Airway Module 2

Airway The Respiratory System Opening the Airway Inspecting the Airway Airway Adjuncts Clear/Maintain Airway Breathing Ventilation Techniques of Ventilation FBAO Adult FBAO Child / Infant Special Considerations

Airway The Respiratory System

Delivers oxygen to the body Removes carbon dioxide from the body

Respiratory System

How Respiration Works

Adult/Child Respiratory Systems

Opening the Airway “One of the most important actions that the First Responder can perform is opening the airway of an unresponsive patient.”

Head-tilt Chin-lift “The method of choice for opening the airway in uninjured patients.”

Rescuer places palm on patient’s forehead.

Rescuer places fingers on chin.

Rescuer performs head-tilt /chin-lift maneuver.

Jaw Thrust “The safest approach to opening the airway in the patient with suspected spinal injury.”

Rescuer stabilizes patient’s head, with collar in place.

Rescuer places fingers on jaw.

Rescuer performs jaw thrust.

Inspect the Airway An unresponsive patient may have fluid or solids in the airway that may compromise the airway. Responsive patients who cannot protect their airway should also have their airways inspected.

Always ensure an open airway.

Airway Adjuncts “Once the airway is open, it may be necessary to insert an airway adjunct (an artificial airway).”

Oropharyngeal Airways

Select oropharyngeal airway.

Another Way to Measure

Insert airway.

Rotate airway into position.

Flange rests against lips.

Child Oropharyngeal Airway

Nasopharyngeal Airways

Determine proper size.

Lubricate airway.

Gently advance airway.

Airway in Place

Clearing / Maintaining the Compromised Airway “These techniques are not sequential; the situation will dictate which technique is most appropriate.”

The Recovery Position Uses gravity to keep the airway clear. Monitor the patient until additional EMS resources arrive and assume care. Used in unresponsive, uninjured patients, breathing adequately.

Recovery Position

Finger Sweeps Use body substance isolation. Uses your fingers to remove solid objects from the airway.. Blind finger sweeps should not be performed in infants or children.

Rescuer performs tongue-jaw lift.

Rescuer inserts finger in patient’s mouth.

Rescuer hooks finger and clears obstruction.

Suction A patient needs to be suctioned immediately when a gurgling sound is heard during breathing or ventilation. Purpose is to remove blood, other liquids, and food particles from the airway.

Portable Electric Suction

Hand-operated Suction

Suction by moving the tip from side to side.

Presence of Breathing “Immediately after opening the airway, check for breathing.”

Rescuer observes patient breathing.

Effort of Breathing Breathing should be effortless. Observe the chest for adequate rise and fall. Look for accessory muscle use.

Inadequate Breathing Rate less than 8 in adults. Rate less than 10 in children. Rate less than 20 in infants.

Inadequate Breathing Inadequate chest wall motion. Cyanosis. Mental status changes. Increased effort. Gasping or Grunting. Slow heart rate associated with slow respirations.

Ventilation If the patient is not breathing they only have the oxygen in their lungs and their bloodstream remaining. In order to prevent death, the First Responder must ventilate the patient.

Techniques of Ventilation “There are many techniques for ventilation - the First Responder must be competent in the following three techniques.”

Techniques Mouth to mask. Mouth to barrier device. Mouth to mouth. In order of preference!

Mouth to Mask Most effective First Responder technique. Mouth to mask ventilation is very effective since you use two hands to seal around the mask.

Pocket mask with O 2 inlet is shown.

Rescuer positions mask on patient’s face.

Rescuer seals mask on face, sealing nose with thumbs.

Rescuer seals mask on face, using hand position.

Rescuer ventilates through pocket mask.

Mouth to Mask Give one slow (1 1/2 - 2 second) breath of sufficient volume to make chest rise. Adequate ventilation determined by: Observe the chest for rise and fall. for rise and fall. Listen and feel for air escape during exhalation.

Continue at Proper Rate ADULTS breaths / min 1 1/2 - 2 seconds each

Continue at Proper Rate Children Infants 20 breaths / min /2 seconds each

Continue at Proper Rate Newborns 40 breaths / min /2 seconds each

Mouth to Barrier Device A barrier device should be used if available. Some rescuers may prefer to use a barrier device during ventilation. Barrier devices should have low resistance to delivered ventilation.

Example of a Barrier Device

Mouth to Mouth Quick, effective method of delivering oxygen to the non- breathing patient. The rescuer’s exhaled air contains enough oxygen to support life. Barrier devices should have low resistance to delivered ventilation.

Mouth to Mouth The decision to perform mouth to mouth by First Responders is a personal choice. Whenever possible, a barrier device should be used.

FBAO - Adult Can be the cause of cardiac arrest Can be the result of cardiac arrest

Partial Airway Obstruction Patient remains responsive. May be able to speak. Good Air Exchange Can cough forcefully. May be wheezing between coughs.

Partial Airway Obstruction Weak ineffective cough. High pitched noise on inhalation. Poor Air Exchange Increased respiratory difficulty. Possibly cyanotic.

Complete Airway Obstruction No air can be exchanged. Patient will be unable to speak, breathe, or cough. Patient may clutch the neck with thumb and fingers. Death will follow rapidly if prompt action is not taken.

Universal Signal

Abdominal Thrusts

Abdominal Thrusts (continued)

Chest Thrusts (pregnant patient)

Attempt to ventilate.

Abdominal Thrusts

Finger Sweep

Chest Thrusts (pregnant patient)

FBAO - Infants/Children “More than 80% of childhood deaths from FBAO are in children below age 5. 65% are infants.”

FBAO - Infants/Children Airway obstructions can be caused by infections. Blind finger sweeps are not done in infants and children.

Determine responsiveness.

Open airway.

Attempt to ventilate.

Deliver five back-blows.

Deliver five chest-thrusts.

Inspect airway.

Repeat...

Special Considerations stoma “Persons who have undergone a laryngectomy have a permanent opening (stoma) that connects the trachea to the front of the neck.”

Chest Thrusts (pregnant patient)

Mask-to-stoma Ventilation