Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Airway Management and Ventilation 8

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Media Slide 8Breathing Sounds Animation Slide 17Lung Anatomy Labeling Exercise

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Breathing Respiratory System Anatomy Signs of Normal Breathing Signs of Abnormal Breathing

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley BREATHING

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Breathing Respiration: act of breathing; exchange of oxygen and carbon dioxide takes place in lungs. Body uses oxygen to produce energy. Respiratory compromise: patient not breathing adequately. Hypoxia: insufficient level of oxygen in blood and tissues.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view an animation illustrating breathing sounds.here BACK TO DIRECTORY

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Breathing Respiratory arrest: absence of breathing. Causes of respiratory compromise: – Asthma – Bronchitis – Heart attack – Severe allergic reactions – Exposure to toxic substances – Inhalation of super-heated air

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Breathing Respiratory system plays role in normal acid-base balance. Without proper pH, brain functions cease. Apnea: absence of breaths.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Breathing Respiratory arrest: absence of breathing. Cardiac arrest: absence of heartbeat. Clinical death: both heartbeat and respirations stop. Biological death: too many brain cells die (irreversible death).

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Breathing How we breathe: It's Automatic! – Lungs elastic and expandable. – Diaphragm primary breathing muscle. – Simple law: as volume increases, pressure decreases. – Inhalation (breath taken in). – Exhalation (breathing out).

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The respiratory cycle.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley RESPIRATORY SYSTEM ANATOMY

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Respiratory System Anatomy Major Structures – Nose; mouth – Throat; epiglottis – Trachea – Larynx – Bronchial tree – Lungs – Alveoli – Lung Anatomy Lung Anatomy

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to participate in an interactive labeling exercise on human lung anatomy.here BACK TO DIRECTORY

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The respiratory system.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Respiratory System Anatomy Respiratory Cycle – Air flows through mouth and nose, into throat, past epiglottis, into trachea. – Air flows into left/right main stem bronchi, through smaller bronchioles to alveoli. – Oxygen/carbon dioxide exchange takes place. – Oxygen travels through walls of alveoli, into blood, delivers it to cells. – Carbon dioxide travels from blood through alveoli walls, where eliminated when exhaled. (continued)

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Respiratory System Anatomy An Open and Clear Airway – Airway: nose, mouth, throat, trachea. – Patent: open and clear airway. – Causes of obstruction  Patient's own tongue  Foreign object  Swelling of tissues **Differences between the airway of an adult and the airway of a child.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to the home of a 62-year- old male complaining of shortness of breath. He cannot speak in complete sentences, so you can tell his breathing is not adequate. Considering the respiratory cycle; what is happening inside his body?

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SIGNS OF NORMAL BREATHING

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Signs of Normal Breathing Look for adequate tidal volume. Listen for air entering and leaving nose and mouth. If unresponsive, feel for air moving into and out of nose and mouth. Observe skin color. Observe level of responsiveness. Normal Breathing

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SIGNS OF ABNORMAL BREATHING

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abnormal Breathing Sounds

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Signs of Abnormal Breathing Signs and Symptoms – Increased work of breathing. – Absent or shallow rise and fall of chest. – Little or no air heard or felt at nose or mouth. – Noisy breathing or gasping sounds. – Breathing that is irregular, too rapid, or too slow. – Breathing that is too deep or labored. (continued)

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Signs of Abnormal Breathing Signs and Symptoms (continued) – Use of accessory muscles in chest, abdomen, and around neck. – Nostrils that flare when breathing. – Skin that is pale or cyanotic. – Sitting or leaning forward in tripod position. – Agonal respirations: slow, sporadic gasps of air from unresponsive patient. – Crackles Crackles – Wheezing Wheezing (continued)

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Signs of Abnormal Breathing Stridor: Indication of obstruction of the upper airway. Remember: Upper Airway includes nose, nasal passages, paranasal sinuses, the pharynx and a portion of the larynx above vocal cords. Lower Airway includes the portion of the larynx below the vocal cords, trachea, bronchi, and bronchioles.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to find an unresponsive 23-year-old male with a history of narcotic abuse. He is making snoring- like breathing sounds with periods of apnea. What are these respirations called?

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Respiratory compromise caused by asthma, bronchitis, drowning, choking. Clinical Death occurs the moment that both breathing and heartbeats stop. Biological (irreversible) Death occurs approximately four to six minutes following clinical death.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Patent airway is clear and open. Air contains approximately 21% oxygen. Signs of inadequate breathing: – Increased work of breathing. – Shallow, rapid, noisy, or gasping breathing.