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Airway Decisions Module. Gaining control of the airway is an essential goal in caring for patients. EMS House of DeFrance By Steve Cole, CCEMT-P. Airway control can be a challenge and it requires solid preparation, staying focused, the right tools and the right decisions. Do I have an airway?.

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Slide3 l.jpg

EMS House of DeFrance for patients.By Steve Cole, CCEMT-P

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Slide4 l.jpg

Airway control can be a challenge and it requires solid preparation, staying focused, the right tools and the right decisions.


Do i have an airway l.jpg
Do I have an airway? preparation, staying focused, the right tools and the right decisions.

http://www.trauma.org/imagebank/imagebank.html

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Is the chest rising evenly l.jpg
Is the chest rising evenly? preparation, staying focused, the right tools and the right decisions.

http://www.trauma.org/imagebank/imagebank.html

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Is he breathing l.jpg
Is he breathing? preparation, staying focused, the right tools and the right decisions.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Are his respirations shallow l.jpg
Are his respirations shallow? preparation, staying focused, the right tools and the right decisions.

http://www.trauma.org/imagebank/imagebank.html

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Are we ventilating l.jpg
Are we ventilating? preparation, staying focused, the right tools and the right decisions.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


What are her breath sounds like l.jpg
What are her breath preparation, staying focused, the right tools and the right decisions.sounds like?

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Is the combitube placed correctly l.jpg
Is the Combitube placed correctly? preparation, staying focused, the right tools and the right decisions.

Do we need to assist her breathing?

What is the respiratory pattern?

Is the oral airway the right size?

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Is this patient in respiratory distress l.jpg
Is this patient in respiratory distress? preparation, staying focused, the right tools and the right decisions.

Tripod position

Decreased tidal volume

Increased work of breathing

Shortness of breath

Restlessness

Irregular breathing

Coughing

Increased pulse rate

Abdominal breathing

Retractions

Poor skin color

Difficulty speaking

Noisy breathing

Increased respiratory rate

Decreased respiratory rate

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Noisy breathing l.jpg
Noisy Breathing preparation, staying focused, the right tools and the right decisions.

  • Crowing

  • Wheezing

  • Gurgling

  • Snoring

  • Stridor

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force



Answers are in part founded in understanding of anatomy and physiology l.jpg
Answers are, in part, founded in understanding of anatomy and physiology

  • Role of CO2

  • Mechanics of breathing

  • Aerobic metabolism

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Principles of clinical decision making l.jpg

Principles of Clinical and physiologyDecision Making


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Principles of Clinical Decision Making and physiology

  • History

  • Assessment

  • Anticipated Outcomes

  • Complications

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Principles of clinical decision making18 l.jpg
Principles of Clinical Decision Making and physiology

  • Past History (AMPLE)

  • Underlying medical

  • conditions (COPD)

  • Present History

  • Onset

  • Provocation

  • Quality

  • Radiation

  • Severity

  • Time

  • Interventions

  • Trauma?

  • Access?

  • Team airway ability?

  • History

  • Assessment

  • Anticipated Outcomes

  • Complications

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Principles of clinical decision making19 l.jpg
Principles of Clinical Decision Making and physiology

  • History

  • Assessment

  • Anticipated Outcomes

  • Complications

Assess for signs of ADEQUATE breathing

Reassess often

Reassess at any deterioration of patient condition

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Principles of clinical decision making20 l.jpg
Principles of Clinical Decision Making and physiology

Experience with similar patients

Patient prediction

Assessment findings

“Charted course” of deterioration

History or MOI

  • History

  • Assessment

  • Anticipated Outcomes

  • Complications

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Principles of clinical decision making21 l.jpg
Principles of Clinical Decision Making and physiology

  • History

  • Assessment

  • Anticipated Outcomes

  • Complications

What will happen if nothing is done?

What are the risks to procedures being considered?

What is the likelihood of a poor outcome?

Assess for procedural effectiveness

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Decision making algorhythm l.jpg
Decision Making Algorhythm and physiology

  • Patient is:

  • Responsive/adequate breathing

    • Oxygen may be indicated

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Decision making algorhythm23 l.jpg
Decision Making Algorhythm and physiology

  • Patient is:

  • Responsive/inadequate breathing

    • Oxygen is indicated

    • Open airway

    • Use NPA

    • Assist ventilations

      • Mouth to mask, BVM, Manually triggered ventilator

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Decision making algorhythm24 l.jpg
Decision Making Algorhythm and physiology

  • Patient is:

  • Responsive/inadequate breathing

    • Oxygen is indicated

    • Open airway

    • Use NPA/OPA

    • Suction as needed

    • Reassess

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Decision making algorhythm25 l.jpg
Decision Making Algorhythm and physiology

  • Patient is:

  • Unresponsive/adequate breathing

    • Oxygen is indicated

    • Use NPA

    • Assist ventilations

      • Mouth to mask, BVM, Manually triggered ventilator

    • Reassess

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Decision making algorhythm26 l.jpg
Decision Making Algorhythm and physiology

  • Patient is:

  • Unresponsive/inadequate or no breathing

    • Oxygen is indicated

    • Open the airway

    • Use NPA/OPA

    • Suction as needed

    • Assist ventilations

      • Mouth to mask, BVM, Manually triggered ventilator

    • Reassess

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Considerations in difficult ventilation situations l.jpg
Considerations in and physiologyDifficult Ventilation Situations

  • Patient positioning

  • Suctioning

  • Manual airway maneuvers

  • Two person mask seal

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


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Considerations in and physiologyDifficult Ventilation Situations

  • Oral and nasopharyngeal airways

  • ECT/PTL

  • Agents to treat swollen airways

  • Verify no obstruction

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Approach to airway l.jpg
Approach to Airway and physiology

  • Trauma

  • Non Trauma

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Airway decisions l.jpg
Airway Decisions and physiology

  • To oxygenate or not

  • Trauma versus nontrauma

  • Ventilate versus oxygenate only

  • Adjunctive device application

  • Effectiveness of patients own respiratory efforts OR of care team’s ventilations

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


To oxygenate or not l.jpg

Assess for adequate breathing and physiology

Consider

History

Assessment

Anticipated Outcomes

Complications

To Oxygenate or Not

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Trauma versus nontrauma l.jpg

Decide early/reconsider throughout care and physiology

Assess for force involved

Medical conditions may lead to trauma

Trauma may complicate medical conditions

History

Assessment

Anticipated Outcomes

Complications

Trauma versus Nontrauma

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Ventilate versus oxygenate only l.jpg

Reduction in minute volume and physiology

Respiratory arrest

Need to eliminate CO2

Reduced tidal volume

History

Assessment

Anticipated Outcomes

Complications

Ventilate versus Oxygenate Only

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Adjunctive device application l.jpg

Progressive and physiology

02

BVM

OPA/NPA

ECT/PTL

History

Assessment

Anticipated Outcomes

Complications

Adjunctive Device Application

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Effectiveness of patients own respiratory efforts or of care team s ventilations l.jpg

Assess for improvement in patient condition and physiology

Verify device effectiveness/placement

Use end tidal C02 detectors

Assess for adequate ventilation

History

Assessment

Anticipated Outcomes

Complications

Effectiveness of Patients Own Respiratory Efforts OR of Care Team’s Ventilations

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Assessment of our breathing for them l.jpg
Assessment and physiology“of our breathing for them”

  • Effort of breathing

  • Compliance

  • Chest rise

    • Evenness

    • Depth

  • Intercostal bulging

  • Skin Color

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Assessment of our breathing for them37 l.jpg
Assessment and physiology“of our breathing for them”

  • CO2 detector

  • Lung sounds

  • Epigastric sounds

  • General condition

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Assessment of their breathing l.jpg
Assessment and physiology“of their breathing”

  • Effort of breathing

  • Number of ventilations per minute

  • Pattern of breathing

  • Frequency of breathing

  • Plus assessment of items under our breathing for them

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Key airway decisions l.jpg

How bad is he? and physiology

Is the patient better or worse?

What can I do to improve the patient’s condition?

Experience and assessment

Compare one assessment to another

Ensure adequacy of airway/ventilation

Key Airway Decisions

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number one l.jpg
Case Number One and physiology

  • A 17 year old female involved in a car accident (see next slide). She is unresponsive and has gurgling respiration on removal from the car. She is immobilized in a supine position on a spine board.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


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Case Number One and physiology

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number two l.jpg
Case Number Two and physiology

A 22 year old male has been stabbed

in the throat. First responders tell you he was conscious and could not speak beyond a whisper. He said he felt like his airway was blocked and it was hard to breath. He was struggling to breath. Minutes later, on your arrival he has stopped breathing.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number two43 l.jpg
Case Number Two and physiology

http://www.trauma.org/imagebank/imagebank.html

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number three l.jpg
Case Number Three and physiology

A tractor has rolled over a 54 year old male. He is conscious and complaining of shortness of breath. He has diminished breath sounds on the right side and uneven chest rise. There is no JVD. HR is 150. RR is 28. BP is 148/88. Skin is pink, warm and dry.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number four l.jpg
Case Number Four and physiology

  • An 18 year old male was beaten by several men after an argument. His LOC is responsive and breathing is irregular and shallow.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number four46 l.jpg
Case Number Four and physiology

http://www.defrance.org/photogallery.htm

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number five l.jpg
Case Number Five and physiology

  • A 7 year old boy drowned in a backyard pool. There is gurgling on ventilation attempts. He is pulseless and not breathing.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number five48 l.jpg
Case Number Five and physiology

http://www.defrance.org/photogallery.htm

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number six l.jpg
Case Number Six and physiology

  • A 20 year old was holding a firecracker in his mouth when in exploded. He is short of breath. RR is 26. HR is 140. He feels like there is swelling in his throat. He is wheezing and has a history of asthma. He does not have his inhaler.

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


Case number six50 l.jpg
Case Number Six and physiology

http://www.defrance.org/photogallery.htm

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force


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