Respiration and Artificial Respiration Flashcards
Inhalation is;
- Active process
* Negative pressure pulls air into lungs
Exhalation;
- Passive process
- Muscles relax; size of chest decreases
- Positive pressure created; air pushed out
• Tidal volume
—amount of air moved in one
breath
• Dead space air—air moved in ventilation not reaching alveoli
—air moved in ventilation not reaching alveoli
• Alveolar ventilation
—air actually reaching alveoli
• Ventilation
—both inhaling and exhaling
Diffusion
—movement of gases from high
concentration to low concentration
• External respiration
—diffusion of oxygen and carbon dioxide (exchange of gases) between alveoli and circulating blood
• Internal respiration
—exchange of gases between blood and cells
During ventilation what happens in the cells
• Oxygen from blood
diffused into cell
• Carbon dioxide diffused from cell into blood
What are the Categories of Respiratory System Failure
- Mechanics of breathing disrupted
- Gas exchange interrupted
- Circulation problems
Hypoxia:
low oxygen level in cells
Hypercapnea
high carbon dioxide level
,
• Brain and body cells need a steady supply of oxygen
– Hypoxia: low oxygen level in cells
• Carbon dioxide must be continuously removed
– Hypercapnea: high carbon dioxide level
What is the goal of evaluating Respiration
• Assesses how well cardiopulmonary system is accomplishing oxygenation and carbon dioxide removal
What are the signs of Respiratory Compensation
• Compensation for hypoxia or hypercapnea
is predictable
• Signs
– Shortness of breath (symptom)
– Increased respiratory rate and depth – Increased heart rate
• Early on, steps of compensation can meet the needs of the body despite respiratory challenge
Respiratory Distress
• Body compensating for a respiratory challenge and meeting metabolic needs
Signs of Respiratory Distress
• Relatively normal mental status
• Relatively normal oxygen saturation and
end tidal carbon dioxide
• Relatively normal skin color
• Shortness of breath
• Increased respiratory rate and heart rate
• Accessory muscle use and position changes
Respiratory Failure
- Occurs when challenge overcomes compensation or compensatory steps can no longer continue
- Also known as inadequate breathing
- Exceptionally important to recognize; often a precursor to respiratory arrest
Signs of Respiratory Failure
• Signs of respiratory distress
• Evidence that compensation is no longer
effective
• Signs of poor oxygenation and/or poor removal of CO2
• Signs of decompensation
• Signs of failed oxygenation and/or removal of CO2
– Altered mental status – Cyanosis
Signs of Decompensation
- No or poor air movement
- Diminished or absent breath sounds
- Breathing rate too rapid, too slow, or irregular
- Patient unable to speak
- Unusual noises (wheezing, crowing, stridor, snoring, gurgling, gasping)
Signs of Respiratory Failure: Pediatric Note
• In addition to other signs, look for retractions and nasal flaring
Critical Decisions: When to Intervene
• Often respiratory failure patients will be breathing and conscious
• Identify adequacy of breathing
– If breathing is inadequate, immediate intervention is necessary
Critical Decisions: When to Intervene
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Positive Pressure Ventilation
- Forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing
- Uses force exactly opposite of how the body normally draws air into the lungs
Negative Side Effects of Positive Pressure Ventilation
- Decreasing cardiac output/dropping blood pressure
- Gastric distention
- Hyperventilation
Key Concerns with PPV
- Do not ventilate patient who is vomiting or has vomitus in airway—PPV will force vomitus into patient’s lungs
- Watch chest rise and fall with each ventilation
- Ensure rate of ventilation is sufficient
Ventilating a Breathing Patient
- Explain procedure to patient
* After sealing mask on patient’s face, squeeze bag with patient’s inhalation
Mouth to Mask Ventilation is Performed using
using a pocket face mask
Performing Mouth to Mask Ventilation
- Open airway
- Connect oxygen and run at 15 Lpm
- Position mask on patient’s face
– Apex over bridge of nose
– Base between lower lip and prominence of chin - Hold mask firmly in place; maintain head tilt
- Exhale into mask port
- Allow passive exhalation
Achieving Tight Mask Seal
- Position thumbs over top of mask, index fingers over bottom of mask, and remaining fingers under patient’s jaw
- Position thumbs along side of mask and remaining fingers under patient’s jaw
Bag-Valve Mask (BVM)
• Handheld
ventilation device
• Used to ventilate nonbreathing patient and/or patient in respiratory failure
Standard Features of BVM
• Self-refilling shell that is easily cleaned
and sterilized
• Non-jam valve that allows an oxygen inlet flow of 15 Lpm
• Nonrebreathing valve
Mechanics of BVM
• Supply of 15 Lpm O2 attached and enters
reservoir
• When squeezed, air inlet closed and oxygen delivered to patient
• When released, passive expiration by patient occurs
Two-Rescuer BVM Ventilation
- Strongly recommended by AHA
- Most difficult part of BVM ventilation is obtaining adequate mask seal
- Hard to maintain seal while squeezing bag
- One rescuer squeezes bag; other rescuer maintains seal
Two-Rescuer BVM Ventilation: No Trauma Suspected
- Open airway with head-tilt, chin-lift maneuver
- Select correct bag-valve mask size
- Kneel at patient’s head; position thumbs over top half of mask, index fingers over bottom half
- Place apex of triangular mask over bridge of nose; lower mask over mouth and upper chin
- Use middle, ring, and little fingers to bring patient’s jaw up to mask
– Maintain head-tilt, chin-lift maneuver - Second rescuer connects and squeezes bag
- Second rescuer releases bag; patient exhales passively
Two-Rescuer BVM Ventilation: Trauma Suspected
- Open airway using jaw-thrust maneuver
- Select correct bag-valve mask size
- Kneel at patient’s head; place thumb sides of your hands along mask to hold it firmly on patient’s face
- Use remaining fingers to bring jaw upward toward mask, without tilting head or neck
One-Rescuer BVM Ventilation
- Open airway
- Select correct size mask
- Position mask on patient’s face
- Squeeze bag
- Release pressure on bag and let patient exhale passively
If Chest Does Not Rise During BVM Ventilation
- Reposition head
- Check for escape of air around mask;
reposition fingers and mask - Check for airway obstruction or obstruction in BVM system
- Use alternative method
Artificial Ventilation of a Stoma Breather
- Clear mucus plugs or secretions from stoma
- Leave head and neck in neutral position
- Use pediatric-sized mask to establish seal around stoma
- Ventilate at appropriate rate for patient’s age
- If unable to artificially ventilate through stoma, seal stoma and attempt artificial ventilation through mouth and nose
Using Flow-Restricted, Oxygen-Powered Ventilation Device
• Use on adults only
• Follow same procedures for mask seal as
for BVM
• Trigger device until chest rises
Automatic Transport Ventilator (ATV)
- Provides automated ventilations
- Can adjust ventilation rate and volume
- Provider must assure appropriate respiratory rate and volume for patient’s size and condition
• How would you decide which positive pressure delivery method to use for your patient?
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Conditions Requiring Supplemental Oxygen
- Respiratory or cardiac arrest
- Heart attacks and strokes
- Shock
- Respiratory distress and lung diseases • Head injuries
- Other serious injuries
Oxygen Systems can be..
• Portable or installed
Oxygen Cylinders D contain how much O2
• Come in various sizes
– D—about 350 L of O2
Oxygen Cylinders E contain how much O2
– E—about 625 L of O2
Oxygen Cylinders M contain how much O2
– M—about 3,000 L of O2
Oxygen Cylinders G contain how much O2
– G—about 5,300 L of O2
Oxygen Cylinders H contain how much O2
– H—about 6,900 L of O2
Oxygen Safety
• Use pressure gauges, regulators, and
tubing intended for use with oxygen
• Use non-sparking wrenches
• Replace disposable gaskets each time a cylinder is changed
• Properly secure oxygen cylinders in a cool, ventilated space
• Never drop cylinder or move by dragging
Oxygen Safety
Delivery Devices: Nonrebreather Mask
• Best way to deliver high concentrations of oxygen to a breathing patient
Delivery Devices: Nonrebreather Mask
- Provides oxygen concentrations of 80%–100%
- Minimum flow rate 8 Lpm
- Maximum flow rate 12–15 Lpm
Delivery Devices: Nasal Cannula
• Best choice for a patient who refuses to wear an oxygen face mask
Delivery Devices: Nasal Cannula
- Provides oxygen concentrations of 24%–44%
* Should deliver no more than 4–6 liters per minute
Delivery Devices: Partial Rebreather Mask
• Very similar to nonrebreather mask
• No one-way valve in opening to reservoir
bag
• Delivers 40%–60% oxygen at 9–10 Lpm
Delivery Devices: Venturi Mask
- Delivers specific concentrations of oxygen by mixing oxygen with inhaled air
- Some have set percentage and flow rate; others have adjustable Venturi port
Delivery Devices: Tracheostomy Mask
- Placed over stoma or tracheostomy tube to provide supplemental oxygen
- Connected to 8–10 Lpm
Humidifier
• Connected to
flowmeter
• Provides moisture to dry oxygen from supply cylinder
Facial Injuries
• Bleeding and swelling can disrupt
movement of air
• Aggressive suction and advanced airway maneuvers may be necessary
Obstructions
• Foreign bodies can impede ventilation of
patients
• If unable to ventilate always consider the possibility of obstruction
Pediatric Notes
• Hypoxia often occurs rapidly
– Children burn oxygen at twice the rate of adults
– Account for many anatomical differences associated with airway
Ventilating Pediatric Patients
- Avoid excessive pressure and volume
- Use properly sized face masks
- Flow-restricted, oxygen-powered ventilation devices contraindicated
- Gastric distention may impair adequate ventilations
Types of Advanced Airway Devices
- Devices requiring direct visualization
* Devices inserted “blindly”
Assisting with Intubation
- Maximize oxygenation prior to procedure
- Position patient in sniffing position
- Cricoid pressure
- Confirmation
- Securing tube in place
Ventilating the Intubated Patient
- Very little movement can displace an endotracheal tube
- Pay attention to resistance to ventilations; report changes
- If patient is defibrillated, carefully remove bag from tube
Assisting with a Trauma Intubation
- Provide manual in-line stabilization throughout procedure
* Position hands to hold stabilization, but allow for movement of jaw
Blind Insertion Devices
• Examples – King LT-DTM airway – Combitube® – Laryngeal Mask Airway (LMATM) • Usually do not require head to be placed in sniffing position
Chapter Review
• Respiratory failure (inadequate breathing):
breathing is insufficient to support life.
• A patient in respiratory failure or respiratory arrest must receive artificial ventilations.
• Oxygen can be delivered to the nonbreathing patient as a supplement to artificial ventilation.
• Oxygen can also be administered as
therapy to the breathing patient.
• Supplemental oxygen is indicated when breathing is inadequate or in patients that have a condition that would benefit from additional oxygen delivery.
Remember
• Always use proper personal protective
equipment when managing an airway.
• Assessment of breathing must be an ongoing process. Respiratory status can change over time.
• Inadequate breathing requires immediate action.
• Positive pressure ventilations are very different than normal breathing and can have negative side effects.
• Select the most appropriate method of positive pressure ventilations based upon the needs of the individual.
• Always use appropriate safety measures
when handling oxygen.
• Select the appropriate delivery device to provide supplemental oxygen.
• What are the signs of respiratory distress?
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• What are the signs of respiratory failure?
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• For BVM ventilation, what are recommended variations in technique for one or two rescuers?
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• How does the way positive pressure ventilation moves air differ from how the body normally moves air?
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• Describe a patient problem that would benefit from administration of oxygen and explain how to decide what oxygen delivery device should be used.
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- On arrival at the emergency scene, you find an adult female patient who is semiconscious. Her respiratory rate is 7 per minute. She appears pale and slightly blue around her lips
- Is this patient in respiratory failure, and if so what signs and symptoms indicate this? Does this patient require artificial ventilations?
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What is the intervention for a pt with adequate breathing
Non-rebreather or nasal cannula
How do you recognize adequate breathing
Pt is breathing adequately but needs supplemental O2 due to a medical or traumatic condition
. rate and depth of breathing are adequate
. no abnormal breath sounds
. air moves freely in and out of the chest
. skin color is normal
What is the intervention for a pt with inadequate breathing (respiratory failure)
Assisted ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD
Note: a non rebreather mask requires adequate breathing as it does not force air into the lungs
What is the intervention for a pt who is not breathing
Artificial ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD, or ATV at 10-12 / minute for an adult and 20/minute for an infant or children
Note: DO NOT use oxygen powered ventilation devices o infants or children
What are the signs for a pt with inadequate breathing (respiratory failure)
. pt has some breathing but not enough to live
. rate and/or depth outside of normal limits
. shallow ventilation
. Diminished or absent breath sounds
. Noises such as crowing, stridor, snoring, gurgling or gasping
. blue (cyanotic) or gray skin color
. decreased minute volume
What are the signs for a pt with no breathing (respiratory arrest)
. no chest rise
. no evidence of air being moved from the mouth or nose
. no breath sounds
when do you use a non rebreather or nasal cannula
Adequate breathing - pt is talking in full sentences
when do you use a non rebreather
Increasing respiratory distress: visibly short of breath, speaking 3 or 4 work sentences, increasing anxiety
when do you use assisted ventilations: PFM, BVM or FROPVD - assist pt own ventilations, adjusting the rate for rapid or slow breathing
Severe respiratory distress, speaking only 1-2 word sentences very diaphoretic (sweaty), severe anxiety
continues to deteriorate: sleepy with head bobbing, becomes unarousable
What device do you use when a pt is in respiratory arrest: no breathing
Artificial ventilation (air forced into the lungs under pressure) with a pocket face mask, BVM or FROVD, or ATV at 10-12 / minute for an adult and 20/minute for an infant or children
Note: DO NOT use oxygen powered ventilation devices o infants or children
What is the normal respiratory rate and quality for an adult
12-20, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
What is the normal respiratory rate and quality for an child
12-30, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
What is the normal respiratory rate and quality for an infant
25-30, quality breath sounds present & equal, rhythm - regular depth - adequate chest expansion - adequate 7 equal minimum effort
Signs of Inadequate Breathing
. Chest movements are absent, minimal, or uneven
. Movement associate with breathing is limited to the abdomen (abdominal breathing)
. No air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal
. Breath sounds are diminished or absent
. Noises such as cheesing crowing, sirdor, snoring, gurgling, or gasping are heard during breathing
. rate of breathing is too rapid or too slow
. breathing is very shallow, very deep, or appears labored
. The pt skin, lips, tongue, ear lobes or nail beds are blue or gray - cyanotic
. Inspirations are prolonged Indicating a possible upper airway obstruction, or expirations are prolonged (indicating a possible lower airway obstruction)
. Patient is unable to speak, or the patin cannot speak full sentences because of shortness or breath
. In children there may be reiterations (a pulling in of the muscles) above the clavicles and below the ribs
. Nasal flaring (widening of the nostrils of the nose with respiration) may be present, especially in infants and children
cyanotic
a blue or gray color resulting from a lack go oxygen in the blood
what can cause hypoxia
a pt is trapped in a fie
a patient has emphysema
a pt overdoes on a drug that has a depressing effect on the respiratory system
a pt has a heart attack
artificial ventilation
forcing air into the lungs when a pt has stopped breathing or has inadequate breathing. Also called positive pressure ventilation
pocket face mask
a device, usually with a one way valve to aid in artificial ventilation. A rescuer breathes through the valve with the mask is placed over the patient face. It also acts as a barrier to prevent contact with a patients body fluids. It can be used with supplemental oxygen when fitted with an oxygen mask.
