Airway and Oxygen
System Orientation
Objectives
Breathing
Respiratory Anatomy
Assessment
Rescue breathing
Airway obstruction
Oxygen delivery devices
Suction
Breathing
Why we breathe
To bring oxygen into the body
To expel carbon dioxide from the body
Breathing is automatic
Clinical Death—The
moment the breathing and
heartbeat stop
Brain Damage—within 4–6
minutes
Biological Death—within
10 minutes
Breathing
How We Breathe:
Inspiration:
Rib and diaphragm muscles contract.
Chest cavity expands.
The volume inside each lung increases.
The pressure inside each lung decreases.
When the pressure inside the lungs becomes
less than the pressure in the atmosphere, air
rushes into the lungs.
Breathing
How We Breathe:
Inspiration is an active process.
Expiration is a passive process.
Assessment
Signs of Normal Breathing:
Look for rise and fall of the chest.
Listen for air moving:
The sounds should be quiet like a soft breeze.
No unusual sounds
Feel for air moving.
Observe skin color:
Should not be pale or ashen
Should not be tinted blue or gray
Look at the lips, eyes, and nail beds
Assessment
Signs of Inadequate Breathing:
No chest movements, or uneven chest
movements
No air heard or felt at the nose or mouth
Noisy breathing or gasping sounds
Breathing that is irregular, too rapid, or too slow
Breathing that is too shallow, or deep and
labored
Assessment
Signs of Inadequate Breathing:
Breathing that uses muscles in the upper chest
and around the neck
Nostrils that flare when breathing, especially in
children
Skin that is tinted blue, gray, or ashen
Sitting or leaning forward in a tripod position
Normal Respiratory Rates
Respirations:
The normal respiratory rate for adults is 12–20
breaths per minute.
> 28 or < 8 are considered serious.
Newborn infants = 25–50 breaths per min.
Up to 5 years old = 20–30 breaths per min.
5 to 12 years of age = 15–30 breaths per min.
Opening The Airway
Repositioning the Head:
The head-tilt, chin-lift maneuver, is used for ill or
injured patients with no possibility of spinal
injury.
Used when no c-spine injury is suspected
The jaw-thrust maneuver, is used for patients
who have a mechanism of injury that indicates
possible spinal injury.
Used for those who have a suspected c-spine injury or
in those who are unresponsive with mechanism of injury
in which trauma is suspected
Airway Obstruction
Causes of Airway Obstruction
Airway Obstruction
Causes
Tongue
Epiglottis
Foreign objects
Airway Obstruction
Signs
Snoring
Gurgling
Crowing
Stridor
Cyanosis
Anxiety
Labored breathing
Inability to speak
Rescue Breathing
Use personal protective equipment and barrier
devices.
One example of a barrier device is the pocket face
mask.
Mouth-to-Mask Ventilation
Mouth to Mask
Most effective technique
Can be used with airway adjuncts
Mouth to Mask
Problems
Failure to maintain a tight seal
Failure to tilt the head back to open the
airway
Failure to deliver enough breath to see
the chest rise
Providing breaths too quickly
Failure to recognize airway obstruction
Bag-Valve-Mask (BVM) Ventilator
Pediatric and adult BVM ventilators
Bag-Valve-Mask (BVM) Ventilator
Hand positioning for using the BVM with a single rescuer
Aids to Resuscitation
Oropharyngeal Airways
Aids to Resuscitation
Select Oropharyngeal Airway
Aids to Resuscitation
Another Way to Measure
Aids to Resuscitation
Nasopharyngeal Airway
Aids to Resuscitation
Determine Proper Size
Aids to Resuscitation
Gently Advance Airway
Suction Systems
Suctioning Techniques:
USE PERSONAL PROTECTIVE EQUIPMENT.
Never suction for longer than 15 seconds at a time.
Measure the tip of the catheter from the patient’s earlobe to the
corner of the mouth.
Suction only as you remove the tip or catheter.
REMAIN ALERT FOR THE PATIENT’S GAG REFLEX AND FOR SIGNS OF
VOMITING.
Suction Systems
•Oxygen-powered suction unit
•Electrically-powered suction unit
•Portable hand-operated suction unit
•Portable electrical suction unit
Suction Systems
Positioning a Rigid Pharyngeal (Throat) Tip
First Responder’s Role
Dependent on local protocols:
May require direct orders
May be written as a standing order
Do only what you have been trained to do.
Basic life support is possible without equipment.
If you are allowed to use equipment, you must
maintain it and train with it.
Oxygen Therapy
Equipment for Oxygen Therapy:
Oxygen cylinder
Pressure regulator
Flowmeter
Delivery device
Oxygen Therapy
An oxygen delivery system
Oxygen Therapy
Nasal cannula properly placed
Oxygen Therapy
Non-rebreather mask
Check Your Understanding
You are called for a 20 year-old male
patient, struck by a car. You find the
patient unresponsive. You do not see
the patient’s chest rise when he
breathes, but you hear gurgling from his
airway.
What airway control measures might
you take for this patient?
Summary
Breathing
Respiratory Anatomy
Assessment
Rescue Breathing
Airway Obstruction
Aids to Resuscitation
Suction Systems
Questions?
CPR/AED & Cardiac
Arrest
CPR/AED
CPR/AED
“Hearts and Brains
are going to die”
Peter Safar MD
EMS has the most
opportunity to
perform CPR, so we
should be good at
performing good,
quality CPR
CPR/AED
Why is CPR Important
Studies have shown that the general
population will start CPR only 1/3 of the
time and only 15% of that total is done
correctly
CPR/AED
Lets look at the basics:
The first step is to determine
responsiveness, if no response open the
airway, check for breathing, and determine
if a pulse is present
CPR/AED
Not Breathing and No Pulse:
Give 2 breaths-enough to see the chest
rise
Give 30 chest compressions-allow for
chest recoil between compressions
Give 5 cycles of 30:2 before rechecking a
pulse
CPR/AED
Chest compressions and breaths are the
same for adults, child, and infant
Adult age starts at the onset of puberty
(12-14 yoa)
Child is age 1 – onset of puberty
Infant is anyone under the age of 1, chest
compressions are delivered using 2 fingers, and
remember a full head tilt should not be given as
you may obstruct the airway
CPR/AED
The AED should be applied as soon as
possible to the patients bare chest
Make sure the pads adhere to the skin
Remove all clothing from the area where the
pads need to be placed
Remove any medication patches from the
area
Shave any chest hair, the pads need to be on
as much bare skin as possible
If the patient has an implanted Pacemaker,
place the pad at least an inch away
CPR/AED
AEDs are set to correct the cardiac
arrhythmias of V-Fib and V-Tach
CPR/AED
While there are many styles of AEDs
they all work the same. The first step is
to turn the unit on and follow the voice
prompts.
CPR/AED
There are some safety
considerations with the AED and
Children:
If the unit has child pads use these
on children between the ages of 1-8.
Never use child pads on an adult,
the energy delivered by child pads
is not enough for an adult, since the
child pads reduce the energy from
200J to 50J
AEDs should not be used on
infants
Questions?