Airway and Breathing Management PDF

Preview

Summary

Airway and Breathing Management For Patients ...

Description

Airway and Breathing Management! ! • Airway and breathing are first 2 priorities ! • Respiratory function - Inhalation ! ◦ Anatomy ! ‣ Nose ! ‣ Mouth ! ‣ Pharynx ! ‣ Thrachea ! ‣ Bronchi ! ‣ Aviolles ! ◦ Two primary muscles used to breathe:! ‣ Diaphragm ! ‣ Intercostal muscles! ◦ Diaphragm flattens, intercostal muscles cause ribs to expand, space increases = inhalation ! ‣ Pressure sensors! • Exaltation ! ◦ Muscles relax , shrinks space around lungs = exhale ! ! • Respiratory Volumes ! ◦ Tidal volume ! ‣ Our lungs can hold up to 6 liters of air ! • tidal volume is close to 2,500 to 3,000 ml! ◦ Vital capacity ! ‣ The capacity that needs to be there ! ‣ If you go below vital capacity, lungs may collapse! ‣ Capacity from what you must have in there, to max ml! ‣ About 5,000 ml ! ◦ Have to maintain 1,000 ml to be able to function properly ! ◦ Residual volume ! ‣ Amount that is left over after exhaled everything possible ! ‣ Max - 6,000 ml ! ‣ When you blow out all you can and can't get anything else ! ‣ Have to maintain 1,000 ml to be able to function properly ! ! • Respiratory physiology ! ◦ Diffusion from Alveoli to Capillaries ! ◦ Utilize only 5% of O2 breathed in ! ‣ Breath in 25% oxygen ! ‣ Breath out 16%! ◦ Brain cells die in 4 - 6 minutes ! ‣ Brain needs water, sugar, and oxygen ! ! • Pulse Oximetery ! ◦ Measures bound hemoglobin ( O2 or CO)! ◦ Affected by ! ‣ Temperature ! ‣ Perfusion (shock)! ‣ Nail Polish ! ◦ Normal is > 95% SpO2! ‣ Below 90 start to question ! ‣ Mid to lower 80s, not getting the oxygen you need! ◦ Do not use in carbon monoxide poisoning ! ◦ Used in patients ! ‣ Heart attack ! ‣ Asthma ! ‣ Anyone struggling to breathe !

‣ Simply place on finger ! • Neuroregulation of Respirations ! ◦ Regulated by chemical receptors that are monitoring blood ! ◦ Chemoreceptors measure blood for ! ‣ Carbon dioxide levels ! ‣ Oxygen Levels ! ‣ pH! ◦ Primary stimulus to breath is CO2 level ! ‣ Increasing CO2 will stimulate breathing ! ‣ Decreasing CO2 will prevent breathing ! ◦ Hypoxic Drive ! ‣ Uses low O2 levels to trigger breathing ! • COPD ! ‣ "Fail safe" ! ‣ Body pays attention to levels ! • Hypoxia ! ◦ Where going without oxygen ! ◦ Conditions that cause this ! ‣ Myocardial Ischemia - heart attack ! ‣ Pulmonary Edema - fluid in lungs ! ‣ Inhalation of poisons ! ‣ Stroke ! ‣ Chest injury ! ‣ Shock ! ‣ Chronic obstructive pulmonary disease ! ‣ Asthma ! • BSI Precautions ! ◦ Gloves are required ! ◦ Be careful with oxygen for certain patients - stroke, COPD, etc..! ◦ Gown as required! ◦ Eye protection is required! ◦ Protect yourself from the patient ! ! • Is airway preset and adequate?! ◦ 1. Level of Consciousness ! ‣ Higher level of obstruction ! • Specifically from the tongue ! ◦ 2. Ability to speak ! ‣ Talking means airway is partially open - LOOK ! ◦ 3. Inspect the airway ! ◦ 4. Listen to the airway ! ◦ Snoring, whistling, etc.. lower airway obstruction ! ◦ Can they protect their Airway???! ! • Present (patent) airway ! ◦ Air must move in and out ! ◦ Increased work of breathing ! ! • Absent Airway ! ◦ Must make present ! ◦ Unresponsive ! ◦ Airway maneuvers! ‣ Head - tilt Chin- lift ! • Use forehead and mandible ! ‣ Child - neutral plus - looking forward and then up a little ! ‣ Infant - neutral - looking forward, straight ahead or straight up at ceiling ! ◦ If they have a spinal injury ! ‣ Utilize a jaw thrust ! • Moves just the mandible !

◦ Foreign body obstruction - inadequate/ absent airway! ‣ Manual techniques ! ‣ Finger Sweep ! • If you see it, then go sweep it out; if not do not ! ‣ Suctioning! • Utilize a tube! • Smaller objects and fluids ! ◦ Airway absent and conscious ! ‣ Heimlich ! ◦ Airway absent and unconscious ! ‣ CPR! • Airway Abjuncts:! ◦ Oralpharyngeal airways ! ‣ Go in throat ! ‣ Indications ! • Open airway in unresponsive patient! ‣ Contraindications! • Gag reflex ! • If they have a gag reflex, go for the nose ! ‣ Determining correct size! • Lips to back of the tongue ! ◦ Measure from corner of mouth to angle of mandible below ear! ‣ Insertion with rotation ! • Turn upside down, point towards hard pallet ! • Use cross finger technique ! • Half way in then rotate ! • Cannot do this method on children ! ‣ Insertion with Tongue blade ! • Holds tongue up and out of the way ! ◦ Nasopharyngeal Airway ! ‣ Into the nose ! ‣ Struggling to maintain airway - stroke, intoxicated, etc.. ! ‣ Indications ! • Lubricate ! • Struggling to maintain airway ! ‣ Contraindications ! • Potential for skull fracture ! • Facial fractures ! ‣ Determine correct size ! • Measure from nose to the ear! ‣ Majority of nasal airways are cut to go into right nostril ! ‣ Bevel towards the septum/middle ! ‣ Insertion ! • Have to use lubricant ! ◦ Apply airway to lube ! • Right nostril ! • Angle down and twist a little and push ! ! ! Suctioning ! ! • BSI (body substance isolation) Precautions ! ◦ Gloves as required ! ◦ Masks as required ! ◦ Gown ! ◦ Eye protection ! • Indications ! ◦ Removal of fluids and secretions ! ‣ Blood!

• • •

•

•

•

•

‣ Vomit ! ‣ Smal food particles ! Gurggling sounds, suction very quickly ! Contraindications ! ◦ How big of an object it can suck ! ◦ Not just suctioning fluid, but also oxygen ! Suction equipment ! ◦ Fixed Wall Mounted ! ‣ On side of ambulance ! ‣ Mounted in hospital wall ! ‣ Runs on electricity ! ‣ Strong suction power ! ◦ Portable electric ! ‣ Run off chargeable battery ! ◦ Portable hand powered ! ‣ Wildernes settings ! • Search and rescue ! • Disaster management ! ‣ Works as well as you're able to pump it ! Suction Catheters ! ◦ Using to suck debris up ! ◦ Hard or rigid catheter ! ‣ Tonsil sucker, tonsil tip, Yankauer ! ‣ Used to suction the mouth and oropharynx ! ◦ Soft Catheter ! ‣ Whistle tip or French catheter! ‣ Used to suction nose! ‣ Used in pediatric patients - never use a hard one ! Techniques of Suctioning ! ◦ Inspect suction devices regularly ! ◦ Turn on suction ! ◦ Attach catheter ! ◦ Confirm Suction is working ! ◦ Measure catheter ! ‣ Same as measuring airway ! ‣ Corner of mouth to ear ! ◦ Open the mouth using the cross finger technique ! ‣ Go in without suction - pinch tube or cover port ! ‣ Once in, cover port to cause suction, sweep back and forth as you pull out ! Suction times ! ◦ Adult - no more than 15 seconds at a time ! ‣ 14 and up ! ◦ Child - no more than 10 ! ‣ 14 and younger ! ◦ Infant - no more than 5 ! ‣ 1 years old and younger ! Guidelines ! ◦ When solid or large objects require suctioning, log roll and finger sweep ! ◦ Frothy secretions require suctioning, ventilate for 2 minutes and suction again ! ◦ Rinse catheters with saline or water during long transport ! ‣ 15-20 minute transport or longer !

! !

Breathing Management ! ! • Is the airway present?! ◦ If the airway is not present and is not adequate breathing management will not be effective ! ◦ Adequate means no problems ! • Is breathing present and adequate?!

◦ Adequate breathing! ‣ Rate within normal ranges ! ‣ Quality is way, without difficult ! ‣ Rhythm is regular ! ‣ Depth has adequate volume! ◦ Inadequate breathing ! ‣ Rate is outside normal limits ! • Above 30 or lower than 8 ! ‣ Quality is labored or difficult ! ‣ Accessory muscles are being used ! • Abdominal, chest muscles ! ‣ Rhythm is irregular ! ‣ Depth is too shallow ! ‣ Changes in skin color ! !

• Indications for oxygen therapy ◦ Should be given to anyone with signs or symptoms of inadequate breathing ! ◦ Given to anyone who complains of shortness of breath or difficult breathing ! ◦ Should be given to anyone with signs of symptoms of hypo -perfusion! • Precautions ! ◦ compressed gas! ◦ Not combustible but supports combustion ! ◦ Cylinders are stored flat or secured if standing ! ◦ Humidifiers should be added during administration for long periods of Time! • Pressure regulators and flowmeters ! ◦ Considered full at 2,000 psi ! ◦ Considered empty at 500 psi ! ◦ How long a tank will last depends on the flow rate and the size of the cylinder ! • Assemble of an oxygen tank ! ◦ Remove protective seal ! ◦ Inspect the cylinder valve for damage ! ◦ Slowly open and close the cylinder using the pin indexing system ! ◦ Tighten the screw bolt! ◦ Watch the video ! ! • Nasal Cannula ! ◦ Provides 24-40% oxygen at 2-6 L/min! ‣ EX: 3/4 might be best, depends, always a single number never a range! ◦ Prongs of the cannula follow the curve of the airway ! ◦ Rarely the best method for use in a prehospital environment ! ◦ Best using on those who can not tolerate a mask despite coaching to keep the mask ! ◦ Prongs are pointing down ! • Non-rebreather mask ! ◦ Provides about 90% oxygen at 15 L/min! ◦ Fill reservoir prior to applying to patient ! ◦ Reserved must stay full or flow rate is too low ! ◦ Preferred method for delivering oxygen in a prehospital environment! • Contradictions for oxygen ! ◦ Should never be withheld from anyone with signs or symptoms of inadequate breathing ! ◦ Monitor patient and oxygen...