Airway Management and Ventilation Chapter 8 Flashcards
Understanding Airway Management and Ventilation
Define respiration.
The act of breathing; the exchange of oxygen and carbon dioxide that takes place in the lungs.
Define respiratory compromise.
A general term used to describe when a patient is not breathing adequately.
Define respiratory distress.
It refers to breathing that becomes difficult or labored.
Define hypoxia.
A condition in which there is an insufficient level of oxygen in the blood and tissues.
Define respiratory arrest.
The absence of breathing.
What does arrest mean in medical terms?
Absent
Define apnea.
The absence of breath
Define cardiac arrest.
The absence of a heartbeat
Define agonal respirations.
Respirations less than six (6) breaths per minute - an abnormal breathing pattern characterized by slow, shallow breaths that typically occur following cardiac arrest (makes a snoring sound).
What is normal for adult breaths per minute?
12 to 20 breaths per minute is normal.
Breathing is automatic, true or false?
True
Define clinical death.
The moment when breathing and heart actions stop.
Upon clinical death how long does it take for oxygen to start depleting and cells begin to die?
4 to 6 minutes
Define biological death.
Biological death occurs approximately 4 to 6 minutes after onset of clinical death and results when there is an excessive amount of brain cell death.
What is the most critical timeframe for the patient to receive CPR?
At the onset of clinical death through up to the first 6 minutes.
How long does it take before irreversible death may occur in a patient with no oxygen.
10 minutes
Can clinical death be reversed?
Yes
Can biological death be reversed?
No
How long after clinical death does biological death happen?
10 minutes
Define diaphragm.
The dome shaped muscle that separates the chest and abdominal cavities. It is the major muscle used in breathing.
Define inhalation.
The process of breathing in a.k.a. inspiration.
Define inspiration.
Refers to the process of breathing in.
Define cyanosis.
Bluish discoloration of the skin and mucous membranes; a sign that body tissues are not receiving enough oxygen.
Define pharynx.
The throat
Define epiglottis.
A flap of Cartlidge and other tissues located above the larynx. It helps to close off the airway when the person swallows.
Find larynx.
The section of the airway between the throat and the trachea that contains the vocal chords. It is also called the voice box.
Define trachea.
The windpipe
What are the nine (9) components of the respiratory system anatomy?
- Nose
- Mouth
- Throat (pharynx)
- Epiglottis
- Trachea
- Larynx
- Bronchial tree
- Lungs
- Alveoli
Describe the respiratory cycle.
When the breathing muscles contract and enlarge the chest cavity, air flows through the mouth and nose, into the throat, passed the epiglottis, and into the trachea. Air then flows into the left and right main stem bronchi and then through the smaller bronchioles to the clusters of alveoli. The alveoli are surrounded by tiny blood vessels called capillaries. It is here in the alveoli that oxygen and carbon dioxide exchange takes place. Oxygen travels through the walls of the alveoli and into the blood, which delivers it to the cells. Carbon dioxide travels from the blood through the alveoli walls, where it is eliminated when we exhale.
Labored breathing is always a sign of a partial airway obstruction. true or false?
True
Describe a normal patient airway.
An airway that is open and clear
What are normal breaths per minute for a child?
15 to 30 breaths per minute.
What are normal breaths per minute for an adult?
12 to 20 breaths per minute
What are normal breaths per minute for an infant?
25 to 50 breaths per minute
Define tidal volume.
The amount of air being moved in and out of the lungs with each breath.
What five (5) signs should you check for normal breathing?
- Adequate tidal volume
- Listen for air entering and leaving the nose and mouth
- If the patient is unresponsive, you may feel for air moving into and out of the nose and mouth
- Observe skin color
- Observe the patient’s level of responsiveness
Define dyspnea.
Difficult or labored breathing
Define accessory muscles.
Muscles of the neck, chest, and abdomen that can assist during respiratory difficulty.
Define agonal respirations.
An abnormal breathing pattern characterized by slow, shallow breaths that typically occur following cardiac arrest.
Name the common signs and symptoms of abnormal breathing.
Increased work or effort to breath
Absent or shallow rise and fall of the chest
Little or 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 deep or labored, especially in infants and children
Use of accessory muscles in the chest, abdomen, and around the neck
Nostrils that flare when breathing, especially in children
Skin that is pale or cyanotic (tinted blue)
Sitting or leaning forward in a tripod position in an effort to make breathing easier
Define rescue breathing.
The act of providing positive pressure ventilations for a patient who has inadequate respirations.
What percent of oxygen is in the atmosphere?
21%
What percent of oxygen is exhaled from your lungs?
16%
When should rescue breathing begin?
For patients with less than 10 breaths per minute.
How many breaths should be delivered to a normal conscious adult?
One breath every 5 to 6 seconds.
How many breaths should be delivered to an adult patient with an advanced airway?
One breath every 6 to 8 seconds.
What is the oxygen concentration when using a BVM?
21%
Define positive pressure ventilation.
The process of using external pressure to force air into a patient’s lungs, such as with mouth to mask or bag mask ventilations.
Define ventilation.
The supplying of air to the lungs. (Also see pulmonary resuscitation)
Define pulmonary resuscitation.
A technique by which breaths are provided to a patient in an attempt to artificially maintain normal lung function. (Also called rescue breathing or artificial ventilation)
Define head tilt chin lift maneuver.
A technique used to open the airway of a patient with no suspected neck or spine injury.
Define jaw thrust maneuver.
A technique used to open the airway of a trauma patient with a possible neck or spine injury.
If a patient vomits during CPR what should you do?
Use suction or other means to clear the airway, reposition the airway, and restart CPR.
What are the five (5) steps used for mouth to mask ventilation?
- Kneel beside the patient and confirm unresponsiveness.
- Open the airway, using the most appropriate maneuver.
- Firmly hold the mask in place while keeping the airway open.
- Take a normal breath and breathe slowly into the one-way valve, delivering each breath over one second.
- If the initial breath is successful but the patient does not begin breathing adequately on his own, begin CPR.
When are mouth to mask ventilations recommended?
When there is only a single rescuer present to provide rescue breaths.
Describe the signs of adequate ventilations.,
There is chest rise and fall;
Resistance is felt as the patient’s lungs expand, and you can hear air leaving the patient’s airway as the chest falls.
What are the eight (8) steps of mouth to shield ventilation.
- Kneel beside the patient and confirm unresponsiveness.
- Open the airway, using the most appropriate maneuver,
- Place the barrier over the mouth; keep the airway open as you pinch the nose closed,
- Open your mouth wide and take a normal breath,
- Place your mouth over the shield opening. Make a tight seal by pressing your lips against it.
- Exhale slowly into the patient’s mouth until you see the chest rise. If this first attempt to provide a breath fails, reposition the patient’s head and try again.
- Break contact with the face shield to allow the patient to exhale. Quickly take in another breath and ventilate the patient again. You will give two (2) initial breaths.
- If the patient does not begin breathing adequately on his own, begin CPR.
Define stoma.
Any permanent opening that has been surgically made; the opening in the neck of a neck breather.
Define gastric distention.
Inflation of the stomach
Name the different airway characteristics of infants and children.
- The mouth and nose are much smaller and more easily obstructed.
- The tongue takes up more space in the mouth and throat.
- The trachea (windpipe) is smaller and more easily obstructed by swelling. It is also softer and more flexible and can become obstructed by tilting the head back to far (hyperextension)
- The chest muscles are not as well-developed, causing the infant and child to depend more on the diaphragm for breathing.
- The chest cavity and lung volumes are smaller, so gastric distention (air getting into the stomach) occurs more commonly.
Define laryngectomy.
The total or partial removal of the larynx.
What are the 3 steps of ventilating a stoma patient?
- keep the patient head in a neutral or normal position. Do not tilt the head.
- ensure that the stoma is free and clear of any obstructions such as mucus or vomit. Do not remove the breathing tube if one is in place.
- use the same procedures as you would for mouth to barrier resuscitation EXCEPT, do not pinch the patient’s nose closed and place the mask or facials on the neck over the stoma.
You are first to arrive on scene with a crash victim who is not breathing but is still in the vehicle. You suspect a possible spine or neck injury. What should you do?
Opening the airway and assisting ventilations are easier to perform when the patient is lying down. This means that a crash victim who is not breathing but is still in his vehicle must be repositioned.
There is always a risk of causing further spine injury if you move the patient, but you must be realistic. If you wait for other EMS personnel to arrive, or if you take time to put on a rigid cervical collar and secure the patient to a spine bored, the patient will likely not survive due to a lack of oxygen to the brain.
Airway and breathing are always the first priorities of patient care.
What is the most common problem with rescue breathing?
Air in the stomach (distention) and vomiting.
What are the five (5) most common causes of airway obstruction?
- obstruction by the tongue (anatomical obstruction)
- foreign objects (mechanical obstruction)
- tissue damage
- allergic reactions
- infections
What are the five common signs of a partial airway obstruction?
- snoring
- gurgling
- crowing
- wheezing
- stridor
Name the signs of a complete airway obstruction?
Patient is:
Unable to speak
Unable to breathe
Unable to cough
Patient will often grasp his neck and open his mouth (the universal sign for choking).
According to the American Heart Association what is the most effective method for clearing the airway of an adult or child when choking?
Abdominal thrusts
Name the four (4) steps of an abdominal thrust.
- stand behind the patient. Place one leg between the patients legs to obtain a stable stance
- reach around with one hand to locate the patient’s navel
- with the other hand, make a fist and place it just above the patient’s navel
- grasp your best with the other hand in pool in and up with swift, from thrusts
You approach a victim who appears to be choking. What should you do?
- Ask “are you choking” or “can you speak”
- Look and listen for signs of complete obstruction or poor air exchange.
- Tell the patient you will help, and begin abdominal thrusts until the object is dislodged or the patient become unconscious.
If a patient becomes unresponsive during abdominal thrusts what should you do?
Act quickly to determine if you were able to provide adequate ventilation. Because the tongue is the most common cause of airway obstruction for those patients, make certain to open the airway using the most appropriate maneuver, prior to attempting ventilation. Once you have confirmed that you were unable to ventilate, begin CPR.
Define chest thrust.
A manual thrust delivered to create pressure that can help expel an airway obstruction in an infant, pregnant, or obese patient.
You arrive at the scene of an unconscious patient who you’ve been told has an airway obstruction, what should you do?
- take the appropriate BSI precautions
- with the patient lying face up (supine), tap and shout to assess responsiveness
(if this happens while off duty tell someone to call 911) - begin CPR with chest compressions
- after each set of 30 compressions, open the airway and check for evidence of a foreign object and remove it if visible
- attempt to rescue breaths. If breaths do not go in, continue CPR with chest compressions
Define gag reflex.
A retching action, hacking, or vomiting that is induced when someone touches a certain level of the patient’s throat.
Define oropharyngeal airway (OPA).
A curved breathing tube inserted into the patient’s mouth. It will hold the base of the tongue forward. (Also called oral airway)
Define nasopharyngeal airway (NPA).
A flexible tube that is lubricated and then inserted into a patient’s nose to the level of the nasopharynx (back of the throat) to provide an open airway. (Also called nasal airway)
Define bag mask device.
An aid for pulmonary resuscitation made up of a face-mask, self-refilling bag, and valves that control the one-way flow of air. (Also referred to as a bag valve mask BVM)
When should an OPA or NPA device be used?
Whenever you perform positive pressure ventilations.
A patient who is responsive and breathing abnormally will most likely not tolerate which type of airway device OPA or NPA?
OPA or a pharyngeal airway - A patient who is breathing abnormally will more likely have a gag reflex, which will prohibit the insertion of an OPA. In this case, opt for NPA first rather than risk having the patient vomit.
You should use the finger sweep technique on responsive patients or unresponsive patients who have a gag reflex. true or false?
False - the finger sweep technique should only be used on unresponsive patients without a gag reflex.
While performing a finger sweep, if dentures become dislodged you should attempt to replace them back in the patient’s mouth. true or false?
False - they can become an airway hazard.
Using equipment and techniques for airway inbreeding management requires special supervised training and practice to learn and maintain skills. true or false?
True
When using an OPA you must still manually maintain the patient’s airway. true or false?
True
If you meet resistance while inserting the NPA what should you do?
Attempt insertion in the opposite nostril.
An airway that is the wrong size has the potential to cause more harm than good. How do you measure an oropharyngeal airway?
From the corner of the mouth to the lobe of the ear in the same direction the OPA will be placed.
How do you measure and nasopharyngeal airway?
From the tip of the nose to the lobe of the ear in the same direction the NPA will be placed.
Most NPAs are made with the bevel facing to the left; therefore, they are meant to fit into the right nostril. true or false?
True
It is not recommended to insert an NPA against its natural curvature because it is likely to rotate on its own after being inserted. true or false?
True
What is the most commonly used device for ventilating a non-breathing patient?
(BVM) bag mask ventilation
The bag mask device delivers what percent of oxygen to the patient when it is squeezed through the unit to the patient’s lungs?
21%
A pocket face mask delivers what percent of oxygen to the patient’s lungs?
Between 10% and 16%
The bag mask device can be connected to an oxygen supply source to enrich room air and deliver a concentration of what percent of oxygen?
100%
For the best possible results, the bag mask device should be used with how many rescuers?
2
If using the one rescuer bag mask ventilations what method should you use to secure an appropriate seal?
The CE method
To clear blood, mucus, and other body fluids from the patient’s airway, and EMR will usually position the patient in what position?
The recovery position
How long should you provide suction to clear an airway?
No more than 15 seconds for adults, 10 seconds for children, and 5 seconds for infants.
This is critical because while you are suctioning you’re not ventilating, and it removes valuable oxygen along with the dangerous fluids.
What sequence should you use if there are copious amounts of fluid in a patient’s airway?
Suction, ventilate, and then section again in a continuous sequence as long as necessary.
How do you measure the suctioning wand before suctioning a patient?
Prior to inserting into the nose, measure the catheter as you would for an NPA.
Prior to inserting into the mouth, measure the catheter as you would for an OPA.
When using suction in the mouth, what are the areas you should concentrate on?
Concentrate on the back corners of the mouth, where most fluids tend to accumulate.
What are the 8 steps of suctioning?
- BSI
- attach the catheter and activate the unit
- position yourself at the patient’s head
- measure the catheter
- open the patient’s mouth and clear obvious matter and fluid from the oral cavity by letting the mouth drain or by using finger sweeps with a gloved hand
- insert the tip of the catheter to the appropriate depth. Usually, the tip is inserted to the base of the tongue. If you’re using a rigid catheter, place the convex (curved out) side against the roof of the mouth with the tip at the base of the top
- apply suction only when the tip of the catheter is in place at the back of the mouth or base of the tongue and as you begin to withdraw it twist and turn it from side to side and sweep the mouth. The twisting action prevents the end of the catheter from grabbing the soft tissue.
- remained alert for signs of a gag reflex and vomiting
Rescue breathing is:
A. any effort to restart normal heart rhythms
B. any effort to revive or restore normal breathing
C. the use of mechanical devices to restart breathing
D. the ability to restore normal heart rhythm and breathing
B. any effort to revive or restore normal breathing
When performing the head tilt chin lift maneuver on an adult, tilt the head:
A. as far back as possible
B. into the sniffing position
C. to get the tongue to close the epiglottis
D. so that upper and lower teeth are touching
A. as far back as possible
The recommended method for opening the airway of a patient with possible neck or find injury is what maneuver? A. jaw thrust B. mouth to nose C. abdominal thrust D. Head tilt chin lift
A. jaw thrust
Clinical death occurs when the patient’s:
A. brain cells begin to die
B. breathing has stopped for four minutes
C. pulse has been absent for five minutes
D. heartbeat and breathing have stopped
D. heartbeat and breathing have stopped
A pocket face mask allows the rescuer to provide ventilations without:
A. having to hold the mask firmly in place
B. delivering his own breaths to the patient
C. direct contact with the patient’s mouth and nose
D. worrying about keeping the head and spine in line
C. direct contact with the patient’s mouth and nose
During rescue breathing, you should check for adequate breathing by:
A. looking for chest rise and fall
B. listening for airflow from the mouth and nose
C. observing skin color, such as paleness or cyanosis
D. looking for chest rise and fall, listening for airflow, and observing skin color
D. looking for chest rise and fall, listening for airflow, and observing skin color
If an infant becomes unresponsive before you can clear and airway obstruction, you should first:
A. place the infant face down and lift her chest with your hands
B. place her on a firm surface and begin chest compressions
C. hold her face up and deliver chest thrusts
D. turn her face down and deliver back slaps
B. place her on a firm surface and begin chest compressions
For suctioning a patient, the appropriate BSI precautions include: A. pocket face mask B. oropharyngeal airway C. eye and face protection D. folded towel under his shoulders
C. eye and face protection
Which one of the following improves ventilations delivered by way of a bag mask device:
A. inserting an oropharyngeal airway
B. applying suction 4 to 6 minutes
C. alternating chest thrusts and squeezing the bag
D. combining finger sweeps with a mouth-to-mouth technique
A. inserting an oropharyngeal airway
Which one of the following is recommended for clearing an airway obstruction in an unresponsive 10-month-old baby? A. abdominal thrusts B. chest thrusts C. back slaps and finger sweeps D. abdominal thrusts and finger sweeps
B. chest thrusts
The primary muscle of respiration is the: A. trachea B. esophagus C. diaphragm D. pharynx
C. diaphragm
What prevents food and other material from entering the trachea? A. tongue B. alveoli C. pharynx D. epiglottis
D. epiglottis
Deep within the lungs what are the tiny balloon like structures where gas exchanges take place? A. alveoli B. bronchioles C. trachea D. epiglottis
A. alveoli
All of the following are signs of inadequate breathing except: A. poor chest rise B. pale or bluish skin color C. use of assessory muscles D. good chest rise and fall
D. good chest rise and fall
When caring for an unresponsive medical patient, tilting the head back improves the airway by:
A. lifting the tongue from the back of the throat
B. shifting the epiglottis from front to back
C. allowing fluids to flow more easily
D. opening the mouth
A. lifting the tongue from the back of the throat
An airway stoma is found on the: A. chest B. arm C. neck D. cheek
C. neck
Noisy breathing is a sign of what kind of airway obstruction? A. bilateral B. complete C. adequate D. partial
D. partial
You just made two attempts to ventilate an unresponsive child without any airway obstruction. Your next step is to: A. begin chest compressions B. continue to ventilate C. perform five chest thrusts D. provide back slaps
A. begin chest compressions
