Section 2: Airway

1
Section 2 Airway
2
Chapter 6

• Airway

3
Objectives (1 of 6)

• Name and label the major structures of the
  respiratory system.
• Describe the steps in performing the head
  tilt-chin maneuver.
• Relate mechanism of injury to opening the airway.
• Describe the techniques of suctioning.

4
Objectives (2 of 6)

• Describe how to artificially ventilate a patient
  with a pocket mask.
• Describe how to measure and insert an
  oropharyngeal (oral) airway.
• Describe how to measure and insert a
  nasopharyngeal (nasal) airway.
• Define the components of an oxygen delivery
  system.

5
Objectives (3 of 6)

• Identify a nonrebreathing face mask and state the
  oxygen flow requirements needed for its use.
• Describe the indications for using a nasal
  cannula versus a nonrebreathing face mask.
• Explain the rationale for basic life support,
  artificial ventilation, and airway protective
  skills taking priority over most other basic life
  support skills.

6
Objectives (4 of 6)

• Demonstrate the steps in performing the head
  tilt-chin lift maneuver.
• Demonstrate the steps in performing the
  jaw-thrust maneuver.
• Demonstrate the techniques of suctioning.
• Demonstrate the steps in providing mouth-to-mouth
  artificial ventilation with body substance
  isolation (barrier shields).

7
Objectives (5 of 6)

• Demonstrate how to use a pocket mask to
  artificially ventilate a patient.
• Demonstrate the steps in performing the skill of
  artificially ventilating a patient with a
  bag-valve-mask device for one and two rescuers.
• Demonstrate the steps in performing the skill of
  artificially ventilating a patient with a
  bag-valve-mask device while using the jaw-thrust
  maneuver.

8
Objectives (6 of 6)

• Demonstrate the correct operation of oxygen tanks
  and regulators.
• Demonstrate the use of a nonrebreathing face mask
  and state the oxygen flow requirements needed for
  its use.
• Demonstrate the use of a nasal cannula and state
  the flow requirement needed for its use.

9
Anatomy Review
10
Breathing Process Inhalation

• Active part of breathing
• Diaphragm and intercostal muscles contract,
  allowing the lungs to expand.
• The decrease in pressure allows lungs to fill
  with air.
• Air travels to the alveoli where exchange of
  gases occurs.

11
Breathing Process Exhalation

• Does not normally require muscular effort
• Diaphragm and intercostal muscles relax.
• The thorax decreases in size, and ribs and
  muscles assume their normal positions.
• The increase in pressure forces air out.

12
The Bodys Need for Oxygen
13
Gas Exchange

• Inhalation delivers oxygen-rich air to alveoli.
• Oxygen diffuses into the blood.
• Breathing is primarily adjusted by the level of
  carbon dioxide in the blood.

14
Hypoxia

• Signs
• Nervousness, irritability, and fear
• Tachycardia
• Mental status changes
• Use of accessory muscles for breathing
• Difficulty breathing, possible chest pain

15
Conditions Resulting in Hypoxia

• Stroke
• Chest injury
• Shock
• Lung disease
• Asthma

• Myocardial infarction
• Pulmonary edema
• Acute narcotic overdose
• Smoke inhalation

16
Recognizing Adequate Breathing

• Normal rate and depth
• Regular pattern
• Regular and equal chest rise and fall
• Adequate depth

17
Normal Respiration Rates

• Adults 12 to 20 breaths/min
• Children 15 to 30 breaths/min
• Infants 25 to 50 breaths/min

18
Recognizing Inadequate Breathing

• Labored breathing
• Use of accessory muscles
• Pale or blue skin
• Cool, clammy skin
• Irregular respirations
• Abnormal lung sounds

19
Positioning an Unconscious Patient (1 of 3)

• Kneel beside the patient.
• Provide in-line cervical stabilization.

20
Positioning an Unconscious Patient (2 of 3)

• Turn patient by pulling the distant hip and
  shoulder.
• Control the head and neck so they move as a unit
  with the torso.

21
Positioning an Unconscious Patient (3 of 3)

• Roll onto backboard if available.
• Open patients airway and assess breathing.

22
Opening the Airway

• Head tilt-chin lift
• Nontrauma patients, medical patients
• Jaw-thrust
• Suspected spinal injury

Head tilt-chin lift
23
Basic Airway Adjuncts (1 of 6)

• Oropharyngeal airways
• Keep the tongue from blocking the upper airway
• Allow for easier suctioning of the airway
• Used in conjunction with BVM device
• Used on unconscious patients without a gag reflex

24
Basic Airway Adjuncts (2 of 6)

• Inserting an oropharyngeal airway
• 1. Select the proper size airway.
• 2. Open the patients mouth.
• 3. Hold the airway upside down and insert it
  in the patients mouth.
• 4. Rotate the airway 180 until the flange rests
  on the patients lips.

25
Basic Airway Adjuncts (3 of 6)
1
2
3
26
Basic Airway Adjuncts (4 of 6)

• Nasopharyngeal airways
• Used on conscious patients who cant maintain an
  airway
• Can be used on patients with a gag reflex
• Should not be used on patients with possible
  skull fractures

27
Basic Airway Adjuncts (5 of 6)

• Inserting a nasopharyngeal airway
• 1. Select the proper size airway.
• 2. Lubricate the airway.
• 3. Gently push the nostril open.
• 4. With the bevel turned toward the septum,
  insert the airway.

28
Basic Airway Adjuncts (6 of 6)
1
2
3
4
29
Suctioning Equipment (1 of 2)
30
Suctioning Equipment (2 of 2)
Tonsil-tip catheter
French, or whistle-tip, catheter
31
Suctioning Technique

• Check the unit and turn it on.
• Select and measure the proper catheter to be
  used.
• Open the patients mouth and insert the tip.
• Suction as you withdraw the catheter.
• Never suction for more than 15 seconds.

32
Recovery Position
33
Supplemental Oxygen

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

34
Supplemental Oxygen Equipment

• Oxygen cylinders
• Available as a compressed gas
• Available in several sizes
• Pin-indexing safety system
• Oxygen regulators
• Humidified oxygen

35
Oxygen Flowmeters

• Pressure-compensated flowmeter
• Affected by gravity must be kept upright
• Bourdon-gauge flowmeter
• Not affected by gravity
• can be used in any
• position

36
Using Supplemental Oxygen (1 of 2)

• Inspect cylinder and markings.
• Crack the cylinder.
• Attach the regulator/flowmeter. Use proper seal.
• Open the cylinder.
• Attach proper delivery device to flowmeter.

37
Using Supplemental Oxygen (2 of 2)

• Adjust flowmeter to desired flow rate.
• Apply the oxygen device to the patient.
• When done, discard the delivery device.
• Turn off the flowmeter.

38
Hazards of Oxygen

• Oxygen supports combustion.
• Keep possible ignition sources away from the
  area.
• Oxygen tanks are under high pressure.

39
Oxygen Delivery Equipment

• Nonrebreathing mask
• Provides up to 90 oxygen
• Used at 10 to 15 L/min
• Nasal cannula
• Provides 24 to 44 oxygen
• Used at 1 to 6 L/min

40
Pulse Oximetry

• Evaluates the effectiveness of oxygenation
• Probe is placed on finger or earlobe.
• Pulse oximetry is a tool.
• Does not replace good patient assessment.

41
Artificial Ventilation

• One- or two-person bag-valve-mask (BVM) device
• Mouth-to-mask ventilation
• Oxygen-powered ventilation device

42
Rate of Artificial Ventilations
Adults 1 breath every 5 seconds Children 1 breath
every 3 seconds Infants 1 breath every 3 seconds
43
Mouth-to-Mask Technique (1 of 2)

• Kneel at patients head and open airway.
• Place the mask on the patients face.
• Take a deep breath and breathe into the mask for
  2 seconds.
• Remove your mouth and watch for patients chest
  to fall.

44
Mouth-to-Mask Technique (2 of 2)
45
Bag-Valve-Mask Device

• Can deliver more than 90 oxygen
• Delivers less tidal volume than mouth-to-mask
  ventilation
• Requires practice to be proficient
• May be used with advanced airways

46
Bag-Valve-Mask Components

• Disposable self-refilling bag
• No pop-off valve (or capability of disabling the
  pop-off valve)
• Outlet valve
• Oxygen reservoir

• One-way, no-jam inlet valve system
• Transparent face mask
• Ability to perform under extreme environmental
  conditions

47
Two-Person BVM Technique (1 of 2)

• Insert an oral airway.
• One caregiver maintains seal while the other
  delivers ventilations.
• Place mask on patients face.
• Squeeze bag to deliver ventilations.

48
Two-Person BVM Technique (2 of 2)
49
One-Person BVM Technique
50
Cricoid Pressure

• Use on unconscious patients to prevent gastric
  distention.
• Place pressure on cricoid with thumb and index
  finger.

51
Flow-Restricted, Oxygen-Powered Devices
52
Flow-Restricted, Oxygen-Powered Devices

• Should not be used on infants and children or
  patients with suspected chest or neck injuries.
• Cricoid pressure will help reduce gastric
  distension.
• Use requires training and considerable practice.

53
Gastric Distention

• Artificial ventilation fills stomach with air.
• Occurs if ventilations are too forceful or too
  frequent or when airway is blocked
• May cause patient to vomit

54
Stomas and Tracheostomy Tubes

• Ventilations are delivered through the stoma.
• Attach BVM device to tube or use infant mask.
• Stoma may need to be suctioned.

55
Causes of Foreign Body Obstruction

• Relaxation of the tongue
• Vomited stomach contents
• Blood clots, bone fragments, damaged tissue
• Swelling caused by allergic reactions
• Foreign objects

56
Recognizing an Obstruction

• Obstruction may be partial or complete.
• Is patient able to speak or cough?
• If patient is unconscious, attempt to deliver
  artificial ventilation.

57
Removing an Obstruction

• Perform Heimlich maneuver.
• Use suction if needed.
• If attempts to clear the airway are unsuccessful,
  transport rapidly.

58
Dental Appliances

• Can be a source of airway obstructions.
• If loose, remove.
• Intact appliances help provide facial structure
  to assure face-to-mask seals.
• Periodically re-asses dental appliance placement.

59
Facial Bleeding

• Can be a challenging situation.
• Control bleeding with pressure and suction as
  needed.