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EMT Basic Advanced Airway Management

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Presentation on theme: "EMT Basic Advanced Airway Management"— Presentation transcript:

1 EMT Basic Advanced Airway Management
Pharyngeal Esophageal Airway Device (PEAD) A.K.A. Combitube© Feel free to share this with anybody, so long as credit is given….Thanks PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer West Valley Fire District, Willamina, OR

2 The Cat Fan (No Pun Intended)
I am an avid cat lover and have 4 cats of my own. Even still, I laugh at this clip!

3 Agenda Review Objectives Lesson 1 Lesson 2 Lesson 3
Respiratory Anatomy & Physiology Lesson 2 Respiratory Volume and Management Lesson 3 Assessing Respiratory Problems

4 Agenda cont’d Lesson 4 Lesson 5 Lesson 6 Respiratory/Cardiac Arrest
Basic Airway Management Lesson 5 Suctioning Lesson 6 Dual-Lumen Airway Devices

5 Agenda cont’d Demonstration Practical Stations Basic Airway Management
Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning Combitube Insertion

6 Practical Testing must be done with the Physician Advisor (or another Physician of his / her choosing)

7 Objectives Describe the anatomy and function of the upper and lower airways Describe respiratory volumes and capacities in relationship to the need for assisted ventilations Identify the specific observations and physical findings commonly found in patients presenting in respiratory and/or cardiac arrest. Identify the basic principles of airway management

8 Objectives (cont’d) Describe the indications for suctioning.
Identify rigid and flexible suction catheters and the indications for use. Identify indications and contraindications for use of the PEAD’s. Identify the advantages and disadvantages of using PEAD’s.

9 Objectives (cont’d) Identify those situations in which PEAD’s may be removed. Demonstrated placement of PEAD’s. Demonstrate methods of assuring and maintaining correct placement of PEAD’s. Demonstrate re-ventilation for missed placement of PEAD’s.

10 Objectives (cont’d) Demonstrate on a manikin the proper technique for the use and maintenance of the following airway adjuncts: Nasal cannula Non-rebreather mask Bag-Valve-Mask Demonstrate sterile suctioning techniques on a manikin with a PEAD in place.

11 Respiratory Anatomy & Physiology
Lesson 1 Respiratory Anatomy & Physiology

12 Respiratory Anatomy & Physiology
General function of the respiratory system Remove carbon dioxide from the blood Transfer oxygen into the blood

13 Function of the Respiratory System
Removes carbon dioxide from the blood Transfers oxygen to the blood

14 The Upper Airway A B C D E F G H Epiglottis Mandible Frontal Sinus
Soft Palate Trachea Glottis Esophagus Vocal Cords Structures: Nose, Nasopharynx, mouth, oropharynx, hypopharynx, larynx, epiglottis Functions: Passage way for air, warms, humidifies, filters, protection – gag reflex & cough, speech

15 The Upper Airway Other Structures Functions Nasopharynx Oropharynx
Hypopharynx Larynx Functions

16 Functions of the Upper Airway
Passageway for air Warm Filter Humidify Protection Gag Reflex Cough Speech

17 The Lower Airway Primary Bronchi Hyoid Bone Right Lung
F G H I J Primary Bronchi Hyoid Bone Right Lung Secondary Bronchi Tracheal Ligament Trachea Larynx Esophagus Left Lung Trachea, main stem bronchi, secondary bronchi, bronchiolus Function: Air passage, gas exchange, warm and humidify

18 Alveoli Gas Exchange

19 Lungs Structure Lobes Pleura

20 Physiology of Respiration
Define Respiration The exchange of gases between a living organism and the environment Define Ventilation Mechanical Process that moves air in and out of the lungs

21 Muscles of Breathing Intercostal Muscles Diaphragm

22 Regulation of Respiration
Where is the Respiratory Center Controlled? Brainstem Medulla Apeustic Center (pons) Pneumotaxic center (pons) Stretch receptors Hering-Breuer reflex Chemoreceptors CSF Blood

23 Voluntary or Involuntary
Both Humans can override body’s urge to breathe But only for so long

24 Respiratory Cycle Inspiration Expiration Active phase
Lasts 1-2 seconds Expiration Passive phase Lasts 5 seconds

25 Respiratory Volume and Management
Lesson 2 Respiratory Volume and Management

26 Drinking Straw Exercise
Breathe through straws for 1 minute

27 Carbon Dioxide & The Respiratory System
High CO2 Increases respiratory rate Low CO2 Decreases respiratory rate Hypoxic Drive Chronic COPD patients

28 Normal Respiratory Rates
Adult Children Infants Newborns 12 – 20 / min 18 – 24 / min 22 – 36 / min 40 – 60 / min

29 Factors Affecting Respiratory Rate
Fever Depressant Drugs Anxiety Insufficient Oxygen Stimulant Drugs Sleep

30 Respiratory Volumes Lung Capacity Tidal Volume Dead Space Alveolar Air
6000 mL of air 500 mL at rest 150 mL 350 mL

31 Minute Volume Total air moved per minute Rate X Volume = Minute volume
Important Assessment Item

32 Factors Affecting Minute Volume
Head, neck, chest injury Shock Diabetes CO2 / O2 rapid changes

33 Maintaining the A in ABC
Patient positioning Suctioning Supplemental Oxygen Mechanical Assistance

34 Pulse Oximetry Measures amount of oxygen in the blood.
Gives percent of hemoglobin saturated Tool only, do not rely on totally Why? Normal Values 95% - 100% Normal 90% - 95% - Mild – Normal for COPD < 90 % Moderate – High Flow Oxygen

35 End-Tidal CO2 Detection
Measured Colorimetric and Digital Tool to aid in determining correct placement

36 Assessing Respiratory Problems
Lesson 3 Assessing Respiratory Problems

37 Patient Assessment

38 General Patient Assessment
Primary Survey LOC ABC’s Speech Pattern Obvious Respiratory Noise Patient Position

39 General Assessment (cont’d)

40 Secondary Assessment SAMPLE history Chief Complaint
Pertinent Negatives Chest Pain (pleuritic vs cardiac) Cough History Edema Vitals

41 Respiratory Assessment
Confusion, Agitation, Orientation Cyanosis (late sign) Diaphoresis Retractions Accessory Muscle Use Jugular Venous Distention Nasal Flaring / Pursed Lip Breathing

42 Palpation Skin Pulse Chest Wall Pain Tracheal Deviation Turgor Color
Temperature Diaphoresis Pulse Rate Rhythm Quality Chest Wall Pain Tracheal Deviation

43 Assessing Lung Sounds Methods Hand Out

44 Lung Sounds Normal Wheezes Rales (Crackles) Stridor Rhonchi
Pleural Rub Listen on every patient End of Expiration End of Inspiration During both phases Expiration

45 Respiratory Diseases COPD Asthma Pneumonia Pulmonary Edema
Pulmonary Embolus Trauma


47 Chronic Obstructive Pulmonary Disease
Pink Puffers and Blue Bloaters Frequently on Home oxygen Assessment Typical Lung Sounds Common Medications May or May not be Hypoxic Drive

48 Asthma

49 Asthma Bronchiole Constriction & Mucous Production Lung Sounds
Wheezes Diminished None Usually Diagnosed

50 Pneumonia

51 Pneumonia Fever Productive Cough General Illness
Colored Sputum General Illness Elderly & Pediatric most at risk Lung Sounds Rhonchi, Rales, Wheezes

52 Pulmonary Edema

53 Pulmonary Edema Congestive Heart Failure Lung Sounds
Acute – Flash Pulmonary Edema Chronic – Heart Failure Medications Orthopnea, PND Lung Sounds Keep them upright with legs dangling

54 Pulmonary Embolus

55 Pulmonary Embolus Lung Sounds History
Surgery Bed Confined Long trip Rapid Transport & High Flow Oxygen

56 Trauma

57 Trauma Maintain spinal control Airway Management High Flow Oxygen
Rapid Transport Seal Chest Wounds Stabilize Impaled Objects

58 Respiratory/Cardiac Arrest Basic Airway Management
Lesson 4 Respiratory/Cardiac Arrest Basic Airway Management

59 Respiratory & Cardiac Arrest

60 Assessing the Patient First Steps of CPR Annie, Annie You Okay?
Other Signs and Symptoms Unconsciousness Cardiac Seizure Agonal respirations or apnea Cyanosis, Ashen, Mottled No signs of spontaneous respiration or circulation No Pulse

61 Combitube

62 When to Use the Combitube
CPR Remember to do CPR! Attach AED! Respiratory Arrest Agonal Respirations without intact gag reflex Respiratory Arrest leads to Cardiac Arrest

63 Airway Management – The Basics
Manual Maneuvers Chin Lift Jaw Lift Jaw Thrust Head Tilt – Chin Lift Modified Jaw thrust

64 Airway Management – The Basics
Mechanical Airways NPA’s OPA’s Description Advantages Disadvantages Indications Contraindications Methods of Insertion

65 Airway Management – The Basics
Ventilation Mouth to Mask BVM Description Advantages Disadvantages Indications Contraindications Methods of Use

66 Evaluation of Effectiveness
How do I know I am ventilating? Chest movement Lung Sounds Epigastric sounds/Abdominal distention Patient Response

67 Lesson 5 Suctioning

68 Reviewing Suctioning BSI – Scene Safety Equipment
Suction device Rigid or Soft Tip Insert with Suction Off Withdraw while Suctioning No more than 15 seconds before ventilating!

69 Oh, That Sucks! Vomitus Aspiration damage Food
Protein dissolving enzymes Hydrochloric Acid Aspiration damage Alveolar Damage Increased fluid Obstruction Aspiration Pneumonia

70 Oh, Go Spit on It Saliva Aspiration Damage Digestive enzymes Bacteria
Fills alveoli Pneumonia

71 Food Clogs airways Interferes with ventilation Pneumonia

72 Blood Contents Aspiration Damage Protein Fibrin Water Electrolytes
Clog small airways Creates chemical reaction

73 Suction Catheters Rigid Advantages Disadvantages Indications
Contraindications Methods of Use Flexible Advantages Disadvantages Indications Contraindications Methods of Use

74 Dual-Lumen Airway Devices
Lesson 6 Dual-Lumen Airway Devices

75 Combitube©

76 Description Other Similar Devices What we use
Pharyngeal tracheal lumen airway (PTLA) EGTA EOA What we use Combitube©

77 Indications for Combitube©
Respiratory Arrest Cardiac Arrest Unconscious, without a gag reflex

78 Contraindications for Combitube©
Gag Reflex Conscious Breathing Adequately Caustic Ingestion Known esophageal disease or varices Under 16 y/o Under 5 feet or over 6 feet 8inches

79 Advantages for Combitube©
Rapid Insertion Limits regurgitation, aspiration & distention Blind insertion High oxygen delivery Less training required Inserted in neutral position

80 Disadvantages for Combitube©
Patient must be unresponsive without gag reflex Some are difficult to obtain adequate seal Some do not totally protect against aspiration Most responsive patients will vomit when removed May damage esophagus

81 Demonstration

82 When Can I Remove the Combitube?
Patient returns to full consciousness Patient able to maintain own airway Orders from OLMC

83 Procedure for Removing
SUCTION READY! Deflate Tube #2 Deflate Tube #1 Tell patient to exhale Pull out quickly and in-line SUCTION

84 Demonstration

85 Skills Labs Basic Airway Management Advanced Airway Management
Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning Advanced Airway Management Combitube

86 Questions?

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