Module 2
Airway
Airway
The Respiratory System
Opening the Airway
Ventilation
Inspecting the Airway
Techniques of
Ventilation
Airway Adjuncts
FBAO Adult
Clear/Maintain Airway
FBAO Child / Infant
Breathing
Special Considerations
Airway
The Respiratory System
The Respiratory System
Delivers oxygen to the body
Removes carbon dioxide
from the body
Respiratory System
How Respiration Works
Adult/Child Respiratory Systems
Opening the Airway
“One of the most important
actions that the First
Responder can perform is
opening the airway of an
unresponsive patient.”
Head-tilt Chin-lift
“The method of choice for
opening the airway in
uninjured patients.”
Rescuer places palm on patient’s forehead.
Rescuer places fingers on chin.
Rescuer performs head-tilt /chin-lift maneuver.
Jaw Thrust
“The safest approach to
opening the airway in the
patient with suspected spinal
injury.”
Rescuer stabilizes patient’s head, with collar in place.
Rescuer places fingers on jaw.
Rescuer performs jaw thrust.
Inspect the Airway
An unresponsive patient may have
fluid or solids in the airway that may
compromise the airway.
Responsive patients who cannot
protect their airway should also
have their airways inspected.
Always ensure an open airway.
Airway Adjuncts
“Once the airway is open, it
may be necessary to insert
an airway adjunct (an
artificial airway).”
Oropharyngeal Airways
Select oropharyngeal airway.
Another Way to Measure
Insert airway.
Rotate airway into position.
Flange rests against lips.
Child Oropharyngeal Airway
Nasopharyngeal Airways
Determine proper size.
Lubricate airway.
Gently advance airway.
Airway in Place
Clearing / Maintaining the
Compromised Airway
“These techniques are not
sequential; the situation will
dictate which technique is
most appropriate.”
The Recovery Position
Uses gravity to keep the airway
clear.
Monitor the patient until additional
EMS resources arrive and assume
care.
Used in unresponsive, uninjured
patients, breathing adequately.
Recovery Position
Finger Sweeps
Use body substance isolation.
Uses your fingers to remove solid
objects from the airway..
Blind finger sweeps should not be
performed in infants or children.
Rescuer performs tongue-jaw lift.
Rescuer inserts finger in patient’s mouth.
Rescuer hooks finger and clears obstruction.
Suction
A patient needs to be suctioned
immediately when a gurgling
sound is heard during breathing or
ventilation.
Purpose is to remove blood, other
liquids, and food particles from
the airway.
Portable Electric Suction
Hand-operated Suction
Suction by moving the tip from side to side.
Presence of Breathing
“Immediately after
opening the airway,
check for
breathing.”
Rescuer observes patient breathing.
Effort of Breathing
Breathing should be effortless.
Observe the chest for adequate
rise and fall.
Look for accessory muscle use.
Inadequate Breathing
Rate less than 8 in adults.
Rate less than 10 in children.
Rate less than 20 in infants.
Inadequate Breathing
Inadequate chest wall motion.
Cyanosis.
Mental status changes.
Increased effort.
Gasping or Grunting.
Slow heart rate associated with
slow respirations.
Ventilation
If the patient is not breathing they
only have the oxygen in their lungs
and their bloodstream remaining.
In order to prevent death, the First
Responder must ventilate the
patient.
Techniques of Ventilation
“There are many techniques
for ventilation - the First
Responder must be
competent in the following
three techniques.”
Techniques
Mouth to mask.
Mouth to barrier device.
Mouth to mouth.
In order of
preference!
Mouth to Mask
Most effective First Responder
technique.
Mouth to mask ventilation is very
effective since you use two hands
to seal around the mask.
Pocket mask with O2 inlet is shown.
Rescuer positions mask on patient’s face.
Rescuer seals mask on face, sealing nose with thumbs.
Rescuer seals mask on face, using hand position.
Rescuer ventilates through pocket mask.
Mouth to Mask
Give one slow (1 1/2 - 2 second) breath
of sufficient volume to make chest rise.
Adequate ventilation determined by:
Observe the chest
for rise and fall.
Listen and feel for air
escape during exhalation.
Continue at Proper Rate
10 - 12 breaths / min
ADULTS
1 1/2 - 2 seconds each
Continue at Proper Rate
Children
Infants
20 breaths / min
1 - 1 1/2 seconds each
Continue at Proper Rate
40 breaths / min
Newborns
1 - 1 1/2 seconds each
Mouth to Barrier Device
A barrier device should be used if
available.
Some rescuers may prefer to use a
barrier device during ventilation.
Barrier devices should have low
resistance to delivered ventilation.
Example of a Barrier Device
Mouth to Mouth
Quick, effective method of
delivering oxygen to the nonbreathing patient.
The rescuer’s exhaled air contains
enough oxygen to support life.
Barrier devices should have low
resistance to delivered ventilation.
Mouth to Mouth
The decision to perform
mouth to mouth by First
Responders is a personal
choice. Whenever possible,
a barrier device should
be used.
FBAO - Adult
Can be the cause
of cardiac arrest
Can be the result
of cardiac arrest
Partial Airway Obstruction
Good Air Exchange
Patient remains responsive.
May be able to speak.
Can cough forcefully.
May be wheezing between coughs.
Partial Airway Obstruction
Poor Air Exchange
Weak ineffective cough.
High pitched noise on inhalation.
Increased respiratory difficulty.
Possibly cyanotic.
Complete Airway Obstruction
No air can be exchanged.
Patient will be unable to speak,
breathe, or cough.
Patient may clutch the neck with
thumb and fingers.
Death will follow rapidly if prompt
action is not taken.
Universal Signal
Abdominal Thrusts
Abdominal Thrusts (continued)
Chest Thrusts (pregnant patient)
Attempt to ventilate.
Abdominal Thrusts
Finger Sweep
Chest Thrusts (pregnant patient)
FBAO - Infants/Children
“More than 80% of childhood
deaths from FBAO are in
children below age 5. 65%
are infants.”
FBAO - Infants/Children
Airway obstructions can be
caused by infections.
Blind finger sweeps are not done
in infants and children.
Determine responsiveness.
Open airway.
Attempt to ventilate.
Deliver five back-blows.
Deliver five chest-thrusts.
Inspect airway.
Repeat...
Special Considerations
“Persons who have undergone
a laryngectomy have a
permanent opening (stoma)
that connects the trachea to the
front of the neck.”
Chest Thrusts (pregnant patient)
Mask-to-stoma Ventilation