Emergency Care - Chapter 10: Respiration and Artificial Ventilation PDF

Emergency Care Fourteenth Edition Chapter 10 Respiration and Artificial Ventilation...

Emergency Care Fourteenth Edition Chapter 10 Respiration and Artificial Ventilation Slides in this presentation contain hyperlinks. JAWS users should be able to get a list of links by using INSERT+F7 Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Topics Physiology and Pathophysiology Respiration Positive Pressure Ventilation Oxygen Therapy Special Considerations Assisting with Advanced Airway Devices Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology Back to Topics Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Mechanics of Breathing (1 of 3) Ventilation is the process of moving air into (inhalation) and out of (exhalation) the chest Inhalation is an active process – Chest muscles expand and the diaphragm contracts – The size of the chest increases – Negative pressure pulls air into lungs Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Mechanics of Breathing (2 of 3) Exhalation is a passive process – Chest muscles and the diaphragm relax – The size of the chest decreases – Positive pressure pushes air out of the lungs Tidal volume is the mount of air moved in one breath Minute volume is the amount of air moved into and out of the lungs per minute Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Mechanics of Breathing (3 of 3) Ventilation is designed to move air to and from the alveoli for gas exchange – Not all of the air breathed reaches the alveoli – Some air occupies dead space Alveolar ventilation refers to the amount of air that actually reaches the alveoli – It can be altered by changes in rate or volume – It depends heavily on tidal volume, but is affected by very fast or very slow rates Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Physiology of Respiration (1 of 3) Alveoli form the ends of the bronchiole tubes – Bunches of sacs are inflated and ventilated as air moves in and out – Each alveolus is a bubble-like structure Pulmonary capillaries bring blood close to the sacs Thin alveoli and capillary walls allow for gas exchange – Oxygen in the alveoli moves into the blood – Carbon dioxide in the blood moves into the alveoli Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Physiology of Respiration (2 of 3) Diffusion is movement of gases from an area of high concentration to an area of low concentration Pulmonary respiration is diffusion of oxygen and carbon dioxide between the alveoli and the circulating blood Cellular respiration is diffusion of oxygen and carbon dioxide between the cells and the circulating blood Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Physiology of Respiration (3 of 3) In order for pulmonary and cellular respiration to occur, the respiratory and circular systems work in conjunction – This is sometimes called the cardiopulmonary system – It may also be called a ventilation-perfusion (V/Q) match When either the respiratory or circular system fails, the process of respiration is defeated Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Cardiopulmonary Pathophysiology (1 of 3) Mechanical failures of the cardiopulmonary system limit the ability of the chest to create pressure changes – Stab wounds allow air into the cavity and make it impossible to create negative pressure – Loss of nervous control makes it impossible to innervate respiratory muscles – Painful chest wall injuries limit chest wall movement – Airway problems like bronchoconstriction limit air flow Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Cardiopulmonary Pathophysiology (2 of 3) Interrupted gas exchange impairs the ability to diffuse oxygen and carbon dioxide – Low oxygen levels in outside air limit the amount of oxygen that can be inhaled – Diffusion problems caused by alveoli that do not work properly limit the ability to exchange gases Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Physiology and Pathophysiology— Cardiopulmonary Pathophysiology (3 of 3) Circulation issues prevent blood from carrying enough oxygen to the cells of the body – Significant blood loss reduces the amount of blood circulated to the alveoli – Insufficient hemoglobin or hemoglobin that is not working properly limits the transport of oxygen Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration Back to Topics Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Adequate and Inadequate Breathing (1 of 4) Brain and body cells need a steady supply of oxygen to maintain normal function – Hypoxia is a low level of oxygen function – Hypercapnia is a high level of carbon dioxide Assess the cardiopulmonary system by evaluating how well it is oxygenating and removing carbon dioxide Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Adequate and Inadequate Breathing (2 of 4) When the cardiopulmonary system fails, the body compensates for hypoxia or hypercapnia – Chemoreceptors stimulate the respiratory system to breathe more rapidly – Respiratory rate and heart rate increase and blood vessels constrict Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Adequate and Inadequate Breathing (3 of 4) Respiratory distress – Compensation is working – The patient has normal mental status, skin color, and oximetry readings Respiratory failure (inadequate breathing) – Compensation is not working – Metabolic needs of the body are not met Respiratory failure is a precursor to respiratory arrest Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Adequate and Inadequate Breathing (4 of 4) Inadequate breathing occurs when a challenge is too great for body’s compensatory mechanisms – Rate of breathing, depth of breathing, or both fall outside of normal ranges – Recognition requires keen assessment skills and prompt action Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Patient Assessment (1 of 4) First, determine if the patient is breathing Second, determine whether breathing is adequate Signs of adequate breathing: – Equal expansion of the chest is seen on inhalation – Air is heard entering and leaving the nose, mouth, and chest – Air is felt moving out of the nose or mouth – Skin has typical coloration – Rate, rhythm, quality, and depth of breath are typical Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Patient Assessment (2 of 4) Signs of inadequate breathing: – Mental status is altered – Chest movements are absent, minimal, or uneven – Pulse rate is slow (children) – Breathing movements are limited to the abdomen – No air is felt or heard at the nose or mouth – Breath sounds are diminished or absent – Wheezing, crowing, stridor, gurgling, or gasping are heard during breathing Copyright © 2021, 2016, 2012 Pearson Education, Inc. All Rights Reserved Respiration—Patient Assessment (3 of 4) Signs of inadequate breathing: – Rate of breathing is too rapid or too slow – Breathing is very shallow, very deep, or labored – Cyanosis is seen in skin, lips, tongue, ears, or nails – Inspirations or expirations are prolonged – Patient is unable to speak – Retractions and nasal flaring are seen (children) – Oxygen saturation readings are low (