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Questions and Answers
What is the main function of the diaphragm during breathing?
Which of the following is NOT a sign that the airway is adequately secured?
What is the primary reason for suctioning the airway?
Which airway adjunct should be used for a patient who is unresponsive and has no gag reflex?
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When performing suctioning on an adult patient, what is the maximum duration allowed for suctioning?
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What positioning adjustment should be made for opening the airway in children?
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What is the correct method for inserting a nasopharyngeal airway?
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What may happen if suctioning is performed for too long?
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What is the normal range for respiratory rate (RR) in breathing?
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Which sign is an early indication of inadequate breathing?
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What is the primary outcome of using positive pressure ventilation (PPV)?
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When using a non-rebreather mask, what percentage of oxygen is ideally delivered?
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What is NOT a characteristic of inadequate breathing (agonal respirations)?
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What should be done if a patient is apneic and exhibits inadequate respiratory rate or tidal volume?
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Which device is commonly used for positive pressure ventilation with a capacity of approximately 1600cc?
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What flow rate should a nasal cannula be set to for optimal oxygen delivery?
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Under which circumstance should oxygen not be administered to a patient needing supplemental oxygen?
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What pressure indicates that an oxygen cylinder is considered 'full'?
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What is the term for an insufficiency in the supply of oxygen to the body's tissues?
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Which method of ventilation is contraindicated for children?
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What type of lubricant is recommended for easing the insertion of nasopharyngeal airways?
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How should an EMT proceed when a patient with dentures requires ventilation?
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Which of the following features is NOT important for bag-valve-mask systems?
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What is the minimum vacuum pressure a suction device must generate?
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What is the maximum flow rate recommended for a nasal cannula?
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What makes it challenging for a single rescuer to deliver BVM artificial ventilations?
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Which type of patient should NOT receive an oropharyngeal airway?
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What should a rescuer be prepared to do when using an oropharyngeal airway?
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What is a notable advantage of the nasopharyngeal airway?
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Which statement is true regarding suctioning a patient's airway?
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What is an advantage of a 'tonsil tip' catheter over a 'French' catheter?
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What should be done before suctioning a patient who is being artificially ventilated?
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What can paramedics administer while en route to a medical facility?
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Which technique is used to maintain airway patency by aligning the airway structures?
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In an emergency, what is a critical sign indicating inadequate breathing?
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What structure separates the trachea from the esophagus in the airway?
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What should be the flow rate set for optimal oxygen delivery using a nasal cannula?
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What should be done if a nasopharyngeal airway is too long?
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What feature is considered undesirable in some older bag-valve-mask devices?
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How can the effectiveness of BVM ventilation be improved when multiple rescuers are present?
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What is the recommended ventilation rate for nonbreathing adult patients?
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What should be used to ease the insertion of a nasopharyngeal airway?
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What action should be taken if the patient's chest does not rise during BVM ventilation?
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What can using a pocket mask with supplemental oxygen achieve compared to a bag-valve-mask device?
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What should be the maximum suctioning time for a patient at a time?
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What condition occurs when the respiratory rate and/or tidal volume is insufficient?
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What term describes a blue or gray color to the skin, indicating breathing difficulty?
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What is the primary maneuver used for opening the airway when no trauma is suspected?
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What is the recommended rate of artificial ventilations for an adult patient who is nonbreathing?
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A nasopharyngeal airway should be lubricated with what type of lubricant?
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What condition is characterized by excessive rapid breathing that may indicate inadequate oxygenation?
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What passageways are found at the lower end of the pharynx?
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What is the primary cause of an obstructed airway in an unresponsive patient?
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Study Notes
Airway Management Overview
- Assessment focuses on airway and breathing functionality, ensuring the airway remains secured at all times.
- Respiratory assessment includes checking for normal airway sounds, ease of speech, and the ability to maintain adequate respiration.
Mechanics of Breathing
- Controlled by the medulla oblongata.
- Main muscle involved in breathing is the diaphragm, creating negative pressure.
- Increased carbon dioxide (CO2) levels trigger the breathing stimulus.
- Normal tidal volume is approximately 500 cc.
Airway Assessment and Management
- Signs of airway obstruction include snoring (partial obstruction, often due to the tongue) and stridor (high-pitched sound indicating laryngeal swelling).
- Ventilation refers to air movement, while respiration involves the exchange of oxygen (O2) and carbon dioxide (CO2).
Airway Opening Techniques
- Techniques include the head tilt-chin lift and modified jaw-thrust.
- For children, a towel should be placed under their shoulders when opening the airway.
Suctioning Protocols
- Two types of suctioning: mounted and portable (either battery-powered or manual).
- Suction catheters include rigid (Yankauer for adults) and soft (French catheter for children and specialized airways).
- Suction only on the way out, with a maximum duration of 15 seconds for adults and 5 seconds for children. Always measure prior to insertion.
- Precautions include avoiding deep insertion to prevent tissue damage and monitoring suction duration to mitigate risks of hypoxia and bradycardia.
Airway Adjuncts
- Oropharyngeal airways (OPA) are used for unresponsive patients without a gag reflex, sized from the corner of the mouth to the tragus of the ear.
- The nasopharyngeal airway (NPA) is used on conscious patients with a gag reflex, sized from the tip of the nose to the tragus of the ear, inserted with the bevel towards the septum.
Assessing Breathing
- Both respiratory rate (15 seconds x 4) and tidal volume are critical in determining adequacy of breathing.
- Adequate breathing is characterized by a respiratory rate of 8-24 and a normal rhythm with equal breath sounds.
- Inadequate breathing shows signs like agonal respirations (irregular patterns) and reduced tidal volume leading to hypoxia.
Ventilation Assistance
- Positive pressure ventilation is indicated when either respiratory rate or tidal volume is inadequate, especially in apneic patients.
- Common devices include bag-valve masks (BVM) with a capacity of 1600 cc delivering 100% oxygen and flow-restricted oxygen-powered ventilation devices (FROPVD) providing 100% O2 at 40 LPM, with caution to prevent over-ventilation.
Oxygen Delivery Methods
- Oxygen tanks can be utilized alongside various delivery systems such as non-rebreather masks (providing ~90% oxygen at 10-15 LPM) and nasal cannulas (delivering 24-44% oxygen at 1-6 LPM).
Bag-Valve-Mask Systems
- Key components include non-jam valve systems, nonrebreathing valves, and a pop-off valve.
- The most challenging aspect for a single rescuer is obtaining an adequate mask seal.
Airway Management Techniques
- Oropharyngeal airways are contraindicated in patients with a gag reflex, those under 8 years old, or contagious respiratory diseases.
- Use of a nasopharyngeal airway is preferred in many cases due to lower likelihood of stimulating the gag reflex and the availability of various sizes.
- Suction devices must generate a vacuum of at least 300 mmHg. Never suction for longer than 15 seconds.
- Before suctioning, hyperventilation may be employed for patients who are artificially ventilated.
Oxygen Delivery
- A nasal cannula is suitable for patients who cannot tolerate a nonrebreather mask and requires lower flow rates.
- Oxygen should always be administered unless specifically instructed otherwise by medical direction.
- Commonly accepted "full” pressure for oxygen cylinders is 2000 psi.
- Oxygen saturation of blood is referred to as oxygenation.
Ventilation Rates and Techniques
- Adult nonbreathing patients require ventilations every 5 to 6 seconds, while children need one ventilation every 3 to 5 seconds.
- An oropharyngeal airway should be used for unresponsive patients without a gag reflex, extending from the patient's front teeth to the angle of the jaw.
Special Considerations
- Maintain an open airway while using a bag-valve-mask device to prevent airway obstruction.
- An epiglottis functions as a protective flap over the trachea, preventing food from entering.
- Avoid using a petroleum-based lubricant for nasal airways; a water-soluble lubricant is advised.
- Tachypnea refers to rapid breathing and may indicate respiratory distress.
Equipment Specifics
- BVM masks can fit around a stoma but should be sized appropriately.
- A properly set-up oxygen delivery system can include a humidifier for moisture.
- When performing a jaw-thrust maneuver, stability of the patient’s head is crucial.
Clinical Signs
- Cyanosis is a sign of inadequate oxygenation and may appear as blue or gray skin or nail beds.
- Recognize signs of inadequate breathing, such as minimal chest movement and diminished breath sounds.
Procedure Refinements
- If an oropharyngeal airway is initially rejected, reattempt insertion more assertively.
- In the event of insufficient ventilation, repositioning the patient's head can be essential to overcoming obstruction.
Conclusion
- Effective airway management and proper ventilation techniques are critical in emergency care, ensuring adequate oxygenation and response to respiratory failure situations.
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Description
Test your knowledge on airway management, focusing on assessment, adjuncts, and treatment protocols. Learn about oxygen therapy techniques and the mechanics of breathing controlled by the medulla oblongata. This quiz covers key concepts crucial for maintaining airway security.
