Emergency Care - Chapter 10: Respiration
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Questions and Answers

What are the two main functions of the cardiopulmonary system in relation to respiration?

The cardiopulmonary system is responsible for oxygenating the body and removing carbon dioxide.

Which of the following are signs of adequate breathing? (Select all that apply)

  • Equal expansion of the chest during inhalation (correct)
  • Air is heard entering and leaving the nose, mouth, and chest (correct)
  • Rate, rhythm, quality and depth of breaths are typical (correct)
  • Skin is a healthy color (correct)
  • Air is felt moving out of the nose or mouth (correct)

    • What are some common causes of hypoxia? (Select all that apply)

  • A patient overdoses on a drug that depresses the respiratory system (correct)
  • A patient has emphysema (correct)
  • A patient is trapped in a fire (correct)
  • A patient has a heart attack, stroke, or embolism (correct)

    • Artificial ventilation always uses the same force that the body normally uses to breathe.

    <p>False (B)</p> Signup and view all the answers

    Which of the following are common methods for providing artificial ventilation? (Select all that apply)

    <p>Mouth-to-mask (A), Two-rescuer bag-valve mask (C), One-rescuer bag-valve mask (D)</p> Signup and view all the answers

    A proper seal is important for artificial ventilation because it ensures that the most air gets into the lungs for adequate oxygen exchange.

    <p>True (A)</p> Signup and view all the answers

    What are three things that can optimize mask use when providing positive pressure ventilation?

    <p>Raising the patient's head at a 30-degree angle, using an airway adjunct, and using a team to ventilate can optimize mask use.</p> Signup and view all the answers

    Which of the following is NOT a true statement about bag-valve masks (BVM)?

    <p>They consist of an oxygen-filled shell that allows for a controlled flow of oxygen. (B)</p> Signup and view all the answers

    Describe how the mechanical workings of a bag-valve mask function.

    <p>When squeezed, the air inlet closes, forcing oxygen into the reservoir and through the mask into the patient's airway. When released, the patient passively exhales, and as they do, oxygen enters the reservoir.</p> Signup and view all the answers

    Explain the difference between a pressure-compensated flowmeter and a constant flow selector valve.

    <p>A pressure-compensated flowmeter is used for larger cylinders in ambulances, while a constant flow selector valve can be used with any size cylinder.</p> Signup and view all the answers

    What are some of the key safety considerations when handling oxygen cylinders? (Select all that apply)

    <p>Always use nonferrous wrenches. (A), Never drop or roll a cylinder on its side. (B), Always store reserve cylinders in a cool, well-ventilated room. (C), Never use grease, oil, or fat-based soap around oxygen equipment. (D), Always use medical-grade oxygen only. (E), Always use pressure gauges, regulators, and tubing intended for use with oxygen only. (F), Always ensure valve parts are in good condition. (G), Always open the valve fully and close it half a turn. (H), Never allow smoking near any oxygen equipment. (I)</p> Signup and view all the answers

    Humidifiers are typically used by EMS, even during short transports, because they help prevent the patient from getting dry mouth.

    <p>False (B)</p> Signup and view all the answers

    Which of the following is NOT a potential medical hazard of oxygen therapy?

    <p>An increased risk of developing a cold. (B)</p> Signup and view all the answers

    When would supplemental oxygen be administered to patients with chest pain? (Select all that apply)

    <p>When the patient has a low oxygen saturation reading. (B), When the patient is experiencing shortness of breath. (C), When the patient is experiencing hypoxia. (D)</p> Signup and view all the answers

    A nonrebreather mask must be inflated before putting it on a patient's face to ensure an adequate oxygen flow.

    <p>True (A)</p> Signup and view all the answers

    What types of patients are nonrebreather masks typically used for?

    <p>Nonrebreather masks are used for patients exhibiting signs of hypoxia, accompanied by shortness of breath, chest pain, and altered mental status.</p> Signup and view all the answers

    What does a Venturi mask do?

    <p>It delivers a specific concentration of oxygen by mixing it with inhaled air. (A)</p> Signup and view all the answers

    A tracheostomy mask is used to provide supplemental oxygen to patients who have a stoma or tracheostomy tube.

    <p>True (A)</p> Signup and view all the answers

    Describe the purpose of the blow-by technique for infants and children.

    <p>The blow-by technique involves holding oxygen tubing or a nonrebreather mask 2 inches from the infant's or child's face, allowing oxygen to flow gently over their face.</p> Signup and view all the answers

    Which of the following requires immediate action when providing care due to possible complications?

    <p>Obstructions (D)</p> Signup and view all the answers

    Dental appliances should always be removed when providing care and treating a patient.

    <p>False (B)</p> Signup and view all the answers

    What is a BURP maneuver and how is it performed during intubation?

    <p>The BURP maneuver is an airway management technique that involves pressing your thumb and index finger on either side of the throat over the cricoid cartilage. This helps to gently direct the throat upward and to the patient's right, providing a clearer view for the intubation procedure.</p> Signup and view all the answers

    When assisting with intubation, it is important to secure the endotracheal tube as soon as possible, rather than waiting for the paramedic to confirm its placement.

    <p>False (B)</p> Signup and view all the answers

    Why is it important to ventilate an intubated patient about 10 times per minute?

    <p>Ventilating an intubated patient at a rate of approximately 10 times per minute ensures adequate delivery of oxygen while preventing the risk of hyperventilation or lung injury.</p> Signup and view all the answers

    When assisting with intubation, it is important to be mindful of any resistance to ventilations, but it's not necessary to report these changes because they are typically insignificant issues.

    <p>False (B)</p> Signup and view all the answers

    When assisting with intubation, the EMT will hold manual stabilization while you apply a cervical collar so there is no need for you to hold manual stabilization after the collar is secured.

    <p>False (B)</p> Signup and view all the answers

    Respiratory failure is considered a minor issue and does not require immediate medical intervention.

    <p>False (B)</p> Signup and view all the answers

    What are common signs and symptoms associated with respiratory failure? (Select all that apply)

    <p>Blue skin (cyanosis) (A), Altered mental status (B), Shallow breathing (C), Increased respiratory rate (D)</p> Signup and view all the answers

    Even if a patient is experiencing respiratory failure, they might not need artificial ventilations.

    <p>False (B)</p> Signup and view all the answers

    Flashcards

    Ventilation

    The process of moving air in and out of the chest (inhalation/exhalation).

    Inhalation

    An active process where chest muscles expand and diaphragm contracts to pull air into lungs.

    Exhalation

    A passive process where chest muscles and diaphragm relax, pushing air out of lungs.

    Tidal Volume

    The amount of air moved in one breath during normal breathing.

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    Minute Volume

    The total amount of air moved into and out of the lungs per minute.

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    Alveolar Ventilation

    The amount of air reaching the alveoli, important for gas exchange.

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    Diffusion

    Movement of gases from high to low concentration, essential for gas exchange.

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    Pulmonary Respiration

    Diffusion of oxygen and carbon dioxide between alveoli and circulating blood.

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    Cellular Respiration

    Diffusion of oxygen and carbon dioxide between cells and blood.

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    Cardiopulmonary System

    The respiratory and circulatory systems working together for oxygenation.

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    Hypoxia

    A condition of low oxygen in body tissues, affecting function.

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    Hypercapnia

    An excess of carbon dioxide in the bloodstream.

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    Respiratory Distress

    Compensatory mechanisms are working, but the patient still shows signs of breathing difficulty.

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    Respiratory Failure

    When compensation fails and metabolic needs aren't met, risky for life.

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    Inadequate Breathing

    When the breathing rate, depth, or both fall outside normal ranges.

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    Assessment of Breathing

    Determine if a patient is breathing and if it's adequate through observation and feeling.

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    Signs of Adequate Breathing

    Normal chest expansion, air movement, and typical skin color indicate adequate breathing.

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    Signs of Inadequate Breathing

    Altered mental status, uneven chest movements, abnormal pulse indicate inadequate breathing.

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    Wheezing

    A high-pitched whistling sound during breathing indicating airway constriction.

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    Stridor

    A harsh, high-pitched sound during inhalation due to airway obstruction.

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    Cyanosis

    A bluish discoloration of the skin due to low oxygen levels.

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    Retention

    When the body holds on to carbon dioxide instead of expelling it.

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    Respiratory Rate

    The number of breaths taken per minute, crucial for assessing respiratory status.

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    Acute Respiratory Distress Syndrome (ARDS)

    Severe lung condition leading to inadequate oxygenation and needed intervention.

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    Bronchoconstriction

    Narrowing of the airways, limiting airflow and breathing.

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    Chemical Control

    The body's compensatory mechanisms to adjust breathing rates due to hypoxia or hypercapnia.

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    Pulmonary Capillaries

    Small blood vessels surrounding alveoli where gas exchange occurs.

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    Artificial Ventilation

    Assisting or replacing spontaneous breathing in patients who can't breathe on their own.

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    Positive Pressure Ventilation

    A technique to push air into the lungs by creating positive pressure.

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    Dead Space

    Portion of the airway where air does not participate in gas exchange.

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    Study Notes

    Emergency Care - Chapter 10: Respiration and Artificial Ventilation

    • This chapter covers respiration, artificial ventilation, oxygen therapy, special considerations, and assisting with advanced airway devices.

    Topics

    • Physiology and Pathophysiology
    • Respiration
    • Positive Pressure Ventilation
    • Oxygen Therapy
    • Special Considerations
    • Assisting with Advanced Airway Devices

    Physiology and Pathophysiology - Mechanics of Breathing (1 of 3)

    • Ventilation involves moving air into and out of the chest (inhalation and exhalation).
    • Inhalation is an active process where chest muscles expand and the diaphragm contracts, increasing chest size and creating negative pressure to pull air into the lungs.

    Physiology and Pathophysiology - Mechanics of Breathing (2 of 3)

    • Exhalation is a passive process, where chest muscles and the diaphragm relax, decreasing chest size and creating positive pressure to push air out of the lungs.
    • Tidal volume is the amount of air moved in one breath.
    • Minute volume is the amount of air moved into and out of the lungs per minute.

    Physiology and Pathophysiology - Mechanics of Breathing (3 of 3)

    • Ventilation's goal is to move air to and from alveoli for gas exchange.
    • Not all inhaled air reaches the alveoli; some occupies dead space.
    • Alveolar ventilation is the amount of air reaching alveoli; it's affected by rate and volume, and heavily depends on tidal volume, but is affected by very fast or slow breathing rates.

    Physiology and Pathophysiology- Physiology of Respiration (1 of 3)

    • Alveoli are the ends of bronchiole tubes, functioning as bunches of sacs that inflate and deflate with air movement.
    • Each alveolus is a bubble-like structure.
    • Pulmonary capillaries bring blood close to the alveoli sac. Thin alveoli and capillaries enable gas exchange.
    • Oxygen moves from alveoli into the blood, and carbon dioxide moves from the blood into the alveoli.

    Physiology and Pathophysiology- Physiology of Respiration (2 of 3)

    • Diffusion is the movement of gases from high to low concentration.
    • Pulmonary respiration is the diffusion of oxygen and carbon dioxide between alveoli and circulating blood.
    • Cellular respiration is the diffusion of oxygen and carbon dioxide between cells and circulating blood.

    Physiology and Pathophysiology- Physiology of Respiration (3 of 3)

    • Pulmonary and cellular respiration require respiratory and circulatory systems working together (cardiopulmonary system or ventilation-perfusion (V/Q) match).
    • Respiration is compromised when either system fails.

    Physiology and Pathophysiology- Cardiopulmonary Pathophysiology (1 of 3)

    • Mechanical failures of the cardiopulmonary system limit the chest's ability to create pressure changes.
    • Stab wounds allow air into the chest cavity, preventing negative pressure creation.
    • Loss of nervous control prevents respiratory muscle innervation.
    • Painful chest wall injuries limit chest wall movement.
    • Airway problems like bronchoconstriction restrict airflow.

    Physiology and Pathophysiology- Cardiopulmonary Pathophysiology (2 of 3)

    • Interrupted gas exchange impairs oxygen and carbon dioxide diffusion.
    • Low oxygen levels in the air limit the amount of oxygen inhaled.
    • Diffusion problems in alveoli can reduce gas exchange.

    Physiology and Pathophysiology- Cardiopulmonary Pathophysiology (3 of 3)

    • Circulation problems prevent the body from receiving enough oxygen.
    • Significant blood loss reduces the amount of oxygenated blood reaching the alveoli.
    • Insufficient hemoglobin or poor hemoglobin function limit oxygen transport.

    Respiration-Adequate and Inadequate Breathing (1 of 4)

    • Brain and body cells require a constant oxygen supply to function.
    • Hypoxia is low oxygen; hypercapnia is high carbon dioxide.
    • Efficient oxygenation and carbon dioxide removal are assessed to evaluate the cardiopulmonary system.

    Respiration-Adequate and Inadequate Breathing (2 of 4)

    • When the cardiopulmonary system fails, the body compensates for hypoxia or hypercapnia by stimulating the respiratory system to breathe more rapidly, increasing heart rate, and constricting blood vessels.

    Respiration-Adequate and Inadequate Breathing (3 of 4)

    • Respiratory distress indicates adequate compensation; the patient has normal mental status, skin color, and oximetry readings.
    • Respiratory failure indicates inadequate compensation; the body's metabolic needs are not met.
    • Respiratory failure can lead to respiratory arrest.

    Respiration-Adequate and Inadequate Breathing (4 of 4)

    • Inadequate breathing occurs when the body's compensatory mechanisms are overwhelmed.
    • The rate and/or depth of breathing fall outside the normal range.
    • Early recognition requires keen assessment skills and prompt action.

    Respiration-Patient Assessment (1 of 4)

    • First, assess breathing presence.
    • Then, assess breathing adequacy.
    • Signs of adequate breathing include:
      • Equal chest expansion.
      • Audible air entering and exiting the nose, mouth, and chest.
      • Air felt entering and exiting the nose or mouth.
      • Normal skin color.
      • Typical breathing rate, rhythm, quality, and depth.

    Respiration-Patient Assessment (2 of 4)

    • Signs of inadequate breathing:
      • Altered mental status.
      • Absent, minimal, or uneven chest movements.
      • Slow pulse rate (in children).
      • Breathing limited to the abdomen.
      • No audible or felt air from the nose or mouth.
      • Diminished or absent breath sounds.
      • Presence of wheezing, crowing, stridor, gurgling, or gasping.

    Respiration-Patient Assessment (3 of 4)

    • Signs of inadequate breathing:
      • Abnormally fast or slow breathing rate.
      • Shallow, deep or labored breathing.
      • Cyanosis in skin, lips, tongue, ears, or nails.
      • Prolonged inspiration or expiration.
      • Inability to speak.
      • Retractions and nasal flaring (children).
      • Low oxygen saturation readings (<95%).
      • Body position suggesting distress.

    Respiration-Patient Assessment (4 of 4)

    • Hypoxia is insufficient oxygen supply to tissues.
    • Common causes include:
      • Trapped in fire.
      • Emphysema.
      • Respiratory system depression from drug overdose.
      • Heart attack, stroke, or embolism.
    • Signs include cyanosis and altered mental status.
    • Address the cause and administer oxygen.

    Respiration-Patient Care

    • Provide artificial ventilation to non-breathing or inadequately breathing patients.
    • Provide supplemental oxygen to breathing patients with inadequate breathing.
    • Intervene promptly if breathing is inadequate because the condition will worsen without intervention.

    Positive Pressure Ventilation (1 of 2)

    • Artificial ventilation uses positive pressure to force air or oxygen into the lungs.
    • It is used when a patient has stopped breathing or has inadequate breathing.
    • Positive pressure creates a force opposite to normal breathing.

    Positive Pressure Ventilation (2 of 2)

    • Negative side effects of positive pressure ventilation include:
      • Reduced cardiac output and blood pressure due to affected heart refilling.
      • Gastric distention due to air diversion into the stomach.
      • Vasoconstriction due to excess carbon dioxide removal (hyperventilation).

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (1 of 33)

    • Common positive pressure ventilation techniques include:
      • Mouth-to-mask.
      • Two-rescuer bag-valve mask.
      • One-rescuer bag-valve mask.
    • Do not ventilate a patient who is vomiting or has vomitus in the airway.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (2 of 33)

    • To ensure adequate ventilations:
      • Watch the chest rise and fall with each ventilation.
      • Ensure the ventilation rate is sufficient.
    • Inadequate ventilation occurs when the chest does not rise adequately, air escapes, or the rate is too fast or slow.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (3 of 33)

    • When ventilating a rapidly breathing patient:
      • Assess respiration adequacy.
      • Explain procedure.
      • Place mask over mouth and nose.
      • Seal tightly to patient's face.
      • Squeeze bag with patient's inhalation.
      • Adjust rate over following breaths for greater volume and fewer repetitions.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (4 of 33)

    • When ventilating a slowly breathing patient:
      • Assess respiration adequacy.
      • Explain procedure.
      • Place mask over mouth and nose.
      • Seal tightly to patient's face.
      • Squeeze bag with patient's inhalation.
      • Add ventilations between the patient's breaths to reach respiratory rate of 12 per minute.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (5 of 33)

    • Opening the airway involves clearing, suctioning, and positioning the airway.
    • Head-elevated (sniffing) position is often optimal.
    • Neck flexion may be used, head extension, and suprasternal notch alignment with the ear and face parallel to the ceiling.
    • Adjust padding based on the patient's anatomy; young pediatric patients are challenging to position.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (6 of 33)

    • For obese patients, use a ramp position.
    • Raise the torso to a 45-degree angle.
    • Maintain head at the top of the ramp.
    • Ensure suprasternal notch is even with the ear and the face is parallel to the ceiling.
    • Ventilate spine injury patients with the head in a neutral position if possible.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (7 of 33)

    • Sealing the mask involves ensuring a proper seal for air movement into the lungs.
    • The mask should extend from the bridge of the nose to the cleft of the chin to cover the entire mouth.
    • Two hands are used for a proper seal.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (8 of 33)

    • Patient characteristics can make a good seal difficult.
    • Large, bushy beards should be prepared with water or lubricant
    • Dentures should remain in position.
    • Optimize mask use by tilting the patient's head up to 30 degrees, airway adjuncts may be considered, a team to assist ventilation.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (9 of 33)

    • Mouth-to-mask ventilation uses a pocket face mask.
    • Masks are made of soft, collapsible plastic, with infection control features, oxygen inlets, and clear view of the patient's mouth and lips.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (11 of 33)

    • EMT at the top of the patient's head following these steps:
      1. Position yourself directly above the patient's head.
      2. Elevate the patient's head to a sniffing position and insert any adjunct that may be required.
      3. Apply the mask to the patient's face.
      4. Position thumbs over the top of the mask, index fingers on the bottom of the mask.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (12, 13, 14, 15 of 33)

    • Steps in mouth-to-mask without spine injury:

      1. Lift the jaw to the mask while tilting the head backward.
      2. Squeezing the mask with thumbs and fingers.
      3. Ventilate via a one-way valve while watching the chest rise.

    • Steps in mouth-to-mask with a suspected spine injury:

      1. Position yourself directly over the patient's head.
      2. Elevate the head to a sniffing position and insert any adjunct that may be required.
      3. Apply the mask to the patient's face.
      4. Position thumbs/fingers to secure the mask on the patient's face.
      5. Lift the angle of the jaw but do not tilt the head backward.
      6. Squeezing the mask using thumbs and fingers
      7. Ventilate via a one-way valve to watch the chest rise.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (18 of 33)

    • Bag-valve masks (BVMs) are for non-breathing victims.
    • They provide infection control, come in various sizes (adult, child, infant), and feature a self-refilling shell and a non-jam valve with a 15 liter-per-minute oxygen inlet.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (20 of 33)

    • Mechanical workings of BVM ventilation:
      • Oxygen enters the reservoir.
      • When squeezed, the air inlet closes and oxygen is delivered to the patient.
      • When released, the patient passively exhales, and oxygen enters the reservoir.

    Positive Pressure Ventilation- Techniques of Artificial Ventilation (21, 22, 23 of 33)

    • Two-rescuer BVM ventilation (no trauma suspected) or (trauma suspected) steps consist of:
      1. Positioning the patient.
      2. Selecting BVM size.
      3. Mask placement, pressing downward.
      4. Positioning of the mask and aligning with the patient (nose to mouth.
      5. Second rescuer bringing jaw up to the mask.
      6. Second rescuer squeezing the bag until chest rises.
      7. Second rescuer releasing to let patient exhale passively. (Trauma):
        1. Positioning the patient.
        2. Selecting BVM size.
        3. Mask placement; pressing downward.
        4. Positioning of the mask and aligning with the patient, (nose and mouth)
        5. Second rescuer bringing jaw up to the mask; head in a neutral position.
        6. Second rescuer squeezes bag for ventilation.
        7. Second rescuer releases the bag to let patient exhale passively.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (25-26 of 33)

    • One-rescuer BVM ventilation. Steps consist of:

      1. Positioning the patient.
      2. Obtaining correct size BVM.
      3. Positioning the mask on the face of the patient.
      4. Squeeze the BVM, using one hand to cause chest rise.
      5. Release pressure on bag to allow patient to exhale passively.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (27 of 33)

    • If chest doesn't rise during BVM ventilation:
      1. Reposition the patient's head.
      2. Check for and correct mask/finger placement issue.
      3. Check for airway blockages and address if necessary.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (28 of 33)

    • BVM use during CPR:
      • The bag is squeezed every time a breath needs to be delivered.
      • A pocket mask with supplemental oxygen is frequently preferable for one rescuer during CPR than a BVM.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (29 of 33)

    • Artificial ventilation for a stoma breather. Steps include

      1. Clear stoma of mucus
      2. Maintain head/neck in neutral position.
      3. Establish mask seal around the stoma.
      4. Deliver ventilations according to patient age.
      5. If stoma ventilation is unsuccessful, switch to mouth-nose method.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (30 of 33)

    • Improper ventilation rates harm patients
      • Too slow leads to hypoventilation and hypoxia.
      • Too fast causes hyperventilation and vasoconstriction.
    • Focus on ventilation with another rescuer securing the airway during ventilation.
    • Adults: 10-12 breaths per minute; children: 12-20 breaths per minute.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (31 of 33)

    • Improper ventilation volumes can harm patients
      • Too much pressure causes gastric distention.
      • Too much volume causes lung trauma.
    • Ventilation should be slow and gentle; lasting about one second.
    • Ventilation should cease when chest movement begins instead of until lungs are fully inflated.

    Positive Pressure Ventilation - Techniques of Artificial Ventilation (32 of 33)

    • Automatic transport ventilators (ATVs) provide positive pressure ventilation during respiratory arrest; they have rate and volume settings and are portable.
    • They're beneficial during prolonged ventilation when only one rescuer is available.
    • Ensure an appropriate mask seal for patient size and condition.

    Oxygen Therapy-Importance of Supplemental Oxygen

    • Oxygen is crucial for bodily functions.
    • Giving supplemental oxygen can be dangerous if doses are too high or low
    • Oxygen can damage heart attack and stroke patients if given too much
    • Oxygen administration relies on evaluation of the patient's oxygen saturation (below 94), hypoxia, and decompensation, suggesting the need for oxygen.
    • Always ventilate cardiac arrest patients.

    Oxygen Therapy-Oxygen Therapy Equipment (1 of 13)

    • Portable oxygen equipment in the field must be safe, lightweight, portable, and dependable.
    • Most systems include cylinders, pressure regulators, and delivery devices.
    • Other devices such as bag-valve masks (BVM) and pocket masks can be used to force oxygen into the patient’s lungs.

    Oxygen Therapy-Oxygen Therapy Equipment (2 of 13)

    • Oxygen cylinders are seamless steel or alloy canisters filled under pressure.
    • Cylinder sizes are designated by letters (e.g., D, E, M, G, H)
    • Each size has a different capacity in liters.
    • Common cylinder colors are green or green/white.

    Oxygen Therapy-Oxygen Therapy Equipment (3,4,5,6 of 13)

    • Larger cylinders are often used in fixed systems for ambulances.
    • Cylinder safety includes:
      • Using intended gauges, regulators, and tubing.
      • Using non-ferrous wrenches.
      • Ensuring valve seat inserts and gaskets are in good condition.
      • Using medical-grade oxygen.
      • Open and close valves correctly to avoid forcing valves.
      • Store reserve cylinders in a cool, ventilated room, secured properly.
      • Perform hydrostatic tests every 5 years.
      • Never drop or let cylinders fall.
      • Never leave cylinders upright without proper support.
      • Never allow smoking near oxygen equipment.
      • Never use oxygen equipment near open flame.
      • Do not use grease, oil, or fat-based soaps on devices that will be attached to a cylinder.
      • Do not use adhesive tape on a cylinder.
      • Do not drag or roll cylinders.

    Oxygen Therapy-Oxygen Therapy Equipment (7, 8,9 of 13)

    • Place oxygen cylinders horizontally or upright, but securely supported.
    • Connection to a cylinder requires a regulator that can safely deliver 30 to 70 psi (pounds per square inch). For cylinders E size or smaller, a yoke assembly is used to secure the regulator; for larger cylinders, a threaded outlet is used. Before connecting a regulator to a cylinder, open the main valve slightly to clear dirt and dust.
    • Flowmeters allow controlled oxygen delivery in liters per minute (l/min).
      • Low pressure flowmeters include pressure-compensated flowmeters (larger cylinders in ambulances) and constant flow selector valves.
      • High-pressure flowmeters are sometimes necessary for devices or respirators/ventilators.

    Oxygen Therapy-Oxygen Therapy Equipment (10,11,12,13 of 13)

    • Illustrations of both pressure-compensated and constant flow selector valves may be used to regulate the flow of oxygen, and should be included in review.
    • High-pressure flowmeters provide oxygen delivery through tubing attached to a threaded connector.
    • Humidifiers may be used to moisten dry oxygen.
    • Humifiers are generally avoided by EMS personnel because of risk of infection transmission.

    Oxygen Therapy-Hazards of Oxygen Therapy (1 of 2)

    • Non-medical hazards are rare if equipment is properly maintained
      • Punctured/leaking tanks can become dangerous projectiles.
      • Oxygen supports combustion and can cause fires to burn rapidly.
      • Oxygen under pressure creates rapid explosive reactions if mixed with oil.

    Oxygen Therapy-Hazards of Oxygen Therapy (2 of 2)

    • Medical hazards may take time to develop and are uncommon for EMTs.
      • Oxygen toxicity or air sac collapse involves excessive oxygen concentration.
      • Eye damage is a possible complication when certain types of patients are given oxygen over a prolonged period.
      • Respiratory depression or arrest can happen when hypoxic drive is affected in COPD patients.
      • Underlying conditions such as myocardial infarction or stroke may be worsened by high oxygen concentration.

    Oxygen Therapy-Administering Oxygen

    • Various oxygen delivery devices are available.
    • Follow instructor's directions to safely and effectively use the equipment.

    Oxygen Therapy-Supplemental Oxygen for Patients with Chest Pain (1 of 14)

    • Use oxygen when patients experience shortness of breath, low oxygen saturation or hypoxia.
    • Mild distress may be treated with low-concentration oxygen delivered through nasal cannula.
    • Moderate to severe distress may require high-concentration oxygen via non-rebreather mask.

    Oxygen Therapy-Supplemental Oxygen for Patients with Chest Pain (2-3 of 14)

    • A nonrebreather mask is best for high concentration oxygen delivery. Ensure proper placement and seal on the face. Inflate the reservoir bag prior to mask placement.
    • The reservoir bag must be adequately filled and ensure there is appropriate flow, maintained at 15 liters per minute for best efficacy (80-90% oxygen concentration).
    • Exhaled air is diverted away from the patient, by a flutter valve and prevents rebreathing.

    Oxygen Therapy-Supplemental Oxygen for Patients with Chest Pain (7,9, 12, 13, 14 of 14)

    • A nasal cannula delivers low oxygen concentrations and is held in place by fitting the tubes over the ears and then over the chin; typical flow rates are 4-6 liters per minute (24-44%); preferred device for patients refusing face masks.
    • A partial rebreather masks are very similar to nonrebreather masks but have a one-way valve. Patients rebreathe one third of the exhaled air—this style is sometimes used to preserve carbon dioxide levels for patients who require stimulation to initiate breathing. Partial rebreathers deliver 40-60% oxygen at 9–10 liters per minute.
    • A Venturi mask allows for controlled oxygen concentration by mixing oxygen with inhaled air; often used for COPD patients.
    • A tracheostomy mask fits over the stoma of a tracheostomy tube. The typical flow rate is 8-10 liters per minute.
    • Handle children with appropriate caution and equipment; infants and children with respiratory distress, inadequate respirations, or potential shock benefit from the blow-by technique; hold oxygen tubing or nonrebreather mask 2 inches from the face allowing oxygenation over the face.

    Special Considerations (1–4 of 4)

    • Facial injuries may require frequent suction to clear blood or debris.
    • Adjuncts or endotracheal tubes may be required—airway adjuncts or endotracheal tubes may be needed to ensure a safe airway.
    • Solids that obstruct the airway cannot be removed using a suction unit alone.
    • Abdominal thrusts, chest thrusts, or finger sweeps may be needed.
    • Dental appliances, like dentures should remain in place unless they pose an airway risk. Partial dentures may dislodge during an emergency. If a device obstructs the airway, remove it immediately.
    • Infants and children require specific considerations
      • Tongue occupies more space in the oral cavity.
      • Soft trachea and more flexible heads.
      • Larger chest walls.
      • Respiratory rate may be twice as high in children compared to adults.
    • Management considerations for infants and children
      • Avoid excessive pressure and volume for ventilations.
      • Use appropriately sized face masks, such as pediatric-sized nonrebreather masks.
      • Avoid inappropriate amounts of oxygen; Gastric distention may impede adequate ventilations.

    Assisting With Advanced Airway Devices- Preparing the Patient for Intubation (1-3 of 3)

    • EMTs may pre-oxygenate patients to prepare for intubation.
    • The paramedic positions the patient—head elevated, using a sniffing position.
    • The paramedic removes the oral airway to ensure tube can be placed directly.
    • EMTs may assist with the BURP maneuver for easier intubation
      • Press the thumb and index finger against the cricoid cartilage and gently direct the throat up and to the right.

    Assisting With Advanced Airway Devices- Ventilating the Intubated Patient (1-2 of 2)

    • Hold the endotracheal tube firmly against the teeth with two fingers; work the BVM with the other hand.
    • Ventilate about 10 times per minute, matching ventilations to the patient's breathing effort when possible.
    • Pay careful attention to patient resistance during ventilation—record any substantial changes. If defibrillation occurs, carefully remove the bag from the tube.
    • Be aware of the patient's mental status and if medication injection is required, the BVM must be removed.

    Assisting With Advanced Airway Devices - Assisting with Trauma Intubation (1-2 of 2)

    • Provide in-line manual stabilization throughout the intubation, using a cervical collar while stabilizing the patient's head. The paramedic provides the in line stabilization.
    • Once intubation is complete, the tube will be anchored.
    • Manual stabilization must continue, in addition to cervical collar support, until the head is secured in place.

    Chapter Review (1-2 of 2)

    • Inadequate breathing/respiratory failure—breathing insufficient to support life.
    • Non-breathing patients in respiratory failure/arrest need artificial ventilations.
    • Supplemental oxygen is sometimes used for breathing patients who show signs indicative of inadequate breathing or need for supplemental oxygen.

    Remember (1-3 of 3)

    • Use appropriate personal protective equipment for airway management.
    • Respiration status assessment is an ongoing process; respiratory status can change.
    • Inadequate breathing requires immediate action.
    • Positive pressure ventilation differs significantly from normal breathing; use the most appropriate technique based on individual need.
    • Use proper safety measures when handling oxygen.
    • Select the appropriate oxygen delivery device for the patient's needs.

    Questions to Consider (1-2 of 2)

    • What are signs of respiratory distress or respiratory failure?
    • How does positive pressure ventilation differ from normal breathing?
    • Describe a patient situation that benefits from oxygen administration and how to select the appropriate oxygen delivery device to use based on the type of distress.

    Critical Thinking (1-2 of 2)

    • A semiconscious adult female presents with respiratory rate of 7 per minute. She appears pale and slightly blue around her lips.
    • Is the patient in respiratory failure?
    • What signs and symptoms indicate respiratory failure?
    • Should the patient receive artificial ventilation?

    Appendix 1 and 2

    • These are supplementary illustrations that display the processes for the types of equipment discussed in the text for both procedures, so review the procedures and the equipment shown in the appendix to enhance understanding.

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    Emergency Care - Chapter 10: Respiration and Artificial Ventilation PDF

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    Explore the essentials of respiration and artificial ventilation in this quiz on Chapter 10 of Emergency Care. Covering key topics like oxygen therapy and advanced airway devices, this quiz will help reinforce your understanding of the mechanics of breathing and their physiological implications.

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