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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

EMS House of DeFrance By Steve Cole, CCEMT-P

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

slide4

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
Do I have an airway?

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

is the chest rising evenly
Is the chest rising evenly?

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

is he breathing
Is he breathing?

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

are his respirations shallow
Are his respirations shallow?

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

are we ventilating
Are we ventilating?

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

what are her breath sounds like
What are her breath sounds like?

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

is the combitube placed correctly
Is the Combitube placed correctly?

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
Is this patient in respiratory distress?

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
Noisy Breathing
  • 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
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 making17
Principles of Clinical Decision Making
  • History
  • Assessment
  • Anticipated Outcomes
  • Complications

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

principles of clinical decision making18
Principles of Clinical Decision Making
  • 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
Principles of Clinical Decision Making
  • 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
Principles of Clinical Decision Making

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
Principles of Clinical Decision Making
  • 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
Decision Making Algorhythm
  • Patient is:
  • Responsive/adequate breathing
    • Oxygen may be indicated

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

decision making algorhythm23
Decision Making Algorhythm
  • 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
Decision Making Algorhythm
  • 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
Decision Making Algorhythm
  • 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
Decision Making Algorhythm
  • 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
Considerations inDifficult Ventilation Situations
  • Patient positioning
  • Suctioning
  • Manual airway maneuvers
  • Two person mask seal

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

considerations in difficult ventilation situations28
Considerations inDifficult 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
Approach to Airway
  • Trauma
  • Non Trauma

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

airway decisions
Airway Decisions
  • 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
Assess for adequate breathing

Consider

History

Assessment

Anticipated Outcomes

Complications

To Oxygenate or Not

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

trauma versus nontrauma
Decide early/reconsider throughout care

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
Reduction in minute volume

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
Progressive

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
Assess for improvement in patient condition

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
Assessment“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
Assessment“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
Assessment“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
How bad is he?

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
Case Number One
  • 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

case number one41
Case Number One

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

case number two
Case Number Two

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
Case Number Two

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

case number three
Case Number Three

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
Case Number Four
  • 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
Case Number Four

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

case number five
Case Number Five
  • 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
Case Number Five

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

case number six
Case Number Six
  • 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
Case Number Six

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

Kansas Airway Supplement

Kansas BEMS EMS Educator Task Force

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