Emergency Medical Response Airway and Ventilation.

Emergency Medical Response

Airway and Ventilation


You Are the Emergency Medical Responder

Your medical emergency response team has been called to the fitness center by building security on a report that an employee complained of having difficulty breathing. You and your partner arrive and find the man conscious but in distress. The patient’s chief complaint is difficulty breathing. He says he just “overdid it” on the treadmill. He appears to be out of breath and is having trouble speaking in full sentences. You begin a primary assessment and determine that the patient is in respiratory distress.

Lesson 14: Airway and Ventilation


An Open Airway is the Priority

Ensuring an open airway is the most important step you can take in caring for a patient because a person cannot breathe without an open airway

A patient who can speak or cry is conscious, has an open airway, is breathing and has a pulse


Respiratory System Overview

Upper airway tract Begins at the mouth Includes the nose, pharynx and larynx

Lower airway tract Begins below the level of the vocal cords Includes the trachea, bronchi,

bronchioles and alveoli


Pathophysiology Breathing difficulties for various reasons

Low-oxygen environment Infections

Choking Unconscious, altered LOC, poisoning Diseases

COPD Emphysema

Oxygenation – the amount of oxygen in the blood


Respiratory Emergencies

Respiratory distress: When someone has difficulty breathing

Respiratory arrest: The cessation of breathing

By recognizing respiratory distress and taking immediate action, you may prevent respiratory arrest


Causes of Respiratory Distress

A partially obstructed airway

Illness Chronic conditions,

such as asthma Electrocution Heart attack

Injury to the head, chest, lungs or abdomen

Allergic reactions Drugs Poisoning Emotional distress


Signs and Symptoms of Respiratory Emergencies

Slow or rapid breathing

Unusually deep or shallow breathing

Gasping for breath Wheezing, gurgling

or high-pitched noises

Unusually moist or cool skin

Flushed, pale, ashen or bluish skin color

Shortness of breath Dizziness or light-

headedness Pain in the chest or

tingling in the hands, feet or lips

Apprehensive or fearful feelings


Activity

You and your partner are summoned to a local conference center in response to an emergency call. A person who was scheduled to speak at a conference began complaining of difficulty breathing about 10 minutes before he was scheduled to speak. On arrival at the scene, you find the patient sitting on the floor, breathing rapidly. The patient states that all of sudden he began to feel dizzy and his lips started tingling.


Specific Respiratory Emergencies

Chronic Obstructive Pulmonary Disease (COPD)

Asthma Pneumonia Acute pulmonary edema Hyperventilation Pulmonary embolism Emphysema

Blue bloater Pink puffer


Signs of an Open Airway

Two methods for opening an airway Head tilt / chin lift Jaw thrust

Chest is rising and falling Air is heard and felt coming out of

patient’s mouth and nose with exhalation The conscious patient is able to speak in

full sentences without distress The conscious patient is speaking in

normal tones


Signs of an Inadequate Airway

Visibly unable to catch breath Gasping for air Abnormal breath sounds -

www.easyauscultation.com Grunting / gurgling Stridor – harsh, high-pitched noise Snoring Wheezing

Apnea – complete absence of breathing


Causes of Airway Obstruction Mechanical

Foreign body Solid object, such as food, in adults Large chunks of food and small

objects (toy parts or balloons) in children younger than 4 years

Anatomical Tongue – most common Swelling due to trauma, infection,

asthma, emphysema or anaphylaxis


Techniques to Clear Airway Obstruction

Back blows Abdominal thrusts Chest thrusts Modified CPR for unconscious patients


Techniques to Remove Foreign Material from the Upper Airway

Finger sweeps Only for an unconscious patient Only when foreign matter is seen in a

patient’s mouth Use the index finger for an adult or child

and the little finger for a smaller child and an infant

Suctioning H.A.IN.E.S. – High Arm in Endangered Spine


Signs of Inadequate Breathing

Rib muscles pulling in on inhalation

Pursed lip breathing

Nasal flaring Fatigue or

sweating Excess use of

abdominal muscles

Tripod position Deviated trachea

Abnormal breath sounds (stridor, wheezing, crackles/rales)

Inadequate depth of breathing

Too slow or too rapid rate

Paradoxical breathing

Irregular respiratory patterns


Signs of Inadequate Oxygenation

Cyanosis Pale, cool, ashen, clammy skin Mottling Altered mental state, such as restlessness,

agitation, confusion or anxiety


Artificial Ventilation Methods

Various mechanical means to help patients breath

Just enough to see chest rise, about 1 second Gastric distention

Why does artificial ventilations increase an individuals chance of survival? The air we breath is composed of many

substances, the most important is oxygen, which accounts for 21% of the air we breath

Exhaled air is composed of 16%, more than enough to sustain life


Artificial Ventilation Methods cont

Mouth-to-mouth Mouth-to-mask Mouth-to-nose breathing Mouth-to-stoma breathing Bag-Valve-Mask resuscitator (BVM)


BVM Resuscitator Ventilations

Three-part device: a bag, a valve and a mask

Advantages: Increased oxygen blood levels Ability to be connected to emergency

oxygen Increased effectiveness of ventilations

when used correctly by two rescuers Protection against disease transmission

and inhalation hazards Useful with advanced airway adjuncts

Disadvantage?


Ventilation Rates and Patient Age

30 to 60 breaths per minute: 1 ventilation about every 1 to 2 seconds for a newborn (0 to 1 month)

12 to 20 breaths per minute: 1 ventilation about every 3 seconds for a child or an infant

8 to 10 breaths per minute: 1 ventilation about every 5 seconds for an adult


You Are the Emergency Medical Responder

While waiting for emergency medical services personnel to arrive, you complete a SAMPLE history and secondary assessment. You have helped the patient into a position of comfort for breathing when he suddenly loses consciousness and stops breathing. He has a pulse.


EnrichmentAssessing Breath Sounds

Use a stethoscope to listen to lungs In the front, listen along the midclavicular

line at the second intercostal space On the sides, listen along the midaxillary

line between the fourth and fifth intercostal spaces

In the back, listen along the midclavicular line below the scapula

Compare sounds heard on both sides Suspect obstruction if abnormal sounds, such

as wheezing, rales, rhonchi or stridor, are heard


EnrichmentSellick’s Maneuver

Also known as cricoid pressure Appropriate during positive pressure

ventilation situations when a patient requires intubation

Two rescuers needed: one to perform the maneuver, another to perform the intubation

Application of pressure on both sides of cricoid cartilage using the thumb and index finger, with pressure applied firmly toward the back of the neck


EnrichmentAsthma Medications

Long-term control medications Quick-relief medications (rescue

medications) Medications for allergy-induced asthma

Read Enrichment pages 247 - 250


Asthma Medication Delivery Systems

Metered-dose inhaler Dry powder inhaler Small-volume nebulizer Pill or liquid Injection


Peak Flow Meter

Measurement of person’s ability to push air out of lungs in one quick breath

Tool for evaluating response to treatment and for warning if asthma is worsening


Common Side Effects of Asthma Medications

Increased heart rate

Palpitations Nausea or

vomiting Nervousness Sleepiness

Dry mouth Cough Hoarseness Headache Throat irritation

Emergency Medical Response Airway and Ventilation.

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