Airway, Respiration, and Ventilation Overview

Airway, Respiration, and Ventilation

• Airway Anatomy: Divided into upper (nasopharynx, oral cavity, pharynx, larynx) and lower (trachea, bronchi) airways. The cricoid cartilage is the only complete ring in the trachea and is the narrowest point in a child's airway. The epiglottis prevents food from entering the trachea during swallowing.

• Airway Obstruction: Can result from foreign bodies, the tongue, swelling, or secretions. Snoring indicates upper airway obstruction; gurgling suggests fluid in the upper airway, requiring suction.

• Airway Maneuvers:

• Head-tilt/chin-lift: Opens the airway in non-trauma patients by tilting the head back and lifting the chin. Avoid if a spinal injury is suspected.

• Jaw-thrust: Used for suspected spinal injuries by moving the jaw forward with fingers behind the lower jaw angle. Inline stabilization of the cervical spine is crucial in suspected trauma, awaiting a cervical collar.

• Sniffing position: Used for optimal ventilation and intubation, by having the patient sit upright with the head and chin thrust slightly forward.

• Signs of Inadequate Breathing:

• Adventitious breath sounds (e.g., stridor, wheezing, rhonchi, crackles/rales)

• Irregular breathing (bradypnea, tachypnea, irregular rhythm)

• Unequal chest expansion

• Accessory muscle use

• Cyanosis

• Cool, moist skin

• Retractions

• Lung Sounds:

• Stridor: High-pitched crowing sound during inhalation, indicates upper airway obstruction.

• Wheezing: High-pitched whistling sound (typically exhalation), signifies lower airway constriction (e.g., asthma, COPD).

• Rhonchi: Low-pitched, noisy sounds during exhalation, suggesting mucus in the lungs (e.g., COPD, pneumonia, asthma, bronchitis).

• Crackles/Rales: Wet cracking sounds, indicating fluid in the alveoli (e.g., CHF, pulmonary edema).

• Oxygenation: Pulse oximetry readings may be inaccurate with nail polish, carbon monoxide poisoning, hypovolemia, or peripheral vasoconstriction.

• Hypoxia:

• Early signs: Restlessness, irritability, apprehension, tachycardia, retractions.

• Late signs: Altered mental status, weak pulse, cyanosis, bradypnea, altered level of consciousness (LOC).

• Oxygen Delivery:

• Nasal Cannula: Delivers 24-44% oxygen at 1-6 LPM. Not suitable for suspected hypoxia.

• Non-Rebreather Mask (NRB): Provides up to 90-95% oxygen at 10-15 LPM, used for suspected/confirmed hypoxia.

• Bag-Valve Mask (BVM): Delivers 100% oxygen with a reservoir and supplemental oxygen (10-15 LPM), used for inadequate breathing.

• Mouth-to-mask device: Provides 55% oxygen with supplemental oxygen at 15 LPM.

• Special Techniques:

• Abdominal Thrusts (Heimlich maneuver): Used to clear airway obstruction in a conscious patient.

• CPAP: Used for respiratory distress, pulmonary edema, hypoxia, COPD, submersion incidents. Contraindicated in hypoventilation, hypotension, altered mental status, and chest trauma.

• OPA/NPA: Oropharyngeal airways (OPAs) maintain airway patency in unconscious patients; contraindicated in conscious patients. Nasopharyngeal airways (NPAs) are used in semiconscious patients with gag reflex but contraindicated in severe head injury or nasal trauma.

Cardiovascular Emergencies

• Perfusion Triangle: Heart, blood vessels, blood.

• Valves: Tricuspid (right atrium to right ventricle), Bicuspid (left atrium to left ventricle).

• Pulse Assessment: Evaluated for quality (thready, weak, strong, bounding), rhythm (regular or irregular), and location (central – carotid, femoral; peripheral - brachial, radial, posterior tibial, dorsalis pedis). Brachial pulse for infants; carotid for older children/adults.

• CPR: Initiated for pulseless patients or children with a pulse below 60 bpm.

• AED: Used for unresponsive, pulseless patients; effective for ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). Asystole and pulseless electrical activity (PEA) are not shockable.

• Target Oxygen Saturation:

• ACS: 90%

• Stroke: 95-98%

• Post-cardiac arrest: 92-98%

• Aspirin: Antiplatelet medication; contraindicated in patients with GI bleeding or allergy. (Important note: must be chewed, possible side effects include GI pain, ulcers, bleeding, hearing loss, nausea.)

• Nitroglycerin: Vasodilator, contraindicated if systolic blood pressure (SBP) is low.

This quiz covers essential concepts of airway anatomy, obstruction, and maneuvers. You will learn about the structure and function of the upper and lower airways, as well as techniques for managing airway issues. Test your knowledge on how to assess and respond to airway challenges in various scenarios.