Chapter 9 Airway

1. Chapter 9 Airway

2. Respirations • Every cell of the body requires _______________________ to survive • Oxygen must come in and carbon _______________________ must go out

3. Metabolism • Metabolism--Process where the body’s cells convert food to _______________________ • Adequate _______________________ required • Carbon dioxide produced as a _______________________ product

4. Oxygen Requirements • Normal air consists of ____________% oxygen • Exhaled air consists of ____________% oxygen • All cells require oxygen to live • CPR produces only ____________% of the normal cardiac output

5. Respiratory Anatomy • Nose: The _______________________ pathway • _______________________ : Secondary pathway • Pharynx: The _______________________ • Larynx: Connects the pharynx and trachea • voice box • _______________________ cartilage • _______________________ : leaf shaped flap that covers trachea to prevent food from entering lungs

6. Respiratory Anatomy • _______________________ : Windpipe • Bronchial Tree: Branching of trachea • Bronchi • Bronchioles • Lungs -Left lung has ___________ lobes -Right lung has ____________ lobes • _______________________ : Tiny air sacs where gas exchange occurs

7. Respiratory Anatomy • Diaphragm: _______________________ that controls breathing • Upper Airway: nasopharynx to just below larynx • Lower Airway: Larynx to _______________________

8. Diaphragm • Has characteristics of both voluntary and _______________________ muscles • _______________________ -shaped muscle • Divides thorax from abdomen • _______________________ during inhalation • _______________________ during exhalation

9. Anatomy Review

10. Breathing Process: Inhalation • _______________________ part of breathing • Diaphragm and intercostal muscles contract, allowing the lungs to _______________________ . • The decrease in pressure allows lungs to fill with air. • Air travels to the _______________________ where exchange of gases occurs.

11. Tidal and Minute Volume • Tidal Volume: the amount of air, in _______________________ , that is moved in and out of the lungs with each breath • ___________ to ___________ mL per kilogram • ___________ mL is average for an adult male • Minute Volume: the amount of air moved through the lungs in one _______________________ • Tidal volume X respiratory _______________________

12. Breathing Process: Exhalation • Does not normally require _______________________ effort • Diaphragm and intercostal muscles _______________________ . • The thorax _______________________ in size, and ribs and muscles assume their normal positions. • The increase in pressure forces air out.

13. The Body’s Need for Oxygen

14. Gas Exchange • Inhalation delivers oxygen-rich air to alveoli. • Oxygen diffuses into the _______________________ • The body does not use all the inhaled _______________________ .

15. Gas Exchange

16. Control of Breathing • Brain _______________________ controls breathing • Stimulus for breathing is one of the following: • _______________________ Drive: Breathing regulated by the amounts of carbon dioxide in arterial blood - _______________________ Stimulus -As CO2 levels increase, rate increases • _______________________ Drive: Breathing regulated by the amount of oxygen in the arterial blood - _______________________ system -As O2 levels increase, rate decreases

17. Normal Breathing Characteristics • Normal rate and _______________________ • Regular _______________________ • Good breath _______________________ in both lungs • Regular rise and fall movements in the chest • Easy, not labored

18. Hypoxia • Hypoxia is the lack of _______________________ • Signs • _______________________, irritability, and fear • Tachycardia • Mental status changes • Use of _______________________ muscles for breathing • Difficulty breathing, possible _______________________ pain

19. Conditions Resulting in Hypoxia • Myocardial _______________________ • Pulmonary edema • Acute narcotic overdose • Smoke inhalation • _______________________ • Chest injury • Shock • Lung disease • _______________________

20. Normal Respiration Rates • Adults: ____________ to ____________ breaths/min • Children: ____________ to ____________ breaths/min • Infants: ____________ to ____________ breaths/min

21. Recognizing Inadequate Breathing • _______________________ breathing • Use of accessory muscles • Pale or _______________________ skin • Cool, _______________________ skin • Irregular respirations • _______________________ lung sounds

22. Opening the Airway • Head tilt-chin lift • _______________________ patients, medical patients • Jaw-thrust • Suspected _______________________ injury

23. Head Tilt/Chin Lift

24. Jaw Thrust

25. Assessment of the Airway • _______________________. • _______________________. • _______________________.

26. Basic Airway Adjuncts (1 of 6) Oropharyngeal airways • Keep the _______________________ from blocking the upper airway • Allow for easier suctioning of the airway • Used in conjunction with _______________________ device • Used on unconscious patients without a _______________________ reflex

27. Basic Airway Adjuncts (2 of 6) Inserting an oropharyngeal airway • Select the proper _______________________ airway. • _______________________ the patient’s mouth. • Hold the airway upside down and insert it in the patient’s mouth. • Rotate the airway ___________° until the flange rests on the patient’s lips.

28. Basic Airway Adjuncts (3 of 6)

29. Basic Airway Adjuncts (4 of 6) • Nasopharyngeal airways • Used on _______________________ patients who can’t maintain an airway • Can be used on patients _______________________ a gag reflex • Should not be used on patients with possible _______________________ injuries or nose bleeds

30. Basic Airway Adjuncts (5 of 6) Inserting a nasopharyngeal airway • Select the proper size airway. • _______________________ the airway. • Gently push the _______________________ open. • With the bevel turned _______________________ the septum, insert the airway.

31. Basic Airway Adjuncts (6 of 6)

32. Suctioning Equipment (1 of 2)

33. Suction Equipment (2 of 2)

34. Suctioning Technique (1 of 2) • Check the unit and turn it on. • Select and _______________________ proper catheter to be used. • Open the patient’s mouth and _______________________ tip. • Suction as you _______________________ the catheter. • Never suction for more than ___________ seconds.

35. Suctioning Technique (2 of 2)

36. Recovery Position

37. Supplemental Oxygen • All patients in _______________________ arrest should get oxygen. • Any patient with a _______________________ or cardiac emergency needs oxygen. • Never withhold oxygen from anyone who may _______________________ from it.

38. Supplemental Oxygen Equipment Oxygen cylinders • Available as a compressed ____________-____________________________ gas • Available in several sizes • Pin-indexing safety system • Oxygen _______________________ • _______________________ oxygen

39. Oxygen Flowmeters • _______________________ -compensated flowmeter • Affected by gravity; must be kept upright • _______________________ -gauge flowmeter • Not affected by gravity; can be used in any position

40. Using Supplemental Oxygen (1 of 2) • Inspect cylinder and markings. • “_______________________ ” the cylinder. • _______________________ the regulator/flowmeter. • _______________________ the cylinder. • Attach proper delivery _______________________ to flowmeter.

41. Using Supplemental Oxygen (2 of 2) • Adjust flowmeter to desired _______________________ rate. • _______________________ the oxygen device to the patient. • When done, _______________________ the delivery device. • Turn off the flowmeter. • Replace bottle if below ___________ psi (safe residual)

42. Hazards of Oxygen • Oxygen supports _______________________ . • Keep possible _______________________ sources away from the area. • Oxygen tanks are under high _______________________ .

43. Oxygen Delivery Equipment • _______________________ mask • Provides up to ___________% oxygen • Used at ___________ to ___________ L/min • Nasal cannula • Provides ___________% to ___________% oxygen • Used at ___________ to ___________ L/min

44. Calculating Oxygen Duration • (Amount in Bottle (psi)--200 PSI) X Factor Flow (LPM) • 200 PSI is the safety factor to allow for gauge inaccuracy • Answer is in _______________________ of usage • Factor is determined by the _______________________ of the bottle. • D cylinder: 0.16 • E cylinder: 0.28 • M cylinder: 1.56 • H cylinder: 3.14

45. Calculating Oxygen Duration Example: You are delivering oxygen to a patient using a NRB flowing at 10lpm. The bottle is a E cylinder (factor of 0.3). The bottle has 1,500psi remaining. How long will the bottle last?

46. Calculating Oxygen Duration • (Amount in Bottle (psi)--200 PSI) X Factor Flow (LPM) • (1,500-200) X 0.3 10 • 1,300 X 0.3 10 • 390 10 • 39 minutes

47. Methods of Ventilation • Mouth to _______________________ • Two-person _______________________ device • Flow restricted, _______________________ powered device • One-person BVM device

48. Rate of Artificial Ventilations • Adult — 1 breath every __________ to ___________ seconds • 10 to 12 per minute • Children — 1 breath every __________ to ___________seconds • 12 to 20 per minute • Infants — 1 breath every __________ to ___________seconds • 12 to 20 per minute

49. Artificial Ventilation • Mouth to _______________________ (Not Recommended) • pinch nose closed • take a deep breath • seal your mouth over patients mouth • Mouth to _______________________ (Not Recommended) • use chin lift to hold mouth closed • take a deep breath • seal your mouth over patients nose

50. Mouth-to-Mask Technique (1 of 2) • _______________________ at patient’s head and open airway. • Place the mask on the patient’s face. • Take a deep breath and breathe into the patient for____________ second. • Remove your mouth and watch for patient’s chest to fall.