CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
1. Introduction
a. In this lesson, you will learn about the process of breathing and the importance of an open and clear
airway. You will also learn how to recognize and provide emergency care for patients who are not
breathing adequately or who may not be breathing at all.
2. Breathing—Why We Breathe
a. Respiration is the act of breathing.
i.
ii.
iii.
b.
c. A patient who is not breathing adequately is said to be experiencing respiratory compromise.
i.
ii.
iii.
iv.
v.
d.
e. The absence of breathing is called
f. Clinical death
g. Biological death
3. Breathing—How We Breathe
a.
b. The lungs are elastic and expandable.
i. To inhale
ii. To exhale
4. Respiratory System Anatomy
a. Nose—
b. Mouth—
c. Throat (oral pharynx)—
d. Epiglottis—
e. Trachea—
f. Larynx—
g. Bronchial tree—
h. Lungs—
i. Alveoli—
5. Respiratory System Anatomy—Respiratory Cycle
a.
c.
b.
d.
6. Respiratory System Anatomy—An Open and Clear Airway
a. Airway consists of nasopharynx, oropharynx, pharynx, and trachea.
b.
c.
7. Signs of Normal Breathing
a. When observing someone who is breathing normally, the process of breathing in and out is almost
invisible.
b.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
c. Evaluate the patient for the following characteristics.
i.
ii.
iii.
iv.
v.
8. Signs of Abnormal Breathing
a. A patient who is unable to breathe normally is said to have difficulty breathing or be in respiratory
distress (shortness of breath, or dyspnea).
b. Signs and symptoms of abnormal breathing
i.
vii.
ii.
viii.
iii.
ix.
iv.
x.
v.
xi.
vi.
9. Rescue Breathing
a.
10. Opening the Airway—Repositioning the Head
a. First ensure that the nose, mouth, and back of the throat are clear of any obstructions.
b.
c.
d.
11. Opening the Airway—Head-Tilt/Chin-Lift Maneuver
a. Use this method for ill or injured patients with no suspected spine injury.
b.
c.
d.
12. Opening the Airway—Jaw-Thrust Maneuver
a. Use this method for ill or injured patients with possible neck or spine injuries.
b.
c.
d.
e.
f.
13. Barrier Devices
a.
b.
c. Types of barrier devices
i. Pocket face mask
1.
2.
3.
ii. Face shield
1.
2.
3.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
14. Mouth-to-Mask Ventilation
a. Recommended method when there is only a single rescuer
b. Use a pocket face mask to avoid direct skin-to-skin contact.
i.
ii.
iii.
iv.
c. Providing mouth-to-mask ventilations (Make sure you are wearing appropriate personal protective
equipment, or PPE.)
i.
ii.
iii.
iv. Take a normal breath and breathe slowly into the one-way valve, delivering each breath
over one second. Watch for the patient’s chest to rise.
1.
2.
3.
v.
vi.
15. Mouth-to-Shield Ventilation
a. Make sure you are wearing appropriate PPE, and then kneel beside the patient and confirm
unresponsiveness.
b. Open the airway, using the most appropriate maneuver.
c.
d.
e.
f. Exhale slowly into the patient’s mouth until you see the chest rise. If the first attempt to provide a
breath fails, reposition the patient’s head and try again.
g. Break contact with the face shield to allow the patient to exhale. Take in another breath and
ventilate the patient again.
h.
i.
j.
k. Most common problems with the mouth-to-barrier technique
i.
v.
ii.
vi.
iii.
vii.
iv.
16. Mouth-to-Shield Ventilation—Mouth-to-Nose Ventilation
a. For patients who have injuries to the mouth and jaw, missing teeth or dentures, or airway
obstructions that make airway techniques ineffective, use the mouth-to-nose technique.
b. Guidelines for mouth-to-nose ventilation
i.
ii.
iii.
iv.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
c. Be aware that mouth-to-nose ventilation, like mouth-to-mouth ventilation, exposes the rescuer to
potentially infectious body fluids.
17. Special Patients—Infants and Children
a. Differences between infants or children and adults
i.
ii.
iii.
iv.
b. Recognize and aggressively care for airway and respiratory problems in infants and children.
c. Steps to assisting ventilations for an infant or small child who has a pulse but is not breathing
normally
i.
iv.
ii.
v.
iii.
vi.
18. Special Patients—Terminally Ill Patients
a. Many terminally ill patients choose to spend their remaining time at home with family and friends or
enter a hospice program.
b. For guidelines on how to care for hospice or DNR patients, check your jurisdiction for training
programs. Follow your local protocols.
19. Special Patients—Stomas
a.
b.
c.
d.
e. Ventilating a stoma patient
i.
ii.
iii.
iv.
v.
20. Special Patients—Crash Victims
a. Without risking your own safety, take appropriate precautions and reach the victim as quickly as
possible.
b. Look, listen and feel for breathing before moving him.
c. If the patient is breathing, the airway is open and you do not have to move him.
d. If you believe the mechanism of injury may have caused damage to the spine or neck and the
patient is not breathing, stabilize the head and open the airway with the jaw-thrust maneuver.
Check again for breathing.
e. If the patient is breathing, keep the airway open while maintaining the head and neck in a neutral
position. Monitor breathing until assistance arrives.
f. If the patient is not breathing and his position does not allow you to maintain an airway while you
assist ventilations, you will have to reposition him.
21. Air in the Stomach and Vomiting
a. A common problem with rescue breathing is air in the stomach.
b.
c.
d.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
e. In cases of air in the stomach where you see a noticeable bulge, reduce the force of your
ventilations and do the following.
i.
ii.
iii.
22. Airway Obstruction—Causes of Airway Obstruction
a. Lower airway obstructions are difficult to manage and often require advanced training.
b. Upper airway obstructions are more easily managed and assessed.
i.
ii.
c. The following obstructions may be impossible for you to relieve, but you still must attempt to assist
ventilations.
i. Tissue damage—
ii. Allergic reactions—
iii. Infections—
23. Airway Obstruction—Signs of Partial Airway Obstruction
a. Signs of partial airway obstruction
i.
ii.
iii.
b.
c.
24. Airway Obstruction—Signs of Complete Airway Obstruction
a.
b.
c.
25. Airway Obstruction—Clearing a Foreign Body Airway Obstruction
a. Abdominal thrusts are the most effective method for clearing the airway of an adult or child who is
choking.
b. Guidelines for foreign body airway obstruction for a responsive adult or child patient
i.
ii.
iii.
iv.
c. Guidelines for unresponsive adult or child patient suffering from airway obstruction
i.
v.
ii.
vi.
iii.
vii.
iv.
d. Guidelines for responsive infant with airway obstruction
i.
v.
ii.
vi.
iii.
vii.
iv.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
e. Guidelines for unresponsive infant with airway obstruction
i.
ii.
iii.
iv.
v.
26. Airway Obstruction—Obese and Pregnant Patients
a. For these types of patients, attempt to provide chest thrusts.
i.
ii.
iii.
iv.
v.
b. For the obese patient, you can also have the patient stand against a sturdy wall and attempt
abdominal thrusts from the front.
27. Airway Obstruction—Finger Sweeps
a.
b.
c.
28. Aids to Airway Management
a. Three types of equipment are commonly used by Emergency Medical Responders.
i. Oropharyngeal airway (OPA)
ii. Nasopharyngeal airway (NPA)
iii. Bag-mask device
b.
29. Aids to Airway Management—Oropharyngeal Airways
a.
b.
c.
d.
e. Measuring the oropharyngeal airway
i.
ii.
iii.
f. Inserting the oropharyngeal airway
i.
vi.
ii.
vii.
iii.
viii.
iv.
ix.
v.
g. An alternative method for inserting an OPA is to insert it sideways into the mouth until it is
approximately halfway in. Then rotate it 90 degrees.
h. Guideline for infants and children
i.
ii.
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
30. Aids to Airway Management—Nasopharyngeal Airways
a. The nasopharyngeal airway is a soft, flexible tube that is inserted into the nose to create a clear and
open path for air.
b.
c.
d. Measuring the nasopharyngeal airway
i.
ii.
iii.
e. Inserting the nasopharyngeal airway
iv.
v.
vi.
vii.
31. Bag-Mask Ventilation
a.
d.
b.
e.
c.
f.
32. Bag-Mask Ventilation—Two-Rescuer Bag-Mask Ventilation
a.
d.
b.
e.
c.
f.
33. Bag-Mask Ventilation—One Rescuer Bag-Mask Ventilation
a.
e.
b.
f.
c.
g.
d.
34. Suction Systems
a.
b.
c.
d.
35. Suction Systems—General Guidelines for Suctioning
a.
e.
b.
f.
c.
g.
d.
36. Suction Systems—Suctioning Techniques
a.
b.
c.
d.
e.
37. Define the following terms:
a. Abdominal Thrusts:
b. Agonal Respirations:
c. Apnea:
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CHAPTER 8 LECTURE NOTES – AIRWAY MANAGEMENT AND VENTILATION
d. Bag-Mask Device
e. Cardiac Arrest:
f.
Chest Thrust:
g. Cyanosis:
h. Dyspnea:
i.
Gag Reflex:
j.
Gastric Distention:
k. Heat-Tilt/Chin-Lift Maneuver:
l.
Hypoxia:
m. Jaw-Thrust Maneuver:
n. Nasopharyngeal Airway (NPA):
o. Oropharyngeal Airway (OPA):
p. Pulmonary Resuscitation:
q. Rescue Breathing:
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