Chapter 9 Airway Respirations Metabolism Oxygen Requirements Respiratory Anatomy Respiratory Anatomy Respiratory Anatomy Diaphragm

Transcription

1 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

2 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

3 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 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 Basic Airway Adjuncts (1 of 6) Oropharyngeal airways

4 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

5 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.

6 200 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: 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, ) X ,300 X 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

7 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. 51 Mouth-to-Mask Technique (2 of 2) 52 Bag-Valve-Mask Device Can deliver more than % oxygen Delivers less volume than mouth-to-mask Requires practice to be proficient May be used with airways 53 Bag-Valve-Mask Components 54 Two-Person BVM Technique (1 of 2) Insert an airway. One caregiver maintains seal while the other delivers. Place mask on patient s face. Squeeze bag to deliver ventilations. 55 Two-Person BVM Technique (2 of 2) 56 One-Person BVM Technique 57 Manually Triggered Ventilation Devices 58 Manually Triggered Ventilation Devices Reduces rescuer May be difficult to maintain adequate ventilation without assistance Should not be used Should not be used with or suspected cervical spine or chest injuries 59 Ongoing Assessment of Ventilation Adequate Ventilation chest rise and fall Ventilating at appropriate Heart rate returns to normal Inadequate Ventilation Minimal or no chest and fall Ventilations too or slow Heart rate does not return to normal 60 Key Points of Artificial Ventilation Do not inflate Watch for rise Always allow patient to 61 Gastric Distention

8 Always allow patient to 61 Gastric Distention Artificial ventilation fills with air. Occurs if ventilations are too or too frequent or when airway is blocked May adequate ventilations May cause patient to 62 Sellick Maneuver AKA: Pressure Also used to facilitate visualization of vocal cords for endotracheal intubation Formerly used on unconscious patients to prevent distention. No longer recommended for this purpose Place pressure on cricoid with and index finger. 63 Sellick Maneuver 64 Stomas and Tracheostomy Tubes Ventilations are delivered through the. Attach BVM device to tube or use mask. Stoma may need to be. 65 Causes of Airway Obstruction Relaxation of the Vomited stomach contents Blood clots, bone fragments, damaged tissue caused by allergic reactions Foreign objects (especially in children) 66 Recognizing an Obstruction (1 of 2) Obstruction may be or complete. Is patient able to speak or? If patient is unconscious, attempt to deliver artificial ventilation. 67 Removing an Obstruction (2 of 2) Perform maneuver. Use if needed. If attempts to clear the airway are unsuccessful, rapidly. If patient becomes pulseless, perform CPR