airway and oxygen system orientation. objectives breathing respiratory anatomy assessment rescue...

Airway and OxygenAirway and Oxygen

System OrientationSystem Orientation

ObjectivesObjectives

BreathingBreathing

Respiratory AnatomyRespiratory Anatomy

AssessmentAssessment

Rescue breathingRescue breathing

Airway obstructionAirway obstruction

Oxygen delivery devicesOxygen delivery devices

SuctionSuction

BreathingBreathing

Why we breatheWhy we breatheTo bring oxygen into the bodyTo bring oxygen into the body

To expel carbon dioxide from the bodyTo expel carbon dioxide from the body

Breathing is automaticBreathing is automatic

Clinical Death—The moment the breathing and heartbeat stop

Brain Damage—within 4–6 minutes

Biological Death—within 10 minutes

BreathingBreathing

How We Breathe:How We Breathe:Inspiration:Inspiration:

Rib and diaphragm muscles contract.Rib and diaphragm muscles contract.

Chest cavity expands. Chest cavity expands.

The volume inside each lung increases.The volume inside each lung increases.

The pressure inside each lung decreases.The pressure inside each lung decreases.

When the pressure inside the lungs becomes When the pressure inside the lungs becomes less than the pressure in the atmosphere, air less than the pressure in the atmosphere, air rushes into the lungs.rushes into the lungs.

BreathingBreathingHow We Breathe:How We Breathe:

Inspiration is an active process.Inspiration is an active process.

Expiration is a passive process.Expiration is a passive process.

AssessmentAssessment

Signs of Normal Breathing:Signs of Normal Breathing:

Look for rise and fall of the chest.Look for rise and fall of the chest.

Listen for air moving:Listen for air moving:The sounds should be quiet like a soft breeze. The sounds should be quiet like a soft breeze. No unusual soundsNo unusual sounds

Feel for air moving. Feel for air moving.

Observe skin color: Observe skin color: Should not be pale or ashen Should not be pale or ashen Should not be tinted blue or grayShould not be tinted blue or grayLook at the lips, eyes, and nail bedsLook at the lips, eyes, and nail beds

AssessmentAssessmentSigns of Inadequate Breathing:Signs of Inadequate Breathing:

No chest movements, or uneven chest No chest movements, or uneven chest movementsmovements

No air heard or felt at the nose or mouthNo air heard or felt at the nose or mouth

Noisy breathing or gasping soundsNoisy breathing or gasping sounds

Breathing that is irregular, too rapid, or too slowBreathing that is irregular, too rapid, or too slow

Breathing that is too shallow, or deep and Breathing that is too shallow, or deep and laboredlabored

AssessmentAssessment

Signs of Inadequate Breathing:Signs of Inadequate Breathing:

Breathing that uses muscles in the upper chest Breathing that uses muscles in the upper chest and around the neckand around the neck

Nostrils that flare when breathing, especially in Nostrils that flare when breathing, especially in childrenchildren

Skin that is tinted blue, gray, or ashenSkin that is tinted blue, gray, or ashen

Sitting or leaning forward in a tripod positionSitting or leaning forward in a tripod position

Normal Respiratory RatesNormal Respiratory Rates

Respirations:Respirations:

The normal respiratory rate for adults is 12–20 The normal respiratory rate for adults is 12–20 breaths per minute.breaths per minute.> 28 or < 8 are considered serious.> 28 or < 8 are considered serious.

Newborn infants = 25–50 breaths per min.Newborn infants = 25–50 breaths per min.Up to 5 years old = 20–30 breaths per min.Up to 5 years old = 20–30 breaths per min.5 to 12 years of age = 15–30 breaths per min.5 to 12 years of age = 15–30 breaths per min.

Opening The AirwayOpening The Airway

Repositioning the Head:Repositioning the Head:

The The head-tilt, chin-lift maneuverhead-tilt, chin-lift maneuver, is used for ill or , is used for ill or injured patients with no possibility of spinal injured patients with no possibility of spinal injury. injury.

Used when no c-spine injury is suspectedUsed when no c-spine injury is suspected

The The jaw-thrust maneuverjaw-thrust maneuver, is used for patients , is used for patients who have a mechanism of injury that indicates who have a mechanism of injury that indicates possible spinal injury.possible spinal injury.

Used for those who have a suspected c-spine injury or Used for those who have a suspected c-spine injury or in those who are unresponsive with mechanism of injury in those who are unresponsive with mechanism of injury in which trauma is suspectedin which trauma is suspected

Airway ObstructionAirway Obstruction

Causes of Airway ObstructionCauses of Airway Obstruction

Airway ObstructionAirway Obstruction

CausesCausesTongueTongue

EpiglottisEpiglottis

Foreign objectsForeign objects

Airway ObstructionAirway Obstruction

SignsSignsSnoringSnoringGurglingGurglingCrowingCrowingStridorStridorCyanosisCyanosisAnxietyAnxietyLabored breathingLabored breathingInability to speakInability to speak

Rescue BreathingRescue Breathing

Use personal protective equipment and Use personal protective equipment and barrier barrier devices.devices.

One example of a barrier device is the pocketOne example of a barrier device is the pocket face face maskmask. .

Mouth-to-Mask VentilationMouth-to-Mask Ventilation

Mouth to MaskMouth to Mask

Most effective techniqueMost effective technique

Can be used with airway adjunctsCan be used with airway adjuncts

Mouth to MaskMouth to Mask

ProblemsProblemsFailure to maintain a tight sealFailure to maintain a tight seal

Failure to tilt the head back to open the Failure to tilt the head back to open the airwayairway

Failure to deliver enough breath to see Failure to deliver enough breath to see the chest risethe chest rise

Providing breaths too quicklyProviding breaths too quickly

Failure to recognize airway obstructionFailure to recognize airway obstruction

Bag-Valve-Mask (BVM) VentilatorBag-Valve-Mask (BVM) Ventilator

Pediatric and adult BVM ventilators

Bag-Valve-Mask (BVM) VentilatorBag-Valve-Mask (BVM) Ventilator

Hand positioning for using the BVM with a single rescuer

Oropharyngeal AirwaysOropharyngeal Airways

Aids to ResuscitationAids to Resuscitation

Select Oropharyngeal AirwaySelect Oropharyngeal Airway

Aids to ResuscitationAids to Resuscitation

Another Way to MeasureAnother Way to Measure

Aids to ResuscitationAids to Resuscitation

Nasopharyngeal AirwayNasopharyngeal Airway

Aids to ResuscitationAids to Resuscitation

Determine Proper SizeDetermine Proper Size

Aids to ResuscitationAids to Resuscitation

Gently Advance AirwayGently Advance Airway

Aids to ResuscitationAids to Resuscitation

Suction SystemsSuction Systems

Suctioning Techniques:Suctioning Techniques:

USE PERSONAL PROTECTIVE EQUIPMENT.USE PERSONAL PROTECTIVE EQUIPMENT.

Never suction for longer than 15 seconds at a time.Never suction for longer than 15 seconds at a time.

Measure the tip of the catheter from the patientMeasure the tip of the catheter from the patient’’s earlobe to the s earlobe to the corner of the mouth. corner of the mouth.

Suction only as you remove the tip or catheter.Suction only as you remove the tip or catheter.

REMAIN ALERT FOR THE PATIENTREMAIN ALERT FOR THE PATIENT’’S GAG REFLEX AND FOR SIGNS OF S GAG REFLEX AND FOR SIGNS OF VOMITING.VOMITING.

Suction SystemsSuction Systems

•Oxygen-powered suction unit•Electrically-powered suction unit

•Portable electrical suction unit

•Portable hand-operated suction unit

Suction SystemsSuction Systems

Positioning a Rigid Pharyngeal (Throat) TipPositioning a Rigid Pharyngeal (Throat) Tip

First ResponderFirst Responder’’s Roles Role

Dependent on local protocols:Dependent on local protocols:

May require direct ordersMay require direct ordersMay be written as a standing orderMay be written as a standing order

Do only what you have been trained to do.Do only what you have been trained to do.

Basic life support is possible without equipment. Basic life support is possible without equipment.

If you are allowed to use equipment, you must If you are allowed to use equipment, you must maintain it and train with it.maintain it and train with it.

Oxygen TherapyOxygen Therapy

Equipment for Oxygen Therapy:Equipment for Oxygen Therapy:

Oxygen cylinderOxygen cylinder

Pressure regulator Pressure regulator

FlowmeterFlowmeter

Delivery device Delivery device

Oxygen TherapyOxygen Therapy

An oxygen delivery system

Oxygen TherapyOxygen Therapy

Nasal cannula properly placed

Oxygen TherapyOxygen Therapy

Non-rebreather mask

Check Your UnderstandingCheck Your Understanding

You are called for a 20 year-old male You are called for a 20 year-old male patient, struck by a car. You find the patient, struck by a car. You find the

patient unresponsive. You do not see patient unresponsive. You do not see the patientthe patient’’s chest rise when he s chest rise when he

breathes, but you hear gurgling from his breathes, but you hear gurgling from his airway. airway.

What airway control measures might What airway control measures might you take for this patient?you take for this patient?

SummarySummary

BreathingBreathing

Respiratory Anatomy Respiratory Anatomy

AssessmentAssessment

Rescue BreathingRescue Breathing

Airway ObstructionAirway Obstruction

Aids to ResuscitationAids to Resuscitation

Suction SystemsSuction Systems

Questions?Questions?

CPR/AED & Cardiac CPR/AED & Cardiac ArrestArrest

CPR/AEDCPR/AED

CPR/AEDCPR/AED

““Hearts and Brains Hearts and Brains are going to dieare going to die””

Peter Safar MDPeter Safar MD

EMS has the most EMS has the most opportunity to opportunity to perform CPR, so we perform CPR, so we should be good at should be good at performing good, performing good, quality CPRquality CPR

CPR/AEDCPR/AED

Why is CPR ImportantWhy is CPR ImportantStudies have shown that the general Studies have shown that the general

population will start CPR only 1/3 of the population will start CPR only 1/3 of the time and only 15% of that total is done time and only 15% of that total is done correctlycorrectly

CPR/AEDCPR/AEDLets look at the basics:Lets look at the basics:

The first step is to determine The first step is to determine responsiveness, if no response open the responsiveness, if no response open the airway, check for breathing, and determine airway, check for breathing, and determine if a pulse is presentif a pulse is present

CPR/AEDCPR/AED

Not Breathing and No Pulse:Not Breathing and No Pulse:Give 2 breaths-enough to see the chest Give 2 breaths-enough to see the chest

riserise

Give 30 chest compressions-allow for Give 30 chest compressions-allow for chest recoil between compressionschest recoil between compressions

Give 5 cycles of 30:2 before rechecking a Give 5 cycles of 30:2 before rechecking a pulsepulse

CPR/AEDCPR/AEDChest compressions and breaths are the Chest compressions and breaths are the

same for adults, child, and infantsame for adults, child, and infantAdult age starts at the onset of puberty Adult age starts at the onset of puberty

(12-14 yoa)(12-14 yoa)

Child is age 1 – onset of pubertyChild is age 1 – onset of puberty

Infant is anyone under the age of 1, chest Infant is anyone under the age of 1, chest compressions are delivered using 2 fingers, and compressions are delivered using 2 fingers, and remember a full head tilt should not be given as remember a full head tilt should not be given as you may obstruct the airway you may obstruct the airway

CPR/AEDCPR/AED

The AED should be applied as soon as The AED should be applied as soon as possible to the patients bare chestpossible to the patients bare chest

Make sure the pads adhere to the skinMake sure the pads adhere to the skinRemove all clothing from the area where the Remove all clothing from the area where the

pads need to be placedpads need to be placedRemove any medication patches from the Remove any medication patches from the

areaareaShave any chest hair, the pads need to be on Shave any chest hair, the pads need to be on

as much bare skin as possibleas much bare skin as possibleIf the patient has an implanted Pacemaker, If the patient has an implanted Pacemaker,

place the pad at least an inch awayplace the pad at least an inch away

CPR/AEDCPR/AED

AEDs are set to correct the cardiac AEDs are set to correct the cardiac arrhythmias of V-Fib and V-Tacharrhythmias of V-Fib and V-Tach

CPR/AEDCPR/AED

While there are many styles of AEDs While there are many styles of AEDs they all work the same. The first step is they all work the same. The first step is to turn the unit on and follow the voice to turn the unit on and follow the voice prompts.prompts.

CPR/AEDCPR/AEDThere are some safety There are some safety

considerations with the AED and considerations with the AED and Children:Children:

If the unit has child pads use these If the unit has child pads use these on children between the ages of 1-8.on children between the ages of 1-8.Never use child pads on an adult, Never use child pads on an adult,

the energy delivered by child pads the energy delivered by child pads is not enough for an adult, since the is not enough for an adult, since the child pads reduce the energy from child pads reduce the energy from 200J to 50J200J to 50JAEDs should not be used on AEDs should not be used on

infantsinfants

Questions?Questions?