizeSelect proper sizeTip of nose to the tip of Tip of nose to the tip of the ear lobethe ear lobe

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Airway AdjunctsAirway Adjuncts

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Equipment for Equipment for Oxygen DeliveryOxygen Delivery

Non-rebreather mask Non-rebreather mask (NRB)(NRB)Best way to deliver high Best way to deliver high concentration of oxygen concentration of oxygen 12-15 lpm12-15 lpm

Up to 90% concentrationUp to 90% concentration

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NRBNRB

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Equipment for Equipment for Oxygen DeliveryOxygen Delivery

Nasal cannulaNasal cannulaRarely the best method for Rarely the best method for oxygen delivery oxygen delivery

Used on patient’s who do Used on patient’s who do not tolerate the NRB not tolerate the NRB

Delivers 24-44% oxygen at Delivers 24-44% oxygen at 1 - 6 lpms1 - 6 lpms

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Nasal CannulaNasal Cannula

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ReviewReviewAnatomy reviewAnatomy reviewOpening the AirwayOpening the AirwayTechniques of SuctioningTechniques of SuctioningAirway AdjunctsAirway AdjunctsOxygen Delivery DevicesOxygen Delivery Devices