Chapter 10 Flashcards
brain tissue will begin to die within .. to … minutes without oxygen
4; 6
oxygen reaches body tissues and cells through two separate but related processes: … and …
breathing; circulation
during …, oxygen moves from the atmosphere into the lungs. oxygen then crosses the alveolar membrane and attaches to … by a process called diffusion. … carry the hemoglobin, and therefore oxygen, through the boyd, ultimately delivering it to the … to oxygenate the body’s cells. at the same time, co2, produced by the cells in the tissues of the body, moves from the blood into … by diffusion. oxygen-enriched blood is pumped through the body by the heart. CO2 leaves the body during …
inhalation; hemoglobin; red blood cells; capillaries; air sacs; exhalation
the respiratory system consists of all the structures that make up the … and help us breathe, or …
airway; ventilate
the airway is divided into the upper and lower airways. structures that help us breathe: … …. muscles … muscles of breathing … from the brain and … to those muscles
diaphragm; chest wall; accessory; nerves; spinal cord
ventilation is the exchange of air between the … and the …
lungs; environment
the diaphragm and chest wall muscles are responsible for the regular … and … of the chest that accompany normal breathing
rise; fall
the upper airway consists of all anatomic airway structures above the vocal cords: .. … … … .. …
nose mouth jaw oral cavity pharynx larynx
the main function of the upper airway is to …, …, and … air as it enters the body
warm; filter; humidify
pharynx: muscular tube extending from nose and mouth to the level of … and …
composed from top to bottom, of the …, …,a nd …
esophagus; trachea; nasopharynx; oropharynx; laryngopharynx
nasopharynx:
lined with ciliated mucous membrane that filters out … and …
… and … air as it enters the body
dust; small particles; warms; humidifies
oropharynx:
posterior portion of the oral cavity;
the epiglottis is superior to the … –> helps prevent food and liquid from entering it during …
larynx; swallowing
(larynx) complex structure formed by many independent cartilaginous structures
marks where the upper airway ends and the lower airway begins
the thyroid cartilage froms a “v” shape anteriorly–> the adam’s apple
the cricoid cartilage (cricoid …) forms the lowest portion of the larynx
the cricothyroid membrane is the elastic tissue that connects the thyroid superiorly to the cricoid ring inferiorily
the … (… opening) is the area between the vocal cords –> narrowest part of an adult’s airway
ring; glottis; glottis
(larynx) vocal cords are whit bands of thin … –> partially … at rest, produce speech, protect the trachea from the entry of substances like … and ..
muscle tissue; separated; water; vomitus
the function of the lower airway is to deliver … to the …
oxygen; alveoli
trachea (windpipe):
conduit for air entry into the lungs
begins directly below the …
descends anteriorly down the midline of the neck into the …
cricoid cartilage; thoracic cavity
in the thoracic cavity, the trachea divides at the carina into two main stem bronchi, right and left. the bronchi are supported by … and distribute oxygen to the two lungs. lung tissue is covered with the …, a slippery outer membrane. the … lines the inside of the thoracic cavity
cartilage; visceral pleura; parietal pleura
on entering the lungs, each bronchus divides into ever-smaller bronchi, which divide into bronchioles, which are made of …; bronchioles … and … as oxygen passes through them
smooth muscle; dilate; constrict
smaller bronchioles connect to …, where ox and carbon diox are exchanged. these
alveoli
alveoli are millions of thin-walled, balloon-like sacs. alveoli are surrounded by blood vessels (..). Oxygen diffuses across the alveolar membrane into the …,where they are then transported back tot he heart and distributed to the rest of the body. Carbon dioxide (waste) diffuses from these capillaries into the alveoli, where it is exhaled and removed from the body
pulmonary capillaries; pulmonary capillaries
the heart and great vessels (the … and …) are also present in the thoracic cavity and are important for respiration
vena cava; aorta
the … is the area between the lungs, which contains: … … … … major … many …
mediastinum; heart great vessels esophagus trachea bronchi nerves
the … is also found in the thorax and is an important structure of the nervous system; it allows the diaphragm to …, which is necessary for breathing to occur
phrenic nerve; contract
the … and … systems work together to ensure that a constant supply of oxygen and nutrients is delivered to all of the cells of the body and to remove CO2 and waste products from the cells
respiratory; cardiovascular
(ventilation) the physical act of moving air into and out of the lungs, necessary for oxygenation and respiration
inhalation:
the active, … part of breathing–> the diaphragm and intercostal muscles … during inhalation ,which allows air to enter the body and travel to the lungs
muscular; contract
(ventilation) the lungs require the movement of the chest and supporting structures to expand and contract during inhalation and exhalation.
…: the amount of gas in the air or dissolved in fluid, such as blood
measured in mm of mercury
partial pressure
(ventilation) the amount of gas in the oxygen (partial pressure) that resides in the alveoli is … mm Hg
carbon dioxide enters the alveoli from the blood and causes a carbon dioxide partial pressure of … mm Hg
104; 40
(ventilation) oxygenated arterial blood from the heart has a partial pressure of oxygen that is … than the partial pressure of carbon dioxide in the pulmonary capillaries. the body attempts to … the partial pressure, which results in oxygen diffusion across the membrane into the blood. oxygen and carbon dioxide both diffuse until the partial pressures in the air and the blood are …
lower; equalize; equal
(ventilation) inspiration is focused on delivering oxygen to the alveoli; not all inspired air reaches the … for gas exchange
…: a measure of depth of breathing–> the amount of air in mL that is moved into/out of the lungs during a single breath
tidal volume for an average adult is … mL
alveoli; tidal volume; 500
(ventilation) …: the portion of inspired air that fails to reach the alveoli
dead space
(ventilation) exhalation:
unlike inhalation, exhalation does not normally require muscular effort; it is a … process
the diaphragm and intercostal muscles relax, which … the size of the thorax
passive; decreases
(ventilation) with a decreased thoracic size, air in the lungs is compressed into a smaller space. the air pressure in the thorax is then … than the outside pressure. air is pushed out through the … air can enter and leave the lungs only if it travels through the trachea, which is why cleaning and maintaining a patent airway is so important
higher; trachea
(ventilation) regulation of ventilation involves a complex series of … and … that sense gas concentrations in the body fluids and send messages to the respiratory center in the brain to adjust the rate and depth of ventilation
receptors; feedback loops
(ventilation) the body’s need for oxygen is constantly changing. failure to meet this need may result in …, wherein the tissues and cells do not get enough oxygen. if not corrected, patients may die quickly
hypoxia
(ventilation) for most people, the drive to breathe is based on … changes in the … and …
pH; blood; cerebrospinal fluid
(ventilation) patients with chronic obstructive pulmonary disease (COPD) have difficulty eliminating carbon dioxide through exhalation and thus always have … levels of carbon dioxide, which potentially alters their drive for breathing. respiratory centers in the brain gradually … to accommodate high levels of CO2. in patients with COPD, the body uses a “backup system” known as the … to control breathing
higher; adjust; hypoxic drive
(ventilation) use caution when administering high concentrations of oxygen to patients with obstructive pulmonary disease. patients with … respiratory and/or … compromise should receive high concentrations of oxygen regardless of their underlying medical condition
severe; circulatory
(ventilation) early signs of hypoxia: … …. … fast … (…) …
restlessness irritability apprehension fast heart rate (tachycardia) anxiety
(ventilation) late signs of hypoxia: … change weak (thread) … … conscious patients will complain of … of … (…)
mental status;
pulse
cyanosis
shortness of breath (dyspnea)
(ventilation) the best time to give a patient oxygen is … signs and symptoms of hypoxia appear
before
….: the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream
required for internal respiration to take place
oxygenation
oxygenation does not guarantee that internal respiration is taking place
… without oxygenation can occur–for example, in places where oxygen levels in the breathing air have been depleted, such as in mines or confined spaces
ventilation
(respiration) the actual exchange of oxygen and carbon dioxide in the alveoli and in tissues of the body
cells take energy from nutrients through a series of chemical processes known as … (…)
each cell combines nutrients and oxygen, producing energy and waste products (mainly water and carbon dioxide)
metabolism; cellular respiration;
(respiration) external respiration (… respiration)
brings fresh air into the respiratory system
exchanges oxygen and carbon dioxide between the alveoli and blood in the …–> … keeps alveoli expanded, making it easier for gas exchange
pulmonary; pulmonary capillaries; surfactant
(respiration) internal respiration: exchange of oxygen and carbon dioxide between the … and the cells of the body
oxygen passes from blood in capillaries to tissue cells
carbon dioxide and cell wastes pass from the cells into the capillaries, where they are then transported int he venous system back to the lungs
system circulatory systems;
(respiration) without oxygen: 0-1 minute: cardiac … occurs 0-4 minutes: brain damage is … 4-6 minutes: brain damage is … 6-10 minutes: brain damage is … more than 10 minutes: … occurs
irritability; not likely; possible; very likely; irreversible brain damage
… monitor levels of oxygen, carbon dioxide, hydrogen ions, and the pH of cerebrospinal fluid and provide feedback to the respiratory centers
chemoreceptors
air and blood flow must be directed to the same place at the same time: … and … must be matched
ventilation and perfusion
a failure to match ventilation and perfusion is the cause of most abnormalities of oxygen and carbon dioxide exchange. when ventilation is compromised but perfusion continues, blood passes over some alveolar membranes without … taking place, which results in a lack of oxygen diffusing across the membrane and into blood circulation; carbon dioxide is also then not able to diffuse across the membrane into the lungs and instead is recirculated within the bloodstream, which can lead to severe … Similar problems can occur when perfusion across the alveolar membrane is disrupted
gas exchange; hypoxemia
(respiration) intrinsic factors that can cause airway obstruction:
…
… reactions
.. (e.g. tongue obstruction)
infections;
allergic reactions;
unresponsiveness
(respiration) extrinsic factors that can cause airway obstruction:
…
… airway obstruction
trauma; foreign body
(respiration) factors affecting respiration:
external factors, such as … and the partial pressure of oxygen in the ambient environment
internal factors, such as conditions that reduce the … for gas exchange and consequently decrease the body’s oxygen supply, leading to inadequate tissue perfusion (e.g. pneumonia, pulmonary edema, and COPD/emphysema)
atmospheric pressure; surface area
obstruction of blood flow to individual cells and tissue is typically related to trauma emergencies: … simple or tension … open … (sucking chest wound) … …
pulmonary embolism; pneumothorax; pneumothorax;
hemothorax;
hemopneumothorax
other causes of circulatory compromise:
…
…
… shock: abnormal decrease in blood volume
… shock: abnormal increase in blood vessel diameter, decreasing blood pressure
blood loss
anemia
hypovolemic
vasodilatory
unless you are directly assessing a patient's airway, you should not be able to see/hear the patient breathe. signs of normal breathing for adults: … - … breaths/min regular pattern of … and … bilateral clear and equal … regular, equal chest .. and .. adequate … (…)
12-20;; inhalation; exhalation lung sounds; rise; fall depth; tidal volume
signs of abnormal breathing
fewer than 12 breaths/min
more than 20 breaths/min in the presence of … (dyspnea)
… rhythm
diminished, absent, or noisy aucultated breath sounds
reduced flow of … air at nose and mouth
unequal or inadequate chest expansion, resulting in reduced ….
increased effort of breathing–use of … muscles
shallow depth (reduced tidal volume)
skin that is pale, cyanotic, cool, or moist
skin pulling in around ribs/above clavicles during inspiration (…)
shortness of breath; irregular; expired; tidal volume; accessory; retractions
… respirations are often seen in patients with stroke or head injury –> breathing with increasing rate and depth of respirations followed by … (or lack of .. breathing)
Cheyne-Stokes; apnea; spontaneous
… respirations have an irregular or unidentifiable pattern and may follow serious head injuries
ataxic
patients experiencing a metabolic or toxic disorder may display other abnormal respiratory pattenrs such as … respirations –> deep, rapid respirations commonly seen in patients with metabolic acidosis
Kussmaul
emergency medical care for inadequate respiration:
… management
supplemental …
… support
airway; oxygen; ventilatory
Even though the patient may be ventilating appropriately, the actual exchange of oxygen and carbon dioxide at the tissue level may still be compromised by several factors:
a. High …
b. Poisonous …, including carbon monoxide
i. Some EMS services carry hand-held carbon monoxide detectors.
c. …
altitudes; gases; Enclosed spaces
A patient’s level of …and … are excellent indicators of respiration.
consciousness; skin color
when assessing patients, consider proper oxygenation, which can be assessed by
pulse oximetry
….is a measure of the percentage of hemoglobin molecules that are bound in arterial blood.
Oxygen saturation (SpO2)
a pulse oximeter measures the percentage of …
SpO2 should be … to …% while breathing room air. although no definitive threshold for normal values exist, an SpO2 of less than …% in a nonsmoker can indicate hypoxemia
hemoglobin saturation; 98; 100; 96
An SpO2 of …% or lower generally requires treatment unless the patient has a chronic condition causing perpetually low oxygen saturations
90
pulse oximeters can take as long as … seconds to reflect changes in a patients oxygenation status. this time delay is important because a patient can develop respiratory insufficiency well before the pulse oximetry values begin to decline. it is critical to monitor the patient and supplement the assessment with information from the pulse oximeter. pulse oximetry is considered a routine … and can be used as part of any patient assessment
60; vital sign
factors that may cause inaccurate pulse oximetry readings:
…
severe peripheral … (chronic hypoxia, smoking, or hypothermia)
time delay in detecting …
dark or metallic ..
…
…
hypovolemia; vasoconstriction; respiratory insufficiency nail polish dirty fingers CO poisoning
pulse oximetry cannot measure the effectiveness of ventilation or provide info about cellular metabolism. to assess ventilation, you will need to measure …, which is measure d by …
end-tidal CO2; capnometry
adequate breathing does not always equal an adequate
airway
to open airway, position the patient correctly:
the … position is most effective
sometimes the airway must be opened and assessed in the position in which you find the patient, as in a vehicle entrapment
a patient found in the prone position must be …–> log roll the patient as a unit. While care should be taken to avoid injury, remember that airway management almost always takes priority and should not be delayed when caring for patients with life-threatening conditions
unconscious patients should be moved as a unit because of the potential for .. injury
supine; repositioned; spinal
in an unconscious patient, the most common airway obstruction is the patient’s …, which falls back into the throat when the muscles of the throat and tongue relax
tongue
other causes of airway obstruction: … … … … … other foreign objects
dentures blood vomitus mucus food
for patients who have not sustained or are not suspected of having sustained spinal trauma, the … maneuver is sometimes all that is needed for the patient to resume breathing
head tilt-chin lift
if you suspect a cervical spine injury, use the … maneuver.
jaw-thrust
once the airway has been opened, assess whether breathing has returned by quickly looking at the .. and observing for obvious movement. with complete airway obstruction, there will be …:
the chest and abdomen may rise and fall with the patient’s frantic attempts to breathe
chest wall movement alone does not indicate that breathing is adequate
chest; no movement of air
. Even though you may have opened the airway with a head tilt–chin lift or jaw-thrust maneuver, the patient’s mouth may be closed.
a. To open the mouth, place the tips of your .. and ..on the patient’s teeth.
b. Open the mouth by pushing your thumb on the lower teeth and index finger on the upper teeth.
c. The pushing motion will cause the index finger and the thumb to cross over each other, which is why this is called the … technique.
.index finger; thumb; cross-finger
you mut keep the airway clear to ventilate properly. if the airway is not clear, you will force the fluids and secretions into the lungs and possibly cause a …
if you hear gurgling, the patient needs …
complete airway obstruction; suctioning
(suctioning equipment) portable, hand-operated, and fixed (mounted) equipment is essential for resuscitation.
a. A portable suctioning unit must provide enough … and … to allow you to suction the mouth and nose effectively.
b. Hand-operated suctioning units with … chambers are reliable, effective, and relatively inexpensive.
c. A fixed suctioning unit should generate airflow of more than … L/min and a vacuum of more than … mm Hg when the tubing is clamped.
vacuum pressure; flow; disposable; 40; 300
A portable or fixed unit should be fitted with the following:
a. Wide-bore, thick-walled, nonkinking …
b. Plastic, rigid pharyngeal …, called tonsil tips or Yankauer tips
c. Nonrigid plastic …, called French or whistle-tip catheters
d. A nonbreakable, disposable …;
e. … supply for rinsing the tips
tubing; suction tips; catheters; collection bottle; water
a … is a hollow, cylindrical device used to remove fludis from the airway
a … is the best kind of catheter for infants and children–> the large-diameter plastic tips are rigid and do not collapse
suction catheter; tonsil-tip catheter
tips with a curved contour allow for easy, rapid placement in the
oropharynx
French or whistle-tip cathers are soft plastic, nonrigid catheters. they are used to suction the .. and … secretions in the back of the mouth and in situations when you cannot use a rigid catheter:
a patient who has a ..
a patient with ..
if suctioning the nose is necessary
nose; liquid; stoma; clenched teeth
Before inserting any catheter, measure for the proper size.
a. Use the same technique as measuring for an oropharyngeal airway.
b. Do not touch the back of the airway with a suction catheter—this can activate the …, causing vomiting, and increase the possibility of ….
gag reflex; aspiration
Steps to operate the suction unit:
a. Check the unit for proper assembly of all its parts.
b. Turn on the suctioning unit and test it to ensure a vacuum pressure of more than … mm Hg.
c. Select and attach the appropriate suction catheter to the tubing.
300
Never suction the mouth or nose for more than …seconds at one time for adult patients, …seconds for children, and … seconds for infants.
a. Suctioning can result in ….
b. Rinse the catheter and tubing with water to prevent clogging.
c. Repeat suctioning only after the patient has been adequately ventilated and ….
15; 10; 5; hypoxia; reoxygenated
Sometimes a patient may have secretions or vomitus that cannot be suctioned quickly and easily, and some units cannot remove objects such as teeth, foreign bodies, and food. In these cases:
a. Remove the catheter from the patient’s mouth.
b. … the patient to the side.
c. Clear the mouth carefully with a ….
Log roll; gloved finger
If a patient who requires assisted ventilations produces frothy secretions as quickly as you can suction them:
a. Suction the airway for .. seconds (less in infants and children).
b. … for 2 minutes.
c. Continue this alternating pattern of suctioning and ventilating until all secretions have been cleared from the airway.
d. Continuous ventilation is not appropriate if vomitus or other particles are present in the airway.
Clean and decontaminate your suctioning equipment after each use.
15; Ventilate;
an … prevents obstructionof the upper airway by the tongue and allows for passage of air and oxygen to the lungs
airway adjunct
(oropharyngeal airways) keeps the .. from blocking the upper airway
make it easier to … the oropharynx if necessary –> suctioning is possible through an opening down the center or along either side of the oropharyngeal airway
tongue; suction
(oropharyngeal airways) indications:
… patients without a … (breathing or apneic)
apneic patients being … with a …
unresponsive; gag reflex; ventilated; BVM
(oropharyngeal airways) contraindications:
… patients
any patient (conscious or unconscious) who has an intact …
conscious; gag reflex
(oropharyngeal airways) The gag reflex is a protective reflex mechanism that keeps …from entering the airway.
a. Attempting to insert an oral airway in a patient with an intact gag reflex may result in …or spasm of the ….
food; vomiting; vocal cords;
(oropharyngeal airways) an oral airway is a good way to help maintain the airway of a … patient
spinal injury
(oropharyngeal airways) an oral airway may make the head tilt-chin lift and jaw-thrust maneuvers easier to perform. an oral airway that is too large could push the … back into the …, blocking the airway. an airway that is too small could block the airway .., like any foreign body obstruction
tongue; pharynx; directly
(oropharyngeal airways) if you encounter difficulty inserting the oral airway, an alternative method may be used: inserting with a
90 degree rotation
(nasopharyngeal airways) 1. Indications:
a. Patient who is … or has an altered level of consciousness
b. Patient who has an …
c. Patient who is unable to maintain his or her own airway ..
unresponsive; intact gag reflex; spontaneously
patients with an altered mental status or who have just had a seizure may benefit from the … airway
nasopharyngeal
consult med control before inserting a nasopharyngeal airway in a patient who has sustained severe trauma to the head/face, as it may … into the brain
penetrate
a nasopharyngeal airway is usually better tolerated by patients who have an …–> less likely to cause vomiting compared to the oropharyngeal airway
intact gag reflex
(nasopharyngeal airway) Indications:
a. Semiconscious or unconscious patients with an intact gag reflex
b. Patients who otherwise will not tolerate an oropharyngeal airway
Contraindications:
a. Severe … with …draining from the nose
b. History of …
head injury; blood; fractured nasal bone
The …position is used to help maintain a clear airway in an unconscious patient who is not …and is breathing on his or her own with a normal respiratory rate and adequate tidal volume (depth of breathing).
recovery; injured;
Steps to put the patient in the recovery position:
a. Roll the patient onto either side so that the head, shoulders, and torso move at the same time without twisting.
b. …the patient’s lower arm and place the upper hand under his or her ….
Extend; cheek
For patients who have resumed spontaneous breathing after being resuscitated, the recovery position will prevent ….
aspiration of vomitus
The recovery position is not appropriate for patients with suspected …, hip, or pelvic injuries who are unconscious and require ventilatory assistance.
a. Reposition such patients to provide adequate airway access while maintaining appropriate….
spinal; spinal immobilization
Always give supplemental oxygen to patients who are …, because not enough oxygen is being supplied to the tissues and cells of the body. when ventilating any patient in cardiac or respiratory arrest, use … supplemental oxygen;
hypoxic; high-concentration
.Check that the oxygen cylinder is labeled for …oxygen. Look for letters and numbers stamped into the metal on the collar of the cylinder.
i. Check the month and year stamps indicating when the cylinder was last tested.
ii. Aluminum cylinders are tested every … years.
iii. Composite cylinders are tested every .. years.
e. Most often the… (or jumbo D) and …cylinder sizes will be used. The .. cylinder can be carried from the unit to the patient
f. The M tank remains on board the unit as a main supply tank.
g. Other sizes: A, E, G, H, and K
medical ; 5; 3; D; M; D
In an alternative naming system for identifying the size of the oxygen cylinder, cylinders are labeled with M (for medical), followed by a ….
i. The length of time you can use an oxygen cylinder depends on the … in the cylinder and the ….
number; pressure; flow rate
(liquid oxygen) a more commonly use dlaternative to compressed gas oxygen.
Liquid oxygen containers:
i. Tend to be more … than compressed oxygen tanks
ii. Hold a larger … and therefore do not need to be filled as often
iii. Weigh … than aluminum or steel tanks
iv. Need to be kept ..
v. Have special requirements for filling, large-volume storage, and cylinder transfer
People who receive long-term oxygen therapy use … oxygen units.
expensive; volume ; less; upright; liquid
Safety considerations
a. Handle gas cylinders carefully because their contents are under ….
b. Make sure the correct … is firmly attached before transporting cylinders.
c. A puncture or hole in a tank can turn it into a deadly missile.
d. Secure cylinders with ..s when they are stored on the ambulance.
e. Oxygen cylinders that are in use during transport should be positioned correctly and secured.
pressure; pressure regulator; mounting bracket;
Pin-indexing system
a. Prevents such mistakes as an oxygen regulator being accidently connected to a carbon dioxide cylinder
b. When preparing to administer oxygen, check that the …on the cylinder exactly match the corresponding pins on the regulator.
c. Each cylinder of a specific gas type has a given …and a given … of pins, following accepted national standards.
pinholes ; pattern; number
For large cylinders, the safety system is the American Standard Safety System.
i. Oxygen cylinders are equipped with threaded ….
ii. Inside and outside … vary depending on the gas in the cylinder.
iii. Like the pin-indexing system, this prevents accidental attachment of a regulator to a wrong cylinder.
gas outlet valves; thread sizes;
Pressure regulators
a. Pressure regulators reduce the cylinder’s pressure to a useful therapeutic range for the patient—usually .. to …psi.
b. After the pressure is reduced to a workable level, the final attachment for delivering the gas is one of the following:
i. A quick-connect …fitting that will accept a quick-connect … from a pressure hose or ventilator/resuscitator
ii. A …that will permit the regulated release of gas measured in liters per minute
40; 70; female; male plug; flowmeter;
…: usually permanently attached to pressure regulators on emergency medical equipment
flowmeter
a pressure-compensated flowmeter incorporates a … within a tapered ..–> is affected by … and must always be upright
float ball; calibrated tube; gravity
the bourdon-gauge flowmeter is a gauge calibrated to record … –> can be used in any position; generally considered …
flow rate; outdated
Excessive supplemental oxygen can have a detrimental effect on patients with certain illnesses (i.e., COPD, bronchopulmonary dysplasia). … refers to damage to cellular tissue due to excessive oxygen levels in the blood.
Oxygen toxicity
Increased cellular oxygen levels contribute to the production of oxygen …, which can lead to tissue damage and cellular death in some patients.
free radicals
The International Liaison Committee on Resuscitation guidelines published by the American Heart Association recognize there may be negative effects of oxygen toxicity and recommend that oxygen be administered to patients experiencing signs of a .. when they have signs of …, are short of breath, or have a room air oxygen saturation less than …%.
myocardial infarction; heart failure; 94
. Patients experiencing signs of shock should be placed on ….
…is much worse than oxygen toxicity; when in doubt, or if unable to measure oxygen saturation reliably, supplemental oxygen should be administered.
oxygen; Hypoxemia
When pulse oximetry is available, tailor oxygen therapy to the patient’s needs and administer the minimum amount of oxygen necessary to maintain oxygen saturation at or above …%.
i. Exceptions to these minimums include patients who have been exposed to …
94; CO
In general, oxygen-delivery equipment used in the field should be limited to …, …, and ..
nonrebreathing masks, BVMs, and nasal cannulas.
…: The preferred way to give oxygen in prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia
a. With a good mask-to-face seal, such a mask is capable of providing up to … % inspired oxygen.
nonrebreathing masks; 90%
(nonrebreathing masks) combines a mask with a … system–> oxygen fills a reservoir bag attached t the mask by a one-way valv.e exhaled gas escapes through … ports at cheek areas of the mask, preventing the patient from rebreathing exhaled gases
reservoir bag; flapper valve
(nonrebreathing masks) make sure the reservoir bag is .. before placing the mask on the patient
full
(nonrebreathing masks) Adjust the flow rate so the bag does not collapse when the patient inhales.
a. Usually …L/min
b. If the bag does collapse, increase the… .
10–15 ; flow rate
…. Deliver oxygen through two small, tubelike prongs that fit into the patient’s nostrils
nasal cannulas
nasal cannulas can provide … to … % inspired oxygen when the flowmeter is set at 1-6 L/min. For patient comfort, flow rates above 6 L/min are not recommended
24; 44
When you anticipate a long transport time, consider using ….
a. Over a prolonged period, a nasal cannula can dry or irritate the … lining of the nose.
humidification; mucous membrane;
In the prehospital setting, a nasal cannula has limited use.
a. A patient who breathes through the …, or has a …, will get little or no benefit.
b. Always try to give high-flow oxygen through a ….
mouth; nasal obstruction; nonrebreathing mask
…: Similar to nonrebreathing masks, except there is no one-way valve between the mask and the reservoir
partial rebreathing masks
(partial rebreathing masks) patients rebreathe a small amount of their exhaled air, which is advantageous if the patient is … The oxygen enriches the air mixture so that patients receive …% to …% oxygen.
hyperventilating; 80; 90
To convert a nonrebreathing mask to a partial rebreathing mask, remove the … between the mask and the reservoir bag.
one-way valve
(venturi masks) a number of attachments can vary the … while a constant flow is maintained from the regulator. the venturi principle causes air to be drawn into the flow of oxygen as it passes a hole in the line
percentage of oxygen
the venturi mask is a medium flow device that delivers .. to … % oxygen, depending on manufacturer. useful in … management of physiologically stable patients
24; 40; long-term
- Patients with … do not breathe through their mouth and nose.
- …cover the tracheostomy hole and have a strap that goes around the neck.
a. These may not be available in an emergency setting, in which case you should improvise by placing a… over the stoma.
i. Although the mask is shaped to fit the face, you can usually get an adequate fit over the patient’s neck by adjusting the strap.
tracheostomies; Tracheostomy masks; face mask
Some EMS systems provide humidified oxygen.
a. During … transport
b. For certain conditions such as croup
2. Dry oxygen is not considered harmful for … use.
a. Many EMS systems do not use humidified oxygen in the prehospital setting.
3. Always refer to medical control or local protocols for guidance involving patient treatment issues.
extended; short-term
Patients who are breathing inadequately (too fast or too slow, with reduced tidal volume) are usually unable to speak in ….
a. …, … breathing can be just as dangerous as very slow breathing.
complete sentences; fast, shallow;
assisting ventilation in respiratory distress/failure:
two treatment options: … and …
assisted ventilation; continuous positive airway pressure (CPAP)
the purpose of assisted ventilation is to improve the overall … and … status of the patient
oxygenation; ventilatory
Signs and symptoms of inadequate ventilation:
a. Altered…
b. Inadequate …
c. Excessive … use and fatigue
mental status; minute volume; accessory muscle
To assist a patient with ventilations using a BVM:
a. Explain the procedure to the patient.
b. Place the mask over the patient’s nose and mouth.
c. Squeeze the bag each time the patient breathes, maintaining the same …as the patient.
d. After the initial 5 to 10 breaths, slowly adjust the rate and deliver an appropriate….
e. Adjust the rate and tidal volume to maintain an adequate ….
rate; tidal volume; minute volume
available artificial ventilation methods:
… technique
one or two person …
… ventilation device
mouth-to-mask; BVM; manually triggered
Artificial ventilations are necessary to sustain life, but are not the same as normal breathing.
i. In normal breathing, the diaphragm … and … pressure is generated in the chest cavity, which sucks air into the chest.
ii. Positive-pressure ventilation generated by a device … into the chest cavity.
contracts; negative; forces air;
With positive-pressure ventilation:
i. Increased intrathoracic pressure causes compression of the… and reduces … to the heart, which reduces the amount of blood pumped by the heart.
ii. More … is required to have the same effects as normal breathing, which pushes the airway walls out of their normal anatomic shape.
iii. Air is forced into the stomach, causing … that could result in vomiting and aspiration.
vena cava; blood return; volume ; gastric distention
The EMT must regulate the rate and volume of artificial ventilations to help prevent the drop in …
cardiac output
Ventilation rates (for apneic patients with a pulse)
i. Adult: 1 breath per … seconds
ii. Child: 1 breath per … seconds
iii. Infant: 1 breath per … seconds
5–6; 3-5; 3-5
Mouth-to-mouth and mouth-to-mask ventilation
a. A… is routinely used in mouth-to-mouth ventilations.
i. A plastic barrier is placed on the patient’s face that includes a one-way valve to prevent the … of secretions, vomitus, and gases.
ii. Mouth-to-mouth ventilations without a barrier device should be provided only in extreme situations.
barrier device; backflow
A mask with an oxygen inlet provides …during mouth-to-mask ventilation.
i. … the air supplied by your lungs
ii. The gas you exhale contains … % oxygen.
iii. With the mouth-to-mask system, patients get the benefit of significant oxygen enrichment.
iv. This system frees both of the EMT’s hands to help keep the airway open and provide a better seal between the mask and face.
oxygen; supplements; 16%;
Signs of adequate ventilations:
i. Patient’s … improves
ii. Chest … adequately
iii. No … when ventilating
iv. You hear and feel air … as the patient exhales.
color; rises; resistance; escape
(mouth-to-mask) To increase the oxygen concentration, administer high-flow oxygen at … L/min through the oxygen inlet valve of the mask.
i. Combined with your exhaled breath, this will deliver about …% oxygen.
15 ; 55
With an oxygen flow rate of 15 L/min, a BVM can deliver nearly …% oxygen.
i. It can deliver only as much volume as you can …by hand.
100; squeeze
… is the most common method used to ventilate patients in the field
BVM
The BVM provides less… than mouth-to-mask ventilation but delivers a much higher … of oxygen.
i. An experienced EMT can provide adequate tidal volume.
ii. As a new EMT, develop proficiency by ventilating airway-training manikins before using a BVM on a patient.
tidal volume; concentration
If you have difficulty adequately ventilating a patient with a BVM, switch immediately to …, such as the mouth-to-mask technique.
another method
BVM components:
i. Disposable self-refilling …
ii. No …, or a disabled pop-off valve
iii. … outlet valve
iv. Oxygen … that allows for delivery of high-concentration oxygen
v. One-way, no-jam i… with a flow of up to 15 L/min
vi. Transparent face mask
bag; pop-off valve; Nonrebreathing; reservoir; inlet valve;
BVM offers the capability of performing under extreme heat or cold Total volume: Adult: ..-... mL pediatric: ... - ... mL infant: ... to ... mL
1200; 1600
500; 700;
150; 240
The volume of oxygen delivered is based on observing ….
i. Only means of assessing … in the field
chest rise and fall; tidal volume
When using a BVM with high-flow oxygen on an adult patient, squeeze the bag just enough to cause a noticeable …—about …mL/s.
By delivering just enough tidal volume to see the chest rise, the risk of … and associated complications is reduced.
rise of the patient’s chest; 600; gastric distention
To use the one-person BVM technique, follow these steps:
i. Select the proper size of mask and assemble your equipment.
ii. Kneel above the patient’s ….
iii. Maintain the patient’s neck in an extended position unless you suspect a … injury. For a cervical spine injury, stabilize the patient’s head and neck and use the … maneuver. You can use your knees to stabilize the head.
iv. Open the patient’s mouth.
v. …as needed.
head; cervical spine; jaw-thrust; Suction
one-person BVM cont.
vi. Insert an oral or nasal airway to maintain airway patency.
vii. Place the mask on the patient’s face. Make sure the top is over the bridge of the nose and the bottom is in the groove between the lower lip and the chin.
viii. If the mask has a large, round cuff around the ventilation port, center the port over the patient’s …. Inflate the collar for a better fit and seal to the face if necessary.
ix. Create a seal by holding your index finger over the lower part of the mask and your thumb over the upper part of the mask. Use your remaining fingers to pull the lower jaw into the mask (EC-clamp method).
x. Bring the lower jaw up to the mask with the last three fingers of your hand. This helps maintain an open airway.
xi. Squeeze the bag with your other hand until you see adequate chest rise.
xii. Perform this in a rhythmic manner once every …seconds for an adult and once every … seconds for infants and children.
xiii. In patients with ongoing CPR and an advanced airway in place, such as an endotracheal tube, a laryngeal mask airway, or a King airway, use a simplified ventilation rate of 1 breath every … seconds, without pausing chest compressions.
mouth; 5 ; 3; 6
If two EMTs are available, follow these steps:
i. One EMT holds the mask in position by placing the thumbs over the top part of the mask and the index fingers over the bottom half.
ii. The first EMT uses the last three fingers of the hands to bring the lower jaw up to the mask. This helps to seal the mask to the face and maintain an open airway.
iii. The second EMT squeezes the bag with.. until the chest rises adequately in the same manner as the one-rescuer technique.
two hands
For a patient who is breathing too slowly (hypoventilation) with reduced tidal volume:
i. Squeeze the bag as the patient tries to …
ii. For the next 5 to 10 breaths, slowly adjust the rate and delivered tidal volume until adequate … is achieved.
breathe in;
minute volume;
For a patient who is breathing too fast (hyperventilation) with reduced tidal volume:
i. Explain the procedure to the patient if the patient is coherent.
ii. Initially … at the rate the patient has been breathing, squeezing the bag each time the patient ….
iii. For the next 5 to 10 breaths, slowly adjust the rate and the delivered tidal volume until an adequate … is achieved.
assist respirations; inhales; minute volume
If the patient’s chest does not rise and fall, you may need to …the head or use an ….
reposition; airway adjunct
g. If the patient’s chest still does not rise and fall after you have made these corrections, check for an ….
If an obstruction is not present, attempt ventilations using an alternative method, such as the mouth-to-mask technique.
airway obstruction
The BVM may be used in conjunction with an … or with other advanced airway techniques.
endotracheal tube
When using a BVM or any other ventilation device, be alert for …(ie, inflation of the stomach with air).
b. Most commonly affects … , but can affect … c. Most likely to occur when you ventilate the patient too … or too … with a BVM or pocket mask
d. May occur when the airway is … as a result of a foreign body or …head position
e. For this reason, give slow, gentle breaths during artificial ventilation over 1 second.
gastric distention; children; adults; forcefully; rapidly; obstructed; improper
As compliance decreases, you will notice it becoming increasingly … the BVM to get air into the lungs.
difficult to squeeze
Slight gastric distention is not of concern.
Severe inflation of the stomach is dangerous.
i. May cause …and increase … risk during CPR
ii. Can significantly reduce … by elevating the diaphragm, especially in infants and children
vomiting ; aspiration; lung volume
Gastric distention is a common complication with manually triggered ventilation devices—a key reason these devices are not highly recommended.
To prevent or alleviate distention:
i. Ensure that the patient’s airway is appropriately ….
ii. Ventilate the patient at the appropriate ….
iii. Ventilate the patient with the appropriate ….
positioned; rate; volume
If the patient’s stomach appears to be distending, recheck and …the head, and watch for rise and fall of the chest wall as you perform rescue breathing.
Continue slow rescue breathing without attempting to ….
reposition; expel the stomach contents
If gastric distention makes it impossible to ventilate the patient and an ALS provider is not available to perform decompression, consider applying …over the … (last resort).
i. If vomiting occurs as a result, turn the patient’s entire body to the …, … and/or … out the mouth with your gloved hand, return the patient to a supine position, and continue rescue breathing.
pressure; upper abdomen; side; suction; wipe
(passive ventilation) The process of expansion and contraction of the chest creates a “…” for air movement in and out of the chest.
pump
(passive ventilation) During cardiac arrest, you are responsible for providing chest compressions to … and artificial ventilations to … the hemoglobin.
circulate blood; oxygenate
(passive ventilation) Since …assists in the ventilation process, patients receiving high-quality chest compressions benefit from passive ventilation. In passive ventilation, air movement in and out of the chest cavity occurs passively as a result of …
chest wall movement; compressing the chest
(passive ventilation) When the chest is compressed, air is forced out of the thorax.
ii. As the chest recoils following compression, a … pressure is created within the chest, which results in a ….
iii. Air is sucked into the chest cavity, similar to what occurs with muscle contraction during…
negative; vacuum; active inhalation
(passive ventilation) Passive ventilation can be enhanced by inserting an …and providing … to the patient.
oropharyngeal airway ; supplemental oxygen
(passive ventilation) You can also improve oxygenation by applying supplemental oxygen with a … or a …
nasal cannula; nonrebreathing mask.
(manually triggered ventilation devices) Also known as … ventilation devices
b. Allow a single rescuer to use … to maintain a mask-to-face seal while providing positive-pressure ventilation
i. This reduces rescuer …associated with using a BVM on extended transports.
flow-restricted, oxygen-powered; both hands; fatigue
(manually triggered ventilation devices) Disadvantages:
i. May be difficult to maintain adequate ventilation without …
ii. Should not be used routinely because of high incidence of … and possible damage to structures within the chest cavity
iii. Special unit and additional training are required for … and …
iv. Should not be used with …or suspected … or … injuries
assistance; gastric distention; infants and children.; COPD; cervical spine or chest injuries
(manually triggered ventilation devices) Manually triggered ventilation device components:
i. Peak flow rate of 100% oxygen at up to .. L/min
ii. Inspiratory …valve
iii. Audible …that sounds when you exceed the relief valve pressure
iv. Ability to function satisfactorily under normal and varying …
v. … or … positioned so that both your hands can remain on the mask to provide an airtight seal while supporting and tilting the patient’s head and keeping the jaw elevated
40; pressure safety release; alarm ; environmental conditions; Trigger or lever
(manually triggered ventilation devices) As with BVMs, you must make sure there is an effective …between the patient’s face and mask.
seal
(manually triggered ventilation devices) The amount of pressure required varies according to patient .., lung …, and lung ….
i. A COPD patient will need …pressure.
ii. Pressures that are too great can cause a …..
size; lung volume; lung condition; greater; pneumothorax
(Automatic transport ventilator (ATV)/resuscitator)
a. The ATV is a manually triggered ventilation device attached to a control box that allows the … to be set.
i. Lacks the sophisticated control of a hospital ventilator
ii. Frees the EMT to perform tasks such as maintaining the mask seal or ensuring continued airway patency
variables of ventilation;
(Automatic transport ventilator (ATV)/resuscitator) A BVM and mask should always be prepared and ready for use should an ATV malfunction.
c. Most models have adjustments for … and …
i. Estimate tidal volume at … to .. mL/kg.
respiratory rate; tidal volume; 6; 7;
(Automatic transport ventilator (ATV)/resuscitator) The pressure relief valve may lead to hypoventilation in patients with:
i. Poor …(ability of alveoli to expand when air is drawn in during inhalation)
ii. Increased airway …
iii. Airway …
lung compliance; resistance;
obstruction
(Automatic transport ventilator (ATV)/resuscitator) Constant reassessment of the patient is necessary.
i. Assess for …
full chest recoil.
Continuous positive airway pressure (CPAP) is noninvasive ventilatory support for patients experiencing…
respiratory distress.
CPAP increases …in the lungs, opens collapsed …, pushes more …across the alveolar membrane, and forces interstitial fluid back into the….
pressure; alveoli; oxygen; pulmonary circulation
(CPAP) The therapy is typically delivered through a face mask held to the head with a …system.
a. A good seal with minimal leakage between the face and mask is essential.
strapping
(CPAP) Many CPAP systems use … as the driving force to deliver the positive ventilatory pressure to the patient.
Use caution with patients with potentially low …, because CPAP causes a drop in ….
oxygen; blood pressure; cardiac output
(CPAP) Indications
- The patient is alert and able to ….
- The patient displays obvious signs of moderate to severe … from a condition such as pulmonary edema or obstructive pulmonary disease (ie, COPD).
- The patient is breathing …, such that it affects overall minute volume (greater than 26 breaths/min).
- The pulse oximetry reading is less than …%.
follow commands; respiratory distress; rapidly; 90
(CPAP) Contraindications
- Patient in ..
- Signs and symptoms of …or chest …
- Patient who has a …
- Active gastrointestinal … or vomiting
- Patient who is unable to follow verbal commands
- Always reassess the patient for signs of deterioration and/or respiratory failure.
.respiratory arrest; pneumothorax; trauma; tracheostomy;
bleeding; vomiting;
(CPAP) Components of a CPAP unit:
a. …
b. …
c. Circuit containing …
d. … filter
e. … valve
Generator; Mask;
corrugated tubing; Bacteria;
One-way
(CPAP) The CPAP generator creates … throughout the respiratory cycle.
a. This resistance creates a back pressure into the airways that pushes open the …, such as bronchioles and alveoli, as the patient exhales.
b. The amount of pressure can be determined by adjusting a valve within the CPAP system or with a separate valve that can be attached.
c. A pressure of … to … cm H2O is generally an acceptable therapeutic range.
resistance; smaller airway structures; 7.0 to 10.0
(CPAP) Most CPAP units are powered by .., so it is important to have a full cylinder of oxygen when using CPAP.
Disposable CPAP devices are …and relatively easy to operate.
.oxygen; lightweight
(CPAP) Complications
- Some patients may find CPAP …and resist application of the mask.
a. Coach patients through the process rather than forcing the mask on them. - Due to the high volume of pressure generated by CPAP, …is a risk.
- High pressure in the chest can lower the patient’s ….
- If the patient shows signs of deterioration, remove CPAP and begin positive-pressure ventilation using a BVM attached to high-flow oxygen.
claustrophobic; pneumothorax; blood pressure;
Patients who have had a laryngectomy (surgical removal of the larynx) have a permanent …, which is an opening in the neck that connects the trachea directly to the skin.
a. Known as a …
tracheal stoma; tracheostomy
Patients may have other openings in the neck, depending on the type of operation performed.
a. Ignore any opening other than the …
b. It is the only one that can be used to put air into the patient’s lungs.
midline tracheal stoma.
Neither the head tilt–chin lift maneuver nor the jaw-thrust maneuver is required to ventilate a patient with a stoma. If the patient has a tracheostomy tube, ventilate through the tube with a ….
a. A standard 15/22-mm adapter on the BVM will fit onto the tube in the tracheal stoma.
b. Use …. attached directly to the BVM.
BVM; 100% oxygen
If the patient has a stoma but no tube is in place:
a. Use an .. or .. mask with your BVM to make a seal over the stoma.
infant or child
Seal the patient’s mouth and nose with one hand to prevent a leak of air through the ..when you ventilate through a stoma.
a. Release the seal of the patient’s mouth and nose for … .
b. This allows the air to exhale through the …
upper airway; exhalation; upper airway.
If you cannot ventilate a patient with a stoma:
a. Try …the stoma and the mouth with a French or soft-tip catheter.
b. … the stoma while giving mouth-to-mouth ventilation.
suctioning; Seal
Causes of airway obstruction that do not involve foreign bodies:
a. …, from …or acute … reaction
i. Repeated attempts to clear the airway could be dangerous.
ii. These patients require specific emergency medical care.
iii. Rapid transport to the hospital is critical.
b. …(tissue damage from injury)
Swelling; infection ; allergic; Trauma
(Recognition) Mild airway obstruction
a. Patients can still … air, but will have varying degrees of respiratory distress.
b. Great care must be taken to prevent a mild airway obstruction from becoming a severe airway obstruction.
c. The patient may have ..breathing and may be … .
exchange; noisy; coughing;
(Recognition) mild airway obstruction cont.:
d. With good air exchange, the patient can cough forcefully, although you may hear …between coughs (the production of whistling sounds during respiration).
i. Wheezing usually indicates a mild lower airway obstruction.
ii. As long as the patient can breathe, cough forcefully, or talk, you should not interfere with the patient’s efforts to expel the foreign object on his or her own.
iii. Continually reassess the patient’s condition.
e. With poor air exchange, the patient has a weak, ineffective (not forceful) cough and may have increased difficulty breathing, … (high-pitched noise heard mainly on inspiration), and … .
i. Stridor indicates mild upper airway obstruction.
ii. Treat immediately as if there is a severe airway obstruction.
wheezing ; stridor ; cyanosis
(Recognition) Severe airway obstruction
a. Patients cannot …, …, or …
b. The patient may clutch or grasp the throat (the universal distress signal), begin to turn …, and have extreme difficulty breathing.
c. There is little or no …
d. Ask the conscious patient, “Are you choking?”
i. If the patient nods “yes,” provide immediate treatment.
e. If the obstruction is not cleared quickly, the amount of oxygen in the patient’s blood will decrease dramatically.
f. If not treated, the patient will become unconscious and die.
breathe; talk; cough; cyanotic; air movement.;
(Recognition) severe airway obstruction cont:
g. Some patients will be unconscious as you form your general impression.
i. You may not know that an airway obstruction is the cause.
h. Other causes of unconsciousness and respiratory failure:
i. …
ii. …
iii. …
iv. …
v. …
i. If the patient is found unresponsive, does not appear to be breathing, and does not have a pulse, begin CPR with high-quality chest compressions.
Stroke; heart attack trauma seizures drug overdoses
(Recognition) severe airway obstruction cont:
i. When you open the airway and attempt two ventilations following chest compressions, it will be obvious if the airway is blocked.
ii. If there is no chest rise and fall after …to ventilate, or if you feel …while ventilating, consider the possibility of an airway obstruction.
iii. Resistance to ventilation can also be due to poor…
several attempts; resistance; lung compliance.
Perform a … to clear a tongue obstruction.
a. If spinal trauma is suspected, open the airway with a jaw-thrust maneuver.
head tilt–chin lift maneuver
Large pieces of vomited food, mucus, loose dentures, or blood clots in the mouth should be swept forward and out of the mouth with your gloved index finger.
When available, perform …to maintain a clear airway
suctioning
… are the most effective method of dislodging and forcing an object out of the airway of a conscious patient.
a. …, always present in the lungs, is compressed upward and used to expel the object.
b. Use the abdominal thrusts until the object dislodges or the patient becomes ….
Abdominal thrusts; Residual air; unconscious;
For the unresponsive patient with a severe foreign body airway obstruction, reassess to confirm …and inability to …. Begin chest compression just as you would for CPR, following the 30 compressions to 2 breaths ratio.
apnea; ventilate
At the completion of the 30 compressions, perform a …by grasping the jaw with your thumb and index finger.
a. Place your thumb onto the tip of the patient’s… and tongue while placing your index finger under the … of the chin.
b. Be careful not to compress the soft tissues under the chin.
c. Pull the jaw/mouth open and look at the back of the oropharynx for any foreign objects.
d. If you see an object, remove it with a gloved index finger or suction.
e. Never perform a blind sweep of the back of the oropharynx, which may push an object farther down in the airway, making the obstruction worse.
f. Once the object is removed, or if no object was seen, attempt to ventilate.
g. If you are still unable to ventilate, repeat the process.
tongue-jaw lift ; lower teeth; bony portion;
if tongue-jaw lift is unsuccessful, begin … and continue …on the way to the hospital.
rapid transport; abdominal thrusts
Treat patients with a mild airway obstruction and poor air exchange as if they have a s….
Patients with a mild airway obstruction and good air exchange should be monitored closely for deterioration of their condition.
a. If the patient is unable to clear the obstruction and remains conscious, support (or let the patient control) the airway position that is most …and ….
b. Provide supplemental oxygen and transport.
severe airway obstruction; efficient; comfortable
Many dental appliances can cause an …
Manually remove the dental appliance before providing ventilations. Simple manual removal may relieve the obstruction and allow the patient to breathe on his or her own.
airway obstruction;
Leaving well-fitting dentures in place usually makes BVM or mouth-to-mask ventilation much easier.
a. Provides more “…” to the face
b. Helps you provide a good …
structure; face-to-mask seal
Loose dentures interfere with the process and should be ….
- Appliances may loosen while you are providing care.
a. Periodically reassess the patient’s mouth to make sure they are firmly in place. - If possible, place dislodged dentures in a container and …them with the patient.
removed; transport
Facial bleeding
- Airway problems can be particularly challenging in patients with …
- The blood supply to the face is very rich, so injuries can result in severe … and bleeding into the airway.
- Control bleeding with … and … as necessary.
serious facial injuries; tissue swelling; bleeding; direct pressure; suction
