CHAPTER 6 OUTLINE & STUDY PACKET
Breathing and Ventilation
Objectives
Cognitive
2-1.1 Name and label the major structures of the respiratory system on a diagram. (pp. 95–96)
2-1.2 List the signs of inadequate breathing. (pp. 102–103)
2-1.3 Describe the steps in the head-tilt/chin-lift. (pp. 98–99)
2-1.4 Relate mechanism of injury to opening the airway. (p. 99)
2-1.5 Describe the steps in the jaw thrust. (p. 99)
2-1.8 Describe how to ventilate a patient with a resuscitation mask or barrier device. (pp. 103, 106–110)
2-1.9 Describe how ventilating an infant or child is different from an adult.
2-1.10 List the steps in providing mouth-to-mouth and mouth-to-stoma ventilation. (pp. 109–110)
Affective
2-1.19 Explain why basic life support ventilation and airway protective skills take priority over most other basic life support
skills. (pp. 95, 98, 116)
2-1.20 Demonstrate a caring attitude towards patients with airway problems who request emergency medical
services. (pp. 97, 114)
2-1.21 Place the interests of the patient with airway problems as the foremost consideration when making any and all patient
care decisions. (p. 102)
2-1.22 Communicate to empathy to patients with airway problems, as well as with family members and friends of the
patient. (p. 97)
Psychomotor
2-1.23 Demonstrate the steps in the head-tilt/chin-lift. (pp. 98–99)
2-1.24 Demonstrate the steps in the jaw thrust. (p. 99)
2-1.26 Demonstrate the steps in mouth-to-mouth ventilation with body substance isolation
(barrier shields). (pp. 103, 106–110)
2-1.27 Demonstrate how to use a resuscitation mask to ventilate a patient. (pp. 103, 106–110)
2-1.28 Demonstrate how to ventilate a patient with a stoma. (p. 110) 2-1.31 Demonstrate how to ventilate infant and
child patients. (pp. 110–112)
Chapter 6 Outline: Breathing and Ventilation
Introduction to Chapter 6
The airway is discussed in two chapters: Chapters 6 and 7. The most important life-saving skills you will learn as First
Responders involve protection of a patient’s airway—the passageway that allows air to move freely in and out of the lungs.
Among those skills are opening and maintaining an airway, ensuring effective ventilation and, if allowed in your area,
providing oxygen to a patient. The consequences of overlooking the airway and breathing can result in death or permanent
disability in a patient. After scene safety, airway management is the major responsibility of the First Responder.
Point of Interest
*The person who lives to an average life expectancy will take about 200 million breaths in his or her lifetime.
*Mouth-to-mouth ventilation puts the First Responder at risk for infectious disease.
*Maintaining an adequate seal between the face mask and the face when using a BVM can be difficult. Therefore, whenever
possible, use a two-rescuer technique for BVM ventilation.
I. The Respiratory System
A. Anatomy of the respiratory system
1. Nose and mouth
•Warms
•Humidifies
•Filters
2. Pharynx
•Throat
•Divides into esophagus and trachea
3. Epiglottis
•Covers trachea during swallowing
4. Trachea
•Carries air to the lungs
5. Larynx
•Voice box
6. Bronchi
•Inferior portion of the trachea
•Continue to branch off into smaller airways
7. Lungs
•Principal organs of respiration
•Contain millions of alveoli
8. Diaphragm
•Dome-shaped muscle
•Separates thoracic and abdominal cavity
B. How respiration works
1. Inhalation
•Diaphragm and intercostal muscles contract
•Diaphragm moves down
•Decreased pressure in chest
•Air flows into lungs to equal pressure
•Air fills alveoli
•Oxygen passes through capillary wall into blood
•Carbon dioxide and wastes enter alveoli for exhalation
•Active
2. Exhalation
•Diaphragm and intercostal muscles relax
•Increased pressure in chest
•Air exhaled to equalize pressure
•Passive
3. Adequate breathing
•Regular
•Good depth
•No accessory muscle usage
•Appropriate rates
C. Infants and Children
1. Anatomical structures
Smaller
More easily obstructed
Trachea more flexible
Diaphragmatic breathing
II. Airway Techniques
Tongue is the most common airway obstruction
A. Opening the airway:
1. Head-tilt/chin-lift maneuver
•Place hand on forehead
•Tilt head back
•Place fingertips under lower jaw
•Lift chin forward
Precautions
•Do not press too deep into soft tissue
•Do not use thumb to lift chin
•Do not let patient's mouth close
•Only remove dentures if loose
2. Jaw-thrust maneuver
•Used with suspected spine injuries
•Difficult to maintain
•Head must remain in neutral position
•Position yourself above patient's head
•Grasp the angle of the jaw with both hands
•Move jaw forward with lifting motion
•Keep patient's mouth open
B. Inspecting if the airway is patent
1. Sounds may indicate airway obstruction
•Determine if the airway is patent
•Unresponsive patient
–Open mouth with cross-finger technique
–Look for potential obstruction
–Listen for abnormal airway sounds
•Inspecting the airway
–Abnormal airway sounds
a.
b.
c.
d.
Snoring: Airway blocked by tongue
Crowing: Muscles around larynx spasming
Gurgling: Liquid in airway
Stridor: Larynx is swollen
C. Clearing the airway
1. Recovery position
•Used when patient is breathing adequately and has a pulse
•Allows fluids to drain out of the mouth
•Only utilized when trauma is not suspected
•Lift left arm above head
•Cross right leg over left
•Roll patient onto left side
•Flex right leg at the knee
2. Finger sweeps
•Performed only on unconscious patients
•Only utilized when potential obstruction is visualized
•Always wear gloves
•Roll uninjured patient onto left side
•Open the patient's mouth
•Wipe out the patient's mouth
3. Suctioning
•Used to remove liquids from the mouth
D. Assessing breathing
1. Determining the presence of breathing
•Responsive patient
–Look for chest rise and fall
–Look for accessory muscle usage
–Observe the patient's ability to speak
•Unresponsive patient
–Look for chest rise and fall
–Listen for air exiting mouth and nose
–Feel for air exiting mouth and nose
2. Pulse oximetry
*Measures oxygen saturation
*Do not withhold oxygen based on pulse oximetry
*Do not delay oxygen therapy to obtain pulse oximetry
3. Signs of inadequate breathing
a. Too fast or too slow
–Agonal respirations
b. Inadequate chest wall motion
c. Cyanosis
–Peripheral vs. central
d. Mental status changes
e. Increased effort to breathe
–Abdominal breathing
–Retractions
–Nasal flaring
f. Gasping or grunting
g. Slow heart rate with slow respiratory rate
4. Minute volume
*(rate x depth) – dead space
*Dead space
-About 150 mL per breath
*Shallow respirations do not ventilate alveoli
III. Artificial Ventilation
A. Used with inadequate or absent breathing
–Ventilate at appropriate rate
–Force of air is consistent
–Patient's heart rate returns to normal
–Color improves
•Indications of inadequate ventilations
–Chest does not rise or fall
–Ventilation rate is too fast or too slow
–Heart rate does not return to normal
B. Mouth-to-mask ventilation
–Preferred technique
–One-way valve
–Prevents direct contact and exposure
–Must be clear
–Able to form good seal
–Oxygen port if oxygen available
–Position yourself at the patient's head
–Position the mask on the patient's face
–Create a good seal
–Open the airway
–Deliver two slow breaths initially
–Determine if ventilations are adequate
–Continue ventilating at proper rate
–Reposition airway if ventilations unsuccessful or inadequate
C. Mouth-to-barrier device ventilation
–Thin, plastic face shield
–Provides some protection against contamination
–May not have one-way valve
–Provide ventilations as with mouth-to-mask
D. Mouth-to-mouth
–Risk of contamination is high
–Not recommended for regular use
–Only use when no protective device is available
–Pinch nose while creating a seal around the patient's mouth
–Ventilate as with mouth-to-mask ventilations
E. Mouth-to-stoma ventilations
–Permanent opening through trachea to anterior neck
–Expose the stoma
–Clear the stoma of foreign matter with gauze
–Form seal around stoma, preferably with barrier device
–Ventilate as with mouth-to-mask ventilation
–If ventilations are unsuccessful
•Patient may have partial laryngectomy
•Need to seal mouth and nose
•Tilt patient's head back
•Attempt to ventilate again
F. Special considerations
1. Infants and children
•Keep patient's head in neutral position
•Consider an oral airway
•Adult pocket mask can be rotated
•Risk of gastric distention
2. Patients with dental appliances
•Dentures
–If secure, leave them in place
–If loose, remove to prevent airway obstruction
–Reassess frequently to ensure patency
G. Bag-valve-mask ventilation
Anatomy of BVM:
*Self-inflating
*Face mask
*Disable pop-off
*Oxygen inlet
*One-way valve
*Oxygen reservoir
*15/22 mm fitting
*Nonrebreather valve
1. Open the airway
2. Insert OPA/NPA if necessary
3. Position the mask on the patient
•Use "C-E" technique if alone
4. Connect bag to mask
5. Ventilate, squeezing only enough to make the patient's chest rise
6. One-person technique
7. Two-person technique
F. Assisting inadequate breathing
1. Perform ventilations when patient inhales
2. If respirations too slow
•Ventilate between breaths too
3. If respirations too fast
•Ventilate only on inhalations at appropriate rate
Summary
•Make sure to assess for an adequate airway and ventilations in all patients
•Remember, any patient with an altered mental status may be unable to protect their own airway
•Assess both rate and depth to determine adequate respirations
•Make sure that the ventilations you provide are adequate for your patient
•Remember, without a patent airway and adequate respirations, all other interventions will be unnecessary
Chapter 6 Study Packet: Breathing and Vitalization
I. Study Questions (“Q”)
Section 1: The Respiratory System
Q1. How does air move from the nose and mouth to the lungs? Describe the pathway it takes.
Q2. Where is the diaphragm located? What role does it play in respiration?
Q3. What are normal breathing rates for an infant, child, and adult?
Section 2: Airway Techniques
Q1. What is the most common cause of airway obstruction in an unresponsive patient? How can you clear that obstruction?
Q2. What are two ways to clear a patient’s airway of secretions, vomitus, and foreign materials?
Q3. How can you determine if a patient is breathing adequately or inadequately?
Q4. If a conscious patient is breathing inadequately, what should you do?
Section 3: Artificial Ventilation
Q1. What are the signs of inadequate artificial ventilation?
Q2. Why is mouth-to-mask ventilation preferred over other artificial ventilation techniques?
Q3. What are the artificial ventilation rates for newborns, infants, children, and adults?
II. The Call Follow-Up: Read the scenario on pages 93 and 116.
Q1. If you approached an unresponsive patient with snoring respirations, what danger would you suspect the patient was in?
Q2. Why did the First Responders provide artificial ventilation on a patient who was breathing? Explain your reasoning.
III. Knowledge Check: Complete the knowledge check on pages 118-119.
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________9.
IV. Scenario: Read the scenario on page 119 and answer the questions.
For each of the following patients decide if breathing is likely to be adequate or inadequate. Then,
describe the airway and breathing care you would provide.
A. A 16-year-old male patient fell and broke his leg. He is breathing at a rate of 22 breaths per min. His skin is pink
And warm. He has a normal mental status.
B. A 72-year-old male patient has had a respiratory infection for a week. Today, his wife noticed that he seemed “sleepy”
and he was breathing faster than normal. You observed shallow respirations at 44/min.
C. A 56-year-old female patient is having trouble breathing and chest pain. She can speak only in four-to-five word
sentences. She is pale and clammy. She appears slightly anxious.
D. A 24-year-old female patient has crashed her motorcycle. She is found unresponsive with respirations of about 6 to 8 per
min. and appears to be gasping.
V. The Call: An Airway Emergency
Read the scenario. Then answer the questions that follow.
You have been dispatched to the scene of a house fire. As you arrive on the scene two firefighters are carrying a person from
the residence. You immediately take your emergency medical equipment bag and AED to the side of the patient who has
been placed in a safe area. Approaching the patient you observe that she appears to be about 30 years old, is not moving, and
has soot around her nose and mouth. She has not been exposed to fire or intense heat, only smoke.
1. What is the first thing you should do?
2. You determine that the patient has visible secretions around the mouth and signs of inadequate breathing.
How should you proceed?
3. What indication will you have of adequate ventilations?
4. What indications will you have of inadequate ventilations?
VI. Chapter 6 Review:
Breathing and Ventilation
In the space provided, write the word or words that best complete each sentence.
1. You can determine if a patient’s airway is _____________________ if he or she is alert and talking to you in a normal voice.
2. To determine the presence of breathing in an unresponsive patient, look for the rise and fall of the patient’s chest. Then
_____________________ and _____________________ for air coming out of the patient’s nose and mouth.
3. A sign that body tissues are not receiving enough oxygen is _____________________ , or a blue discoloration of a patient’s skin
or mucous membranes.
4. The _____________________ - _____________________ / _____________________ - _____________________ maneuver is
recommended for opening the airway of a patient who does not have a head or spine injury.
5. The _____________________ - _____________________ maneuver is the safest approach to opening the airway of a patient with
suspected spine injury.
6. Sounds that may indicate an airway obstruction include snoring, _____________________ , _____________________ ,
and _____________________ .
7. The _____________________ position uses gravity to help drain fluids from the mouth of a patient instead of into the airway.
8. A First Responder must be competent in three techniques for artificial ventilation. In order of preference, they are: mouth-to
_____________________ , mouth-to- _____________________ , and mouth-to- _____________________ .
9. Gastric _____________________ may significantly impair your attempts at artificial ventilation of an infant, because it forces the
diaphragm up, limiting the amount of air that can enter the lungs.
10. A patient who can speak in only one- or two-word sentences is in _____________________ respiratory distress.
11. List six major components of the respiratory system.
12. List the steps that describe how to perform a head-tilt/chin-lift maneuver.
13. List four unusual sounds that may indicate an airway obstruction.
14. List seven signs of INADEQUATE breathing.
15. List four indications of ADEQUATE artificial ventilation.