1. Chapter 7 Airway and Oxygen Management
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2. Introduction
Under normal circumstances, brain cells can survive approximately four to six minutes after the heart stops beating before irreversible brain damage or death
In a cold environment, brain damage or brain death from lack of oxygen may be delayed beyond this typical timeline
This chapter focuses on techniques used to open and secure an airway, suction, ventilate, and deliver oxygen to a patient
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3. Determining if a Patient’s Airway Is Open
Learning Objective 1
Determining if a Patient’s Airway Is Open
AIRWAY
Airway must be open for oxygen delivery
Requires adequate opening
From the mouth and nose down the trachea to the lungs
PENMAN
AVPU
EMR 7-3

4. Determining if a Patient’s Airway Is Open
Learning Objective 1
Determining if a Patient’s Airway Is Open
POSITIONING CONSIDERATIONS
Victim in a car
If mechanism of injury indicates, suspect a spinal injury
Trauma situation
Jaw thrust maneuver
If no breathing, turn victim as a unit and proceed to open the airway
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5. Determining if a Patient’s Airway Is Open
Learning Objective 1
Determining if a Patient’s Airway Is Open
AIRWAY OBSTRUCTION
Determine if airway is obstructed
Food, toys, dentures, or broken teeth
Secretions
Spasms
Opening obstructed airway
Current AHA guidelines
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6. Suction Devices for Obstructed Airways
Learning Objective 2
Suction Devices for Obstructed Airways
SUCTIONING THE AIRWAY
Secretions causing the obstruction
Perform maneuver to clear secretions
Suctioning necessary if not clear
Preventing aspiration
Clearing secretions helps clear airway
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7. Suction Devices for Obstructed Airways
Learning Objective 2
Suction Devices for Obstructed Airways
MANUAL AND MECHANICAL SUCTIONS
Manual suction
Suctioning unit manually operated
Mechanical suction unit
Portable suction device
Battery operated
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8. Suction Devices for Obstructed Airways
Learning Objective 2
Suction Devices for Obstructed Airways
MECHANICAL SUCTIONING
Catheters
Rigid and flexible longer catheters (basic types)
Suctioning
Vomiting
Gag reflex
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9. Suction Devices for Obstructed Airways
Learning Objective 2
Suction Devices for Obstructed Airways
RECOVERY POSITION
Used when patient breathes without assistance
Allows secretions to drain
Lateral recumbent position
Do not use with
suspected spinal injury
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10. Oropharyngeal and Nasopharyngeal Devices
Learning Objective 3
Oropharyngeal and Nasopharyngeal Devices
AIRWAY DEVICES
Maintain open airway
Keep tongue from obstructing back of mouth
Help maintain open airway
Head-tilt, chin-lift maneuver
Jaw thrust maneuver
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11. Oropharyngeal and Nasopharyngeal Devices
Learning Objective 3
Oropharyngeal and Nasopharyngeal Devices
RIGID OROPHARYNGEAL AIRWAY (OPA)
Used to maintain a patent airway
Placed in unresponsive patients
Comes in various sizes
Most unconscious patients will need an airway placed
Using the OPA
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12. Oropharyngeal and Nasopharyngeal Devices
Learning Objective 3
Oropharyngeal and Nasopharyngeal Devices
NASOPHARYNGEAL AIRWAY (NPA)
Flexible tube inserted into nasal passageway
Used when OPA cannot be used
Not indicated for potential skull or facial fracture
Risk of brain injury through sinus cavity
Using the NPA
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13. Using a Pocket Mask or Bag Valve Mask
Learning Objective 4
Using a Pocket Mask or Bag Valve Mask
BREATHING
After patient’s airway is open, assess for air exchange
Determine if the patient needs ventilation
Determine if the patient needs supplemental oxygen
Add oxygen if available
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14. Using a Pocket Mask or Bag Valve Mask
Learning Objective 4
Using a Pocket Mask or Bag Valve Mask
VENTILATING A PATIENT
Will need ventilation if:
Unresponsive with apnea
Unresponsive with agonal breathing
Bradypnea or tachypnea
EMR will also provide chest compressions in most situations
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15. Using a Pocket Mask or Bag Valve Mask
Learning Objective 4
Using a Pocket Mask or Bag Valve Mask
POCKET MASK
Delivers ventilations during cardiac arrest, respiratory arrest, or severe respiratory compromise
Choosing a size
Using the pocket mask
Possible issues
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16. Using a Pocket Mask or Bag Valve Mask
Learning Objective 4
Using a Pocket Mask or Bag Valve Mask
BAG VALVE MASK (BVM)
Used to provide positive pressure ventilation
Using a BVM
Possible issues
Using a BVM on a patient with a tracheostomy
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17. Indications for Supplemental Oxygen
Learning Objective 5
Indications for Supplemental Oxygen
SUPPLEMENTAL OXYGEN DELIVERY
Applied to patients with respiratory compromise
Delivered via:
Nasal cannula
Non-rebreather mask over the mouth, nose, or tracheostomy
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18. Indications for Supplemental Oxygen
Learning Objective 5
Indications for Supplemental Oxygen
INDICATIONS OF RESPIRATORY COMPROMISE
Rate
Quality
Sounds
Skin color
Verbalizations
Altered mental status (AMS)
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19. Nasal Cannula and Non-Rebreather Mask
Learning Objective 6
Nasal Cannula and Non-Rebreather Mask
NASAL CANNULA (NC)
Soft flexible tube
Two nasal prongs
Oxygen delivery into patient’s nostrils
25 to 45 percent oxygen concentration
Using the nasal cannula
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20. Nasal Cannula and Non-Rebreather Mask
Learning Objective 6
Nasal Cannula and Non-Rebreather Mask
NON-REBREATHER (NRB) MASK
Covers nose and mouth of patient
Has a one-way valve and a reservoir bag
60 to 95 percent oxygen concentration
Using the NRB mask
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21. Nasal Cannula and Non-Rebreather Mask
Learning Objective 6
Nasal Cannula and Non-Rebreather Mask
BLOW-BY OXYGENATION
Used for children
Used for adults who do not like NRB mask
Provides oxygen for patients who cannot tolerate masks
Using blow-by oxygen
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22. Explain Pulse Oximetry
Learning Objective 7
Explain Pulse Oximetry
OXYGEN DELIVERY
Used for patient needing ventilation and supplemental oxygen
Measured in liters per minute
Flow adjusted by regulator on tank
Level determined by signs and symptoms
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23. Explain Pulse Oximetry
Learning Objective 7
Explain Pulse Oximetry
PULSE OXIMETER
Measures oxygen being carried by hemoglobin
Should be above 95 percent
Placement usually on finger
Reading the pulse oximeter
Oxygen delivering devices
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24. Appropriate Handling for Oxygen Tanks
Learning Objective 8
Appropriate Handling for Oxygen Tanks
OXYGEN TANKS
Storage vessel for oxygen
Identified by green color
Come in various sizes
Oxygen regulators
Assembling the oxygen regulator tank
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25. Appropriate Handling for Oxygen Tanks
Learning Objective 8
Appropriate Handling for Oxygen Tanks
CHANGING AN OXYGEN TANK
Monitor amount remaining
Change when needle on gauge is in shaded red area
Change O-ring
Make sure additional O-rings and wrench available
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26. Appropriate Handling for Oxygen Tanks
Learning Objective 8
Appropriate Handling for Oxygen Tanks
OXYGEN TANK SAFETY
Tanks are pressurized
Could become projectiles
Never carry by regulator or stem
Never leave tank standing upright while unsupervised
Spark or flame could easily cause fire
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27. Summary
EMR needs to effectively manage the patient’s airway with positioning, suctioning, or airway devices
After the patient’s airway is open, the EMR should focus on the patient’s breathing
If the patient is not breathing or is getting inadequate oxygenation, the EMR needs to determine what oxygen delivery device to use, as well as the proper oxygen concentration
Basic and necessary skills must be mastered by the EMR to provide adequate oxygenation to the patient
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