Airway Management Chapter 11 PDF

CHAPTER 11 Airway Management Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 6)...

CHAPTER 11 Airway Management Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Airway Management, Respiration, and Artificial Ventilation Applies knowledge of general anatomy and physiology to patient assessment and management in order to assure a patent airway, adequate mechanical ventilation, and respiration for patients of all ages. National EMS Education Standard Competencies (2 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Airway Management  Airway anatomy  Airway assessment  Techniques of assuring a patent airway National EMS Education Standard Competencies (3 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiration  Anatomy of the respiratory system  Physiology and pathophysiology of respiration  Pulmonary ventilation  Oxygenation  Respiration (external, internal, cellular) National EMS Education Standard Competencies (4 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiration (cont’d)  Assessment and management of adequate and inadequate ventilation  Supplemental oxygen therapy National EMS Education Standard Competencies (5 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Artificial Ventilation  Assessment and management of adequate and inadequate ventilation  Artificial ventilation  Minute ventilation  Alveolar ventilation  Effect of artificial ventilation on cardiac output National EMS Education Standard Competencies (6 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Pathophysiology  Applies fundamental knowledge of the pathophysiology of respiration and perfusion to patient assessment and management. Introduction Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The primary component of caring for patients is ensuring that they can breathe adequately.  When the ability to breathe is disrupted, oxygen delivery to tissues and cells is compromised.  Oxygen reaches body tissues and cells through breathing and circulation. Anatomy of the Respiratory System (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-1 The upper and lower airways contain the structures in the body that help us breathe. © Jones & Bartlett Learning. Anatomy of the Respiratory System (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The respiratory system consists of all the structures that make up the airway and help us breathe, or ventilate.  The airway is divided into the upper and lower airways. Anatomy of the Upper Airway (1 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Anatomy of the upper airway  Nose  Mouth  Oral cavity  Pharynx  Larynx Anatomy of the Upper Airway (2 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The upper airway’s main function is to warm, filter, and humidify air as it enters the body.  Pharynx  Muscular tube extending from nose and mouth to level of esophagus and trachea  Composed, from top to bottom, of the nasopharynx, oropharynx, and laryngopharynx  Anatomy of the Upper Airway (3 of 7)  Nasopharynx  Filters out dust and small particles Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Warms and humidifies air as it enters the body FIGURE 11-2 The pharynx. © Jones & Bartlett Learning. Anatomy of the Upper Airway (4 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Oropharynx  Posterior portion of the oral cavity  The epiglottis is superior to the larynx.  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-3 The oral cavity. Anatomy of the Upper Airway (5 of 7) © Jones & Bartlett Learning.  Anatomy of the Upper Airway (6 of 7)  Larynx  Complex structure formed by many Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com independent cartilaginous structures  Marks where the upper airway ends, and the lower airway begins FIGURE 11-6 The larynx. © Jones & Bartlett Learning. Anatomy of the Upper Airway (7 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Larynx (cont’d)  Thyroid cartilage forms a “V” shape anteriorly.  Cricoid cartilage is the first ring of the trachea.  Glottis is the area between the vocal cords. Anatomy of the Lower Airway (1 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The lower airway’s function is to deliver oxygen to the alveoli.  Lower airway includes:  Trachea  Bronchi  Lungs Anatomy of the Lower Airway (2 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Trachea  Conduit for air entry into the lungs  Divides at the carina into two main stem bronchi, right and left  Bronchi are supported by cartilage.  Bronchi distribute oxygen to the lungs. Anatomy of the Lower Airway (3 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-7 The trachea and the lungs are lower airway structures. © Jones & Bartlett Learning. Anatomy of the Lower Airway (4 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Trachea (cont’d)  Bronchioles are made of smooth muscle.  Smaller bronchioles connect to alveoli.  Oxygen is transported back to the heart and distributed to the rest of the body. Anatomy of the Lower Airway (5 of 6)  The heart and great vessels (vena cava and aorta) are found in the thoracic Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com cavity. FIGURE 11-8 The thoracic cavity contains important FIGURE 11-9 The mechanism of anatomic structures for ventilation, ventilation can be illustrated by using a oxygenation, and bell jar. Inhalation and chest expansion, respiration, including the lungs and bronchi, © Jones & Bartlett Learning. anatomic (left) and bell jar (right). © Jones & Bartlett Learning. heart, great vessels (the vena cavae and Anatomy of the Lower Airway (6 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The mediastinum contains:  Heart  Great vessels  Esophagus  Trachea  Major bronchi  Many nerves Physiology of Breathing (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The respiratory and cardiovascular systems work together.  Ensure a constant supply of oxygen and nutrients is delivered to cells  Remove carbon dioxide and waste products  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Physiology of Breathing (2 of 2) Ventilation (1 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Physical act of moving air into and out of the lungs  Inhalation  Active, muscular part of breathing  The diaphragm and intercostal muscles contract.  This generates a negative pressure in the thorax, allowing air to enter. Ventilation (2 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Inhalation (cont’d)  The lungs require the movement of the chest and supporting structures to expand.  Partial pressure: the amount of gas in the air or dissolved in fluid (blood)  Oxygen and carbon dioxide both diffuse until the partial pressures in the air and the blood are equal. Ventilation (3 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-9 The mechanism of ventilation can be illustrated by using a bell jar. Exhalation and chest contraction, anatomic (left) and bell jar (right). © Jones & Bartlett Learning. Ventilation (4 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Inhalation (cont’d)  Inspiration delivers oxygen to the alveoli.  Tidal volume  Dead space Ventilation (5 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Exhalation  Does not normally require muscular effort  Passive process  Diaphragm and intercostal muscles relax.  Smaller thorax compresses air into the lungs. Ventilation (6 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Regulation of ventilation involves a complex series of receptors and feedback loops.  Failure to meet the body’s need for oxygen may result in hypoxia.  Based on pH changes in the blood and cerebrospinal fluid  Hypoxic drive  Typically seen in patients with end-stage COPD Oxygenation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Process of loading oxygen molecules onto hemoglobin molecules in bloodstream  Required for internal respiration to take place  Does not guarantee that internal respiration is taking place  Ventilation without oxygenation can occur where oxygen levels have been depleted. Respiration (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Actual exchange of oxygen and carbon dioxide in the alveoli and tissues of the body  Cells take energy from nutrients through metabolism.  Respiration (2 of 3)  External respiration (pulmonary respiration) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Brings fresh air into the respiratory system  Exchanges oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries FIGURE 11-11 External respiration. © Jones & Bartlett Learning.  Respiration (3 of 3)  Internal respiration  Exchange of oxygen and carbon Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com dioxide between systemic circulatory system and cells FIGURE 11-12 Internal respiration. © Jones & Bartlett Learning. Pathophysiology of Respiration (1 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Factors in the nervous system  Chemoreceptors monitor levels of:  Oxygen  Carbon dioxide  Hydrogen ions  pH of cerebrospinal fluid  Provide feedback to the respiratory centers Pathophysiology of Respiration (2 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ventilation/perfusion ratio and mismatch  Air and blood flow must be directed to the same place at the same time.  Ventilation and perfusion must be matched.  Failure to match is the cause of most abnormalities of oxygen and carbon dioxide exchange. Pathophysiology of Respiration (3 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ventilation/perfusion ratio and mismatch (cont’d)  Gas exchange does not take place.  Lack of O2 in bloodstream  CO2 is recirculated within bloodstream.  Severe hypoxemia can occur. Pathophysiology of Respiration (4 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Factors affecting pulmonary ventilation  Intrinsic factors:  Infections  Allergic reactions  Unresponsiveness (tongue obstruction)  Extrinsic factors:  Trauma Pathophysiology of Respiration (5 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Factors affecting respiration  External factors:  Atmospheric pressure  Partial pressure of O2  Internal factors:  Pneumonia  Pulmonary edema  COPD/emphysema Pathophysiology of Respiration (6 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Circulatory compromise  Trauma emergencies can obstruct blood flow to individual cells and tissue:  Simple or tension pneumothorax  Open pneumothorax  Hemothorax  Hemopneumothorax Pathophysiology of Respiration (7 of 7) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Circulatory compromise (cont’d)  Other causes:  Blood loss  Anemia  Hypovolemic shock  Vasodilatory shock Patient Assessment (1 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Aerosol-generating procedures (AGPs)  CPR  Nebulizer treatments  Endotracheal intubation  Continuous positive airway pressure Patient Assessment (2 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Recognizing adequate breathing  Between 12 and 20 breaths/min  Regular pattern of inhalation and exhalation  Bilateral clear and equal lung sounds  Regular, equal chest rise and fall  Adequate depth (tidal volume) Patient Assessment (3 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Recognizing abnormal breathing  Fewer than 12 breaths/min  More than 20 breaths/min  Irregular rhythm  Diminished, absent, or noisy auscultated breath sounds  Reduced flow of expired air at nose and mouth Patient Assessment (4 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Recognizing abnormal breathing (cont’d)  Unequal or inadequate chest expansion  Increased effort of breathing  Shallow depth  Skin that is pale, cyanotic, cool, or moist  Skin pulling in around ribs or above clavicles during inspiration Patient Assessment (5 of 8)  A patient may appear to be breathing after the heart has stopped.  Called agonal gasps Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Cheyne-Stokes respirations are often seen in patients with stroke or head injury. FIGURE 11-15 Cheyne-Stokes breathing shows irregular respirations © followed by a period of apnea. Jones & Bartlett Learning. Patient Assessment (6 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ataxic respirations  Irregular or unidentifiable pattern  May follow serious head injuries  Kussmaul respirations  Deep, rapid respirations  Common in patients with metabolic acidosis  Patients with inadequate breathing need to be treated immediately. Patient Assessment (7 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assessment of respiration  Even though the patient may be ventilating appropriately, respiration may be compromised.  Level of consciousness and skin color are excellent indicators of respiration. Patient Assessment (8 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assessment of respiration (cont’d)  Also consider oxygenation  Pulse oximetry is considered a routine vital sign.  Can be used as part of any patient assessment End-tidal CO2 (1 of 2)  Measurement of the maximal CO2 at the end of an exhaled breath. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Low CO2 level  Hyperventilation  Decreased CO2 return to the lungs  Reduced CO2 production at the cellular level  High CO2 level  Ventilatory inadequacy  Apnea End-tidal CO2 (2 of 2)  Measured using capnometry and capnography devices Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Normal range is 35–45 mm Hg  Can be used in spontaneously breathing patients with a special nasal cannula Opening the Airway (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Emergency medical care begins with ensuring an open airway.  Rapidly assess whether an unconscious patient has an open airway and is breathing adequately.  Position the patient correctly.  Supine position is most effective.  Opening the Airway (2 of 2)  Unconscious patients should be moved as a unit. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Most common airway obstruction is the tongue. FIGURE 11-23 The most common airway obstruction is the patient’s own tongue, which falls back into the © Jones & throat Bartlett Learning. when the muscles of the throat and tongue relax.  Head Tilt–Chin Lift Maneuver (1 of 2)  Will open the airway in most patients  For patients who have not sustained or Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com are not suspected of having sustained trauma FIGURE 11-24 The head tilt–chin lift maneuver is a simple technique for opening the airway in a patient without a suspected cervical spine injury. © Jones & Bartlett Learning. Head Tilt–Chin Lift Maneuver (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Follow these steps:  With the patient supine, position yourself beside the patient’s head.  Place the heel of one hand on the forehead, and apply firm backward pressure with the palm.  Place the fingertips of the other hand under the lower jaw.  Lift the chin upward, with the entire lower jaw. Jaw-Thrust Maneuver Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If you suspect a cervical spine injury, use this maneuver.  Follow these steps:  Kneel above the patient’s head.  Place your fingers behind the angles of the lower jaw.  Move the jaw upward.  Use your thumbs to help position the jaw. Opening the Mouth (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Even if the airway is opened, the mouth may be closed.  For the cross-finger technique:  Place the tips of your index finger and thumb on the patient’s teeth.  Push your thumb on the lower teeth.  Push index finger on the upper teeth.  The index finger and the thumb cross over each other. Jaw-Thrust Maneuver (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-25 Performing the jaw-thrust maneuver. A. Kneeling above the patient’s head, place your fingers behind the angles of the lower jaw, and move the jaw upward. Use your thumbs to help position the lower jaw. B. A, B: The © Jones completed maneuver & Bartlett Learning. Courtesy of MIEMSS. should look like this. Suctioning (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  You must keep the airway clear to ventilate properly.  Portable, hand-operated, and fixed equipment is essential for resuscitation. FIGURE 11-27 Suctioning equipment is essential for resuscitation. A. Hand-operated unit. B. Fixed unit. C.C: ©Portable A, Jones & Bartlettunit. Learning. Courtesy of MIEMSS. B: © Jones & Bartlett Learning. Suctioning (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A portable or fixed unit should have:  Wide-bore, thick-walled, nonkinking tubing  Plastic, rigid pharyngeal suction tips  Nonrigid plastic catheters  A nonbreakable, disposable collection bottle  Water supply for rinsing the tips Techniques of Suctioning (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Inspect the equipment regularly.  To operate the suction unit:  Check the unit for proper assembly of its parts.  Test the suctioning unit to ensure vacuum pressure of more than 300 mm Hg.  Select and attach the appropriate suction catheter to the tubing. Techniques of Suctioning (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Never suction the mouth or nose for more than 15 seconds at one time for adult patients, 10 seconds for children, and 5 seconds for infants.  Suctioning can result in hypoxia. Techniques of Suctioning (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  When patients have secretions or vomitus that cannot be suctioned easily:  Remove the catheter from the patient’s mouth.  Log roll the patient to the side.  Clear the mouth carefully with a gloved finger. Techniques of Suctioning (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If the patient produces frothy secretions as quickly as you can suction them:  Suction the airway for 15 seconds (less in infants and children).  Ventilate for 2 minutes.  Continue this alternating pattern until all secretions have been cleared. Basic Airway Adjuncts (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Prevent obstruction by the tongue and allow for passage of air and oxygen to the lungs  Oropharyngeal airways  Keep the tongue from blocking the upper airway  Make it easier to suction the oropharynx Basic Airway Adjuncts (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Oropharyngeal airways (cont’d)  Indications:  Unresponsive patients without a gag reflex  Apneic patients being ventilated with a bag-mask device  Contraindications:  Conscious patients  Any patient who has an intact gag reflex Basic Airway Adjuncts (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Nasopharyngeal airways  Used in a patient who:  Is unresponsive or has an altered LOC  Has an intact gag reflex  Is unable to maintain his or her own airway spontaneously Basic Airway Adjuncts (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Nasopharyngeal airways (cont’d)  Indications:  Semiconscious or unconscious patients with an intact gag reflex  Patients who will not tolerate an oropharyngeal airway  Contraindications:  Severe head injury with blood in the nose  History of fractured nasal bone Maintaining the Airway Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Use the recovery position.  Used to help maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own FIGURE 11-32 In the recovery position, the patient is rolled onto © Jones &his Bartlettor herCourtesy Learning. left oforMIEMSS. right side. Supplemental Oxygen (1 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Always give oxygen to patients who are hypoxic.  Some tissues and organs need a constant supply of oxygen to function normally.  Never withhold oxygen from any patient who might benefit from it. Supplemental Oxygen (2 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Supplemental oxygen equipment  Oxygen cylinders contain compressed gas.  Liquid oxygen is becoming a more commonly used alternative. Supplemental Oxygen (3 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Safety considerations  Handle gas cylinders carefully.  Make sure the correct pressure regulator is firmly attached before transport.  A puncture hole in a tank can turn it into a deadly missile.  Secure cylinders when stored on ambulance and when in use during transport. Supplemental Oxygen (4 of 9)  Pin-indexing system Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Prevents such mistakes as an oxygen regulator being accidentally connected to a carbon dioxide cylinder  Every cylinder of a specific gas type has a given pattern and a given number of pins. Supplemental Oxygen (5 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Pressure regulators  Reduce the cylinder’s pressure to a useful therapeutic range, usually 40 to 70 psi.  Final attachment for delivering the gas is either a quick-connect female fitting or a flowmeter. Supplemental Oxygen (6 of 9)  Flowmeters Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Usually permanently attached to pressure regulators on emergency medical equipment  Pressure-compensated flowmeter  Bourdon-gauge flowmeter  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Supplemental Oxygen (7 of 9)  Hazards of supplemental oxygen:  Oxygen toxicity  Combustion Supplemental Oxygen (8 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Combustion  Oxygen does not burn or explode, but it does speed up the combustion process.  Keep any sources of fire away.  Make sure the area is adequately ventilated.  Never leave an oxygen cylinder standing unattended. Supplemental Oxygen (9 of 9) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Oxygen toxicity  Not all patients need high concentrations of oxygen.  Oxygen can have detrimental effects in patients with certain illnesses (COPD).  When pulse oximetry available, tailor oxygen therapy; administer the minimum amount necessary to maintain oxygen saturation at or above 94%.  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Oxygen-Delivery Equipment  Nonrebreathing masks  Bag-mask devices  Nasal cannulas  Nonrebreathing Masks (1 of 2)  Preferred way to give oxygen in the prehospital setting Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patients who are breathing adequately but are suspected of having hypoxia  Combination mask and reservoir bag system FIGURE 11-39 The nonrebreathing mask contains flapper valve ports at the cheek areas of the mask to prevent the patient from © Jones &rebreathing Bartlett Learning exhaled gases. Nonrebreathing Masks (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Make sure the reservoir bag is full before placing the mask on the patient.  Adjust the flow rate so the bag does not collapse when the patient inhales.  When oxygen therapy is discontinued, remove the mask.  Nasal Cannulas (1 of 2)  Deliver oxygen through two small, Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com tubelike prongs that fit into the nostrils  Can provide 24% to 44% inspired oxygen when the flowmeter is set at 1–6 L/min FIGURE 11-40 The nasal cannula delivers oxygen directly through the nostrils. © Jones & Bartlett Learning. Courtesy of MIEMSS. Nasal Cannulas (2 of 2)  Used in patients with mild hypoxemia Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A patient who breathes through the mouth, or has a nasal obstruction, will not benefit.  When you anticipate a long transport time, consider using humidification. Partial Rebreathing Masks Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Similar to nonrebreathing masks  There is no one-way valve between the mask and the reservoir.  Patients rebreathe a small amount of exhaled air.  Venturi Masks  A number of settings can vary the percentage of oxygen while a constant Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com flow is maintained.  Delivers 24%–40% FIGURE 11-41 The Venturi mask. © Jones & Bartlett Learning. Courtesy of MIEMSS.  Tracheostomy Masks (1 of 2)  Patients with tracheostomies do not breathe through their mouth and nose. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 11-42 For a patient with a tracheostomy, if you do not © Joneshave & Bartlett a tracheostomy mask, use a face Learning. mask instead. Tracheostomy Masks (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Tracheostomy masks cover the tracheostomy hole and have a strap that goes around the neck.  May not be available in an emergency setting  Improvise by using a face mask placed at the tracheostomy opening. Assisted and Artificial Ventilation (1 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Basic airway and ventilation techniques are extremely effective.  Follow standard precautions as needed when managing a patient’s airway. Assisted and Artificial Ventilation (2 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Signs and symptoms of inadequate ventilation:  Altered mental status  Inadequate minute volume  Excessive accessory muscle use and fatigue Assisted and Artificial Ventilation (3 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  When assisting with a bag-mask device:  Explain the procedure to the patient.  Place the mask over the nose and mouth.  Squeeze the bag each time the patient breathes.  After the initial 5 to 10 breaths, deliver an appropriate tidal volume.  Maintain an adequate minute volume. Assisted and Artificial Ventilation (4 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Artificial ventilation  Once a patient is not breathing, begin artificial ventilation immediately via:  Mouth-to-mask technique  One- or two-person bag-mask device Assisted and Artificial Ventilation (5 of 12)  Normal ventilation versus positive pressure ventilation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  In normal breathing, the diaphragm contracts and negative pressure is generated in the chest cavity.  Positive pressure ventilation is generated by a device that forces air into the chest cavity. Assisted and Artificial Ventilation (6 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  With positive pressure ventilation:  Increased intrathoracic pressure reduces the blood pumped by the heart.  More volume is required to have the same effects as normal breathing.  Air is forced into the stomach, causing gastric distention. Assisted and Artificial Ventilation (7 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mouth-to-mouth and mouth-to-mask ventilation  Barrier device is routinely used in mouth-to-mouth ventilations.  Mask with an oxygen inlet provides oxygen during mouth-to-mask ventilation.  Assisted and Artificial Ventilation (8 of 12)  Bag-mask device  Provides less tidal volume than Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com mouth-to-mask ventilation  An experienced EMT can provide adequate tidal volume. FIGURE 11-45 A bag-mask device with an oxygen reservoir can deliver nearly 100% oxygen if a good seal between © American the mouth Academy of Orthopaedic Surgeons. and mask is achieved and if supplemental oxygen is used. Assisted and Artificial Ventilation (9 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Gastric distention  Occurs when artificial ventilation fills the stomach with air  Most likely to occur when you ventilate the patient too forcefully or too rapidly  May also occur when the airway is obstructed Assisted and Artificial Ventilation (10 of 12)  Gastric distention (cont’d)  To prevent or alleviate distention: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ensure the patient’s airway is appropriately positioned.  Ventilate at the appropriate rate.  Ventilate with the appropriate volume.  If the stomach appears distended, recheck and reposition the head and perform rescue breathing. Assisted and Artificial Ventilation (11 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Passive ventilation  Expansion and contraction create a “pump” for air movement.  Benefits patients who are receiving chest compressions  Can be enhanced using oropharyngeal airway and supplemental oxygen Assisted and Artificial Ventilation (12 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Automatic transport ventilator (ATV)/resuscitator  Manually triggered device attached to a control box  Allows the variables of ventilation to be set  Lacks the sophisticated control of a hospital ventilator  Frees the EMT to perform other tasks Continuous Positive Airway Pressure (CPAP) (1 of 8)  Noninvasive ventilatory support for respiratory distress Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Many people diagnosed with obstructive sleep apnea wear a CPAP unit at night.  Becoming widely used at the EMT level FIGURE 11-48 Many people in whom obstructive sleep apnea has been diagnosed wear a CPAP unit at night to © Andrey_Popov/Shutterstock. maintain their airway while they sleep. Continuous Positive Airway Pressure (CPAP) (2 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mechanism  Increases pressure in the lungs  Opens collapsed alveoli  Pushes more oxygen across the alveolar membrane  Forces interstitial fluid back into the pulmonary circulation Continuous Positive Airway Pressure (CPAP) (3 of 8)  Mechanism (cont’d) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Therapy is delivered through a face mask held to the head with a strapping system.  Use caution with patients with potentially low blood pressure. Continuous Positive Airway Pressure (CPAP) (4 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Indications  Patient is alert and able to follow commands.  Patient displays obvious signs of moderate to severe respiratory distress.  Respiratory distress occurs after a submersion incident.  Patient is breathing rapidly.  Pulse oximetry reading is less than 90%. Continuous Positive Airway Pressure (CPAP) (5 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Contraindications  Patient in respiratory arrest  Patient is hypoventilating.  Patient cannot speak.  Patient is unresponsive or cannot follow verbal commands.  Patient cannot protect his or her airway.  Patient has hypotension. Continuous Positive Airway Pressure (CPAP) (6 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Contraindications (cont’d)  Signs and symptoms of a pneumothorax or chest trauma  Patient has a tracheostomy.  Active gastrointestinal bleeding or vomiting  Patient has experienced facial trauma.  Patient is in cardiogenic shock.  Patient cannot sit upright.  Patient cannot tolerate the mask. Continuous Positive Airway Pressure (CPAP) (7 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Application  Resistance creates back pressure that pushes open smaller airway structures as the patient exhales.  7.0 to 10.0 cm H2O is acceptable. Continuous Positive Airway Pressure (CPAP) (8 of 8) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Complications  Some patients may find CPAP claustrophobic.  Risk of pneumothorax  Can lower the patient’s blood pressure  If the patient shows signs of deterioration, remove CPAP and begin positive pressure ventilation using a bag-mask device. Special Considerations (1 of 3)  Stomas and tracheostomy tubes  Patients who have had a laryngectomy Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com have a permanent tracheal stoma.  Known as a tracheostomy FIGURE 11-49 A tracheal stoma is typically located in the midline of the neck. The midline opening is the only one that can beAcademy © American used to ventilate of Orthopaedic Surgeons. the patient. Special Considerations (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Stomas and tracheostomy tubes (cont’d)  Neither the head tilt–chin lift maneuver nor the jaw-thrust maneuver is required.  If the patient has a tracheostomy tube, ventilate through the tube with a bag-mask device. Special Considerations (3 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Stomas and tracheostomy tubes (cont’d)  If the patient has a stoma but no tube is in place, use an infant or child mask with your bag-mask device to make a seal over the stoma.  If you cannot ventilate a patient with a stoma:  Try suctioning the stoma.  Seal the stoma while giving mouth-to-mouth. Airway Obstruction (1 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If an obstruction completely blocks the airway, it is a true emergency.  Will result in death if not treated immediately  In an adult, usually occurs during a meal  In a child, can occur while eating, playing with small toys, or crawling Airway Obstruction (2 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The tongue is the most common airway obstruction in an unconscious patient.  Causes of airway obstruction that do not involve foreign bodies:  Swelling, from infection or acute allergic reaction  Trauma (tissue damage from injury) Airway Obstruction (3 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mild airway obstruction  Patients can still exchange air but will have respiratory distress.  Noisy breathing, wheezing, coughing  With good air exchange, do not interfere with the patient’s efforts to expel the object on his or her own. Airway Obstruction (4 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mild airway obstruction (cont’d)  With poor air exchange, the patient may have increased difficulty breathing, stridor, and cyanosis.  Treat immediately.  Airway Obstruction (5 of 6)  Severe airway obstruction  Patients cannot breathe, talk, or cough. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patient may use the universal distress signal, begin to turn cyanotic, and have extreme difficulty breathing. FIGURE 11-50 The universal sign of choking is a person who grasps © Jones & hisCourtesy Bartlett Learning. or her throat and has of MIEMSS. difficulty breathing. Airway Obstruction (6 of 6) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Severe airway obstruction (cont’d)  Provide immediate treatment to the conscious patient.  If not treated, the patient will become unconscious and die.  If the patient is unresponsive, not breathing, and has no pulse, begin CPR with chest compressions. Emergency Medical Care for Foreign Body Airway Obstruction Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Perform a head tilt–chin lift maneuver to clear a tongue obstruction.  Large obstructions should be swept forward out of the mouth with your gloved index finger.  Abdominal thrusts are the most effective method of dislodging and forcing out an object. Dental Appliances Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Can cause an airway obstruction  Examples: crown, bridge, dentures, piece of braces  Manually remove the appliance before providing ventilations.  Leave well-fitting dentures in place.  Loose dentures interfere with the process and should be removed. Facial Bleeding  Airway problems can be particularly challenging in patients with serious facial bleeding. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The blood supply to the face is very rich.  Injuries can result in severe tissue swelling and bleeding into the airway.  Control bleeding with direct pressure, and suction as necessary. Assisting With ALS Airway Procedures  Placement of advanced airways  Preoxygenation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Equipment setup  Performing the procedure “BE MAGIC”  B- Perform Bag-mask preoxygenation.  E- Evaluate for airway difficulties.  M- Manipulate the patient.  A- Attempt first-pass intubation.  GI- Use a supraGlottic airway if unable to intubate.  C- Confirm successful intubation/Correct issues. Review 1. Breathing is controlled by an area in the: A. lungs. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. brainstem. C. spinal cord. D. diaphragm. Review Answer: B Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The pons and the medulla are the respiratory centers in the brainstem that control breathing. Review 1. Breathing is controlled by an area in the: A. lungs. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The lungs contain small pockets called alveoli where the exchange of oxygen and carbon dioxide takes place. B. brainstem. Rationale: Correct answer C. spinal cord. Rationale: Impulses are sent down the spinal cord from the brainstem. D. diaphragm. Rationale: The diaphragm receives the impulses that cause it to contract and bring air in. Review 2. The EMT should assess a patient’s tidal volume by: A. observing for adequate chest rise. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. assessing the facial area for cyanosis. C. counting the patient’s respiratory rate. D. measuring the patient’s oxygen saturation. Review Answer: A Rationale: Tidal volume—the volume of air that is moved into or out of the lungs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com in a single breath—is assessed by observing for adequate chest rise. If shallow chest rise is noted, the patient’s tidal volume is likely reduced. Review 2. The EMT should assess a patient’s tidal volume by: A. observing for adequate chest rise. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Correct answer B. assessing the facial area for cyanosis. Rationale: Cyanosis is an indication of hypoxia, rather than tidal volume. C. counting the patient’s respiratory rate. Rationale: Counting the respiratory rate gives you minute volume: the number of times a patient breaths in 1 minute. D. measuring the patient’s oxygen saturation. Rationale: Oxygen saturation is an indication of tissue perfusion, which is the amount of oxygen attached to the hemoglobin. Review 3. In an otherwise healthy individual, the primary stimulus to breathe is a(n): A. increased level of oxygen in the blood. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. decreased level of oxygen in the blood. C. increased level of carbon dioxide in the blood. D. decreased level of carbon dioxide in the blood. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Under control of the brainstem, rising levels of carbon dioxide in arterial blood normally stimulate breathing in an otherwise healthy patient. Review 3. In an otherwise healthy individual, the primary stimulus to breathe is a(n): A. increased level of oxygen in the blood. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Increased levels of oxygen can be a result of hyperventilation syndrome. B. decreased level of oxygen in the blood. Rationale: This is typically not normal in healthy individuals. It can be a sign of inadequate breathing and results in hypoxia. C. increased level of carbon dioxide in the blood. Rationale: Correct answer D. decreased level of carbon dioxide in the blood. Rationale: This is usually not seen in healthy adults. It is typically a result of hyperventilation syndrome. Review 4. Signs of adequate breathing in the adult include all of the following, EXCEPT: A. pink, warm, dry skin. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. shallow chest rise. C. symmetrical chest movement. D. a respiratory rate of 16 breaths/min. Review Answer: B Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Signs of inadequate breathing in the adult include a respiratory rate less than 12 breaths/min or greater than 20 breaths/min, shallow chest rise (reduced tidal volume), cyanosis, and asymmetrical chest movement (both sides of the chest do not move equally). Review 4. Signs of adequate breathing in the adult include all of the following, EXCEPT: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. pink, warm, dry skin. Rationale: This shows that breathing and perfusion are adequate. B. shallow chest rise. Rationale: Correct answer C. symmetrical chest movement. Rationale: This shows that the mechanical process of breathing is adequate, equal, and symmetrical bilaterally. D. a respiratory rate of 16 breaths/min. Rationale: This is a normal respiratory rate for an adult. Review 5. During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. turn the patient on her side. B. remove the airway at once. C. suction the patient’s mouth. D. use a smaller-sized oral airway. Review Answer: A Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Whenever an unconscious patient begins to vomit—whether you are inserting an oropharyngeal airway or not—you should immediately turn the patient onto his or her side; this will allow drainage of vomit from the mouth and prevent aspiration. After the patient is on his or her side, remove the oral airway and suction the mouth. Review 5. During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. turn the patient on her side. Rationale: Correct answer B. remove the airway at once. Rationale: Remove the airway after the patient has been rolled onto her side. C. suction the patient’s mouth. Rationale: This must be completed after the patient is positioned and the airway is removed. D. use a smaller-sized oral airway. Rationale: Oropharyngeal airways are contraindicated if the patient has a gag reflex. Review 6. In which of the following patients would a nasopharyngeal airway be contraindicated? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. A semiconscious patient with a gag reflex B. An unconscious patient with an intact gag reflex C. A patient who fell 20 feet and landed on his or her head D. An unconscious patient who gags when you insert an oral airway Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex. Review 6. In which of the following patients would a nasopharyngeal airway be contraindicated? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. A semiconscious patient with a gag reflex Rationale: This airway works best with an intact gag reflex. B. An unconscious patient with an intact gag reflex Rationale: This airway works best with an intact gag reflex. C. A patient who fell 20 feet and landed on his or her head Rationale: Correct answer D. An unconscious patient who gags when you insert an oral airway Rationale: This airway can be used when the patient gags with an oral airway. Review 7. You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You should: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. remove the nasal cannula. B. apply a nonrebreathing mask. C. attach an oxygen humidifier. D. increase the flow rate to 6 L/min. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Administering “dry” oxygen through a nasal cannula—especially over a prolonged period of time—can result in drying of the nasal membranes, in which case the patient might complain of a burning sensation in the nose. Humidified oxygen will serve to keep the nasal membranes moist. Review 7. You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com should: A. remove the nasal cannula. Rationale: The oxygen should be humidified. B. apply a nonrebreathing mask. Rationale: This can still cause an irritation due to providing “dry” oxygen. C. attach an oxygen humidifier. Rationale: Correct answer D. increase the flow rate to 6 L/min. Rationale: The oxygen should be humidified. Review 8. A patient is found unconscious after falling from a third-floor window. His respirations are slow and irregular. You should: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. place him in the recovery position. B. apply oxygen via a nonrebreathing mask. C. suction his airway for up to 15 seconds. D. assist his breathing with a bag-mask device. Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The patient is not breathing adequately. Slow, irregular respirations will not result in adequate oxygenation. You should assist the patient’s breathing with a bag-mask device attached to 100% oxygen. Suctioning is indicated if the patient has blood or other liquids in the airway; there is no evidence of this in the scenario. Review 8. A patient is found unconscious after falling from a third-floor window. His respirations are slow and irregular. You should: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. place him in the recovery position. Rationale: Due to the significant MOI, the patient should be placed supine on a long backboard with the head immobilized. B. apply oxygen via a nonrebreathing mask. Rationale: A bag-mask device is indicated if the patient’s respirations are less than 8 breaths/min. C. suction his airway for up to 15 seconds. Rationale: Suction is indicated if a patient has blood or other secretions in the airway. D. assist his breathing with a bag-mask device. Rationale: Correct answer Review 9. When ventilating an apneic adult with a bag-mask device, you should squeeze the bag: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. until it is empty. B. over a period of 2 seconds. C. at a rate of 20 breaths/min. D. until visible chest rise is noted. Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: When ventilating any apneic patient with a bag-mask device, you should squeeze the bag over a period of 1 second and observe for visible chest rise. Ventilate the apneic adult at a rate of 10 breaths/min (one breath every 6 seconds). Ventilate infants and children at a rate of 20 to 30 breaths/min (one breath every 2 to 3 seconds). Review 9. When ventilating an apneic adult with a bag-mask device, you should squeeze the bag: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. until it is empty. Rationale: An appropriately sized bag for an adult will not totally empty. B. over a period of 2 seconds. Rationale: You should squeeze the bag over a period of 1 second. C. at a rate of 20 breaths/min. Rationale: Ventilate the apneic adult at a rate of 10 breaths/min (or one breath every 6 seconds). D. until visible chest rise is noted. Rationale: Correct answer Review 10. You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. suction his airway for up to 15 seconds. B. reposition his head. C. increase the rate and volume of your ventilations. D. decrease your ventilation rate but use more volume. Review Answer: B Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Gastric distention occurs when air enters the stomach. Severe gastric distention can result in vomiting and aspiration if not recognized and treated. To minimize the amount of air that enters the stomach during ventilations, you should reposition the patient’s head. Review 10. You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. suction his airway for up to 15 seconds. Rationale: Suctioning is indicated when there is blood or secretions in the airway. B. reposition his head. Rationale: Correct answer C. increase the rate and volume of your ventilations. Rationale: This action may result in even more air going into the stomach. D. decrease your ventilation rate but use more volume. Rationale: This action may result in even more air going into the stomach.