1
7 Airway
2
Cognitive Objectives (1 of 5)

• 2-1.1 Name and label the major structures of the
  respiratory system on a diagram.
• 2-1.2 List signs of adequate breathing.
• 2-1.3 List signs of inadequate breathing.
• 2-1.4 Describe the steps in performing the head
  tilt-chin lift maneuver.
• 2-1.5 Relate mechanism of injury to opening the
  airway.
• 2-1.6 Describe the steps in performing the
  jaw-thrust maneuver.

3
Cognitive Objectives (2 of 5)

• 2-1.7 State the importance of having suction
  ready for immediate use when providing emergency
  care.
• 2-1.8 Describe the techniques of suctioning.
• 2-1.9 Describe how to artificially ventilate a
  patient with a pocket mask.
• 2-1.10 Describe the steps in performing the skill
  of artificially ventilating a patient with a
  bag-valve- mask device while using the jaw-thrust
  maneuver.

4
Cognitive Objectives (3 of 5)

• 2-1.11 List the parts of the bag-valve-mask
  system.
• 2-1.12 Describe the steps in performing the skill
  of artificially ventilating a patient with a
  bag-valve- mask device for one and two rescuers.
• 2-1.13 Describe the signs of adequate artificial
  ventilation using the bag-valve-mask device.
• 2-1.14 Describe the signs of inadequate
  artificial ventilation using the bag-valve-mask
  device.
• 2-1.15 Describe the steps in ventilating a
  patient with a flow-restricted oxygen-powered
  ventilation device.

5
Cognitive Objectives (4 of 5)

• 2-1.16 List the steps in performing the actions
  taken when providing mouth-to-mouth and
  mouth-to- stoma ventilation.
• 2-1.17 Describe how to measure and insert
  oropharyngeal (oral) airway.
• 2-1.18 Describe how to measure and insert a
  nasopharyngeal (nasal) airway.
• 2-1.19 Define the components of an oxygen
  delivery system.
• 2-1.20 Identify a nonrebreathing face mask and
  state the oxygen flow requirements needed for
  its use.

6
Cognitive Objectives (5 of 5)

• 2-1.21 Describe the indications for using a nasal
  cannula versus a nonrebreathing face mask.
• 2-1.22 Identify a nasal cannula and state the
  flow requirements needed for its use.

7
Affective Objectives

• 2-1.23 Explain the rationale for basic life
  support, artificial ventilation, and airway
  protective skills taking priority over most
  other basic life support skills.
• 2-1.24 Explain the rationale for providing
  adequate oxygenation through high inspired
  oxygen concentrations to patients who, in the
  past, may have received low concentrations.

8
Psychomotor Objectives (1 of 4)

• 2-1.25 Demonstrate the steps in performing the
  head tilt- chin lift maneuver.
• 2-1.26 Demonstrate the steps in performing the
  jaw- thrust maneuver.
• 2-1.27 Demonstrate the techniques of suctioning.
• 2-1.28 Demonstrate the steps in providing
  mouth-to- mouth artificial ventilation with body
  substance isolation (barrier shields).
• 2-1.29 Demonstrate how to use a pocket mask to
  artificially ventilate a patient.

9
Psychomotor Objectives (2 of 4)

• 2-1.30 Demonstrate the assembly of a
  bag-valve-mask unit.
• 2-1.31 Demonstrate the steps in performing the
  skill of artificially ventilating a patient with
  a bag-valve- mask device for one and two
  rescuers.
• 2-1.32 Demonstrate the steps in performing the
  skill of artificially ventilating a patient with
  a bag-valve- mask device while using the
  jaw-thrust maneuver.
• 2-1.33 Demonstrate artificial ventilation of a
  patient with a flow-restricted, oxygen-powered
  ventilation device.

10
Psychomotor Objectives (3 of 4)

• 2-1.34 Demonstrate how to artificially ventilate
  a patient with a stoma.
• 2-1.35 Demonstrate how to insert an oropharyngeal
  (oral) airway.
• 2-1.36 Demonstrate how to insert a nasopharyngeal
  (nasal) airway.
• 2-1.37 Demonstrate the correct operation of
  oxygen tanks and regulators.
• 2-1.38 Demonstrate the use of a nonrebreathing
  face mask and state the oxygen flow requirements
  needed for its use.

11
Psychomotor Objectives (4 of 4)

• 2-1.39 Demonstrate the use of a nasal cannula and
  state the flow requirements needed for its use.
• 2-1.40 Demonstrate how to artificially ventilate
  the infant and child patient.
• 2-1.41 Demonstrate oxygen administration for the
  infant and child patient.

12
Additional Objectives

• Describe how to perform the Sellick maneuver
  (cricoid pressure).
• Explain the rationale for applying cricoid
  pressure.
• Demonstrate how to perform the Sellick maneuver
  (cricoid pressure).
• These are noncurriculum objectives.

13
Anatomy Review
14
Breathing Process Inhalation

• Active part of breathing
• Diaphragm and intercostal muscles contract,
  allowing the lungs to expand.
• The decrease in pressure allows lungs to fill
  with air.
• Air travels to the alveoli where exchange of
  gases occurs.

15
Breathing Process Exhalation

• Does not normally require muscular effort
• Diaphragm and intercostal muscles relax.
• The thorax decreases in size, and ribs and
  muscles assume their normal positions.
• The increase in pressure forces air out.

16
The Bodys Need for Oxygen
17
Gas Exchange

• Inhalation delivers oxygen-rich air to alveoli.
• Oxygen diffuses into the blood.
• Breathing is primarily adjusted by the level of
  carbon dioxide in the blood.

18
Hypoxia

• Not enough oxygen for metabolic needs
• Develops when patient is
• Breathing inadequately
• Not breathing

19
Signs of Hypoxia

• Nervousness, irritability, and fear
• Tachycardia
• Mental status changes
• Use of accessory muscles for breathing
• Difficulty breathing, possible chest pain

20
Conditions Resulting in Hypoxia

• Myocardial infarction
• Pulmonary edema
• Acute narcotic overdose
• Smoke inhalation
• Stroke

• Chest injury
• Shock
• Lung disease
• Asthma
• Premature birth

21
Recognizing Adequate Breathing

• Normal rate and depth
• Regular pattern
• Regular and equal chest rise and fall
• Adequate depth

22
Normal Respiration Rates

• Adults 12 to 20 breaths/min
• Children 15 to 30 breaths/min
• Infants 25 to 50 breaths/min

23
Recognizing Inadequate Breathing

• Fast or slow rate
• Irregular rhythm
• Abnormal lung sounds
• Reduced tidal volumes
• Use of accessory muscles
• Cool, damp, pale or cyanotic skin

24
Head TiltChin Lift

• Kneel beside patients head.
• Place one hand on forehead.
• Apply backward pressure.
• Place tips of finger under lower jaw.
• Lift chin.

Head tilt-chin lift
25
Jaw-Thrust Maneuver

• Kneel above patients head.
• Place fingers behind angle of lower jaw.
• Use thumbs to position the lower jaw.

26
Assessment of the Airway

• (1of 2)

27
Assessment of the Airway (2 of 2)

• Assess whether breathing has returned using look,
  listen, and feel technique.
• Listen by placing your ear about 10 inches above
  patients nose and mouth.
• Feel and listen for movement of air.
• Watch the patients chest and abdomen.
• Place a hand on patients chest to feel for
  movement.

28
Severe Airway Obstruction

• There will be no movement of air.
• Chest and abdomen may rise and fall with
  patients attempts to breathe.
• Chest wall movement alone does not indicate
  breathing.
• Always use three-part approach look, listen,
  and feel for movement of air.

29
Basic Airway Adjuncts (1 of 6)

• Oropharyngeal airways
• Keep the tongue from blocking the upper airway
• Allow for easier suctioning of the airway
• Used in conjunction with BVM device
• Used on unconscious patients without a gag reflex

30
Basic Airway Adjuncts (2 of 6)

• Inserting an oropharyngeal airway
• 1. Select the proper size airway.
• 2. Open the patients mouth.
• 3. Hold the airway upside down and insert it in
  the patients mouth.
• 4. Rotate the airway 180 until the flange rests
  on the patients lips.

31
Basic Airway Adjuncts (3 of 6)
1
2
3
32
Basic Airway Adjuncts (4 of 6)

• Nasopharyngeal airways
• Conscious patients who cannot maintain airway
• Can be used with intact gag reflex
• Should not be used with head injuries or
  nosebleeds

33
Basic Airway Adjuncts (5 of 6)

• Inserting a nasopharyngeal airway
• 1. Select the proper size airway.
• 2. Lubricate the airway.
• 3. Gently push the nostril open.
• 4. With the bevel turned toward the septum,
  insert the airway.

34
Basic Airway Adjuncts (6 of 6)
1
2
3
4
35
Suctioning Equipment (1 of 2)
36
Suction Equipment (2 of 2)
French, or whistle-tip, catheter
37
Suctioning Technique (1 of 2)

• Check the unit and turn it on.
• Select and measure proper catheter to be used.
• Open the patients mouth and insert tip.
• Suction as you withdraw the catheter.
• Never suction adults for more than 15 seconds.

38
Suctioning Technique (2 of 2)
2
1
3
4
39
Recovery Position
40
Supplemental Oxygen

• All patients in cardiac arrest should get oxygen.
• Any patient with a respiratory or cardiac
  emergency needs oxygen.
• Never withhold oxygen from anyone who may benefit
  from it.

41
Supplemental Oxygen Equipment

• Oxygen cylinders
• Available as a compressed combustible gas
• Available in several sizes
• Pin-indexing safety system
• Oxygen regulators
• Humidified oxygen

42
Oxygen Flowmeters

• Pressure-compensated flowmeter
• Affected by gravity must be kept upright
• Bourdon-gauge flowmeter
• Not affected by gravity can be used in any
  position

43
Using Supplemental Oxygen (1 of 2)

• Inspect cylinder and markings.
• Crack the cylinder.
• Attach the regulator/flowmeter.
• Open the cylinder.
• Attach proper delivery device to flowmeter.

44
Using Supplemental Oxygen (2 of 2)

• Adjust flowmeter to desired flow rate.
• Apply the oxygen device to the patient.
• When done, discard the delivery device.
• Turn off the flowmeter.

45
Hazards of Oxygen

• Oxygen supports combustion.
• Keep possible ignition sources away from the
  area.
• Oxygen tanks are under high pressure.

46
Oxygen Delivery Equipment

• Nonrebreathing mask
• Provides up to 90 oxygen
• Used at 10 to 15 L/min
• Nasal cannula
• Provides 24 to 44 oxygen
• Used at 1 to 6 L/min

47
Methods of Ventilation

• Mouth to mask
• Two-person BVM device
• Flow-restricted, oxygen-powered device
• One-person BVM device

Bag-valve-mask
48
Rate of Artificial Ventilations

• Adult 1 breath every 5-6 seconds
• Children 1 breath every 3-5 seconds
• Infants 1 breath every 3-5 seconds

Bag-valve-mask
49
Mouth-to-Mask Technique (1 of 2)

• Kneel at patients head and open airway.
• Place the mask on the patients face.
• Take a deep breath and breathe into the patient
  for 1 second.
• Remove your mouth and watch for patients chest
  to fall.

50
Mouth-to-Mask Technique (2 of 2)
51
Bag-Valve-Mask Device

• Can deliver more than 90 oxygen
• Delivers less tidal volume than mouth-to-mask
• Requires practice to be proficient
• May be used with advanced airways

52
Bag-Valve-Mask Components
53
Two-Person BVM Technique (1 of 2)

• Insert an oral airway.
• One caregiver maintains seal while the other
  delivers ventilations.
• Place mask on patients face.
• Squeeze bag to deliver ventilations.

54
Two-Person BVM Technique (2 of 2)
55
One-Person BVM Technique
56
Flow-Restricted, Oxygen-Powered Devices
57
Ongoing Assessment of Ventilation

• Adequate Ventilation
• Equal chest rise and fall
• Ventilating at appropriate rate
• Heart rate returns to normal
• Inadequate Ventilation
• Minimal or no chest rise and fall
• Ventilations too fast or slow
• Heart rate does not return to normal

58
Sellick Maneuver

• Also referred to as cricoid pressure.
• Use on unconscious patients to prevent gastric
  distention.
• Place pressure on cricoid with thumb and index
  finger.

59
Gastric Distention

• Artificial ventilation fills stomach with air.
• Occurs if ventilations are too forceful or too
  frequent or when airway is blocked
• May cause patient to vomit and increase risk of
  aspiration

60
Stomas and Tracheostomy Tubes

• Ventilations are delivered through the stoma.
• Attach BVM device to tube or use infant mask.
• Stoma may need to be suctioned.

61
Causes of Foreign Body Obstruction

• Relaxation of the tongue
• Vomited stomach contents
• Blood clots, bone fragments, damaged tissue
• Swelling caused by allergic reactions
• Foreign objects

62
Recognizing an Obstruction (1 of 2)

• Obstruction may be mild or severe.
• Is patient able to speak or cough?
• If patient is unconscious, attempt to deliver
  artificial ventilation.

63
Removing an Obstruction (2 of 2)

• Perform Heimlich maneuver.
• Use suction if needed.
• If attempts to clear the airway are unsuccessful,
  transport rapidly.