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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
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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!
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Agenda Review Objectives Lesson 1 Lesson 2 Lesson 3
Respiratory Anatomy & Physiology Lesson 2 Respiratory Volume and Management Lesson 3 Assessing Respiratory Problems
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Agenda cont’d Lesson 4 Lesson 5 Lesson 6 Respiratory/Cardiac Arrest
Basic Airway Management Lesson 5 Suctioning Lesson 6 Dual-Lumen Airway Devices
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Agenda cont’d Demonstration Practical Stations Basic Airway Management
Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning Combitube Insertion
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Practical Testing must be done with the Physician Advisor (or another Physician of his / her choosing)
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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
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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.
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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.
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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.
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Respiratory Anatomy & Physiology
Lesson 1 Respiratory Anatomy & Physiology
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Respiratory Anatomy & Physiology
General function of the respiratory system Remove carbon dioxide from the blood Transfer oxygen into the blood
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Function of the Respiratory System
Removes carbon dioxide from the blood Transfers oxygen to the blood
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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
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The Upper Airway Other Structures Functions Nasopharynx Oropharynx
Hypopharynx Larynx Functions
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Functions of the Upper Airway
Passageway for air Warm Filter Humidify Protection Gag Reflex Cough Speech
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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
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Alveoli Gas Exchange
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Lungs Structure Lobes Pleura
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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
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Muscles of Breathing Intercostal Muscles Diaphragm
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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
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Voluntary or Involuntary
Both Humans can override body’s urge to breathe But only for so long
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Respiratory Cycle Inspiration Expiration Active phase
Lasts 1-2 seconds Expiration Passive phase Lasts 5 seconds
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Respiratory Volume and Management
Lesson 2 Respiratory Volume and Management
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Drinking Straw Exercise
Breathe through straws for 1 minute
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Carbon Dioxide & The Respiratory System
High CO2 Increases respiratory rate Low CO2 Decreases respiratory rate Hypoxic Drive Chronic COPD patients
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Normal Respiratory Rates
Adult Children Infants Newborns 12 – 20 / min 18 – 24 / min 22 – 36 / min 40 – 60 / min
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Factors Affecting Respiratory Rate
Fever Depressant Drugs Anxiety Insufficient Oxygen Stimulant Drugs Sleep
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Respiratory Volumes Lung Capacity Tidal Volume Dead Space Alveolar Air
6000 mL of air 500 mL at rest 150 mL 350 mL
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Minute Volume Total air moved per minute Rate X Volume = Minute volume
Important Assessment Item
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Factors Affecting Minute Volume
Head, neck, chest injury Shock Diabetes CO2 / O2 rapid changes
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Maintaining the A in ABC
Patient positioning Suctioning Supplemental Oxygen Mechanical Assistance
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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
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End-Tidal CO2 Detection
Measured Colorimetric and Digital Tool to aid in determining correct placement
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Assessing Respiratory Problems
Lesson 3 Assessing Respiratory Problems
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Patient Assessment
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General Patient Assessment
Primary Survey LOC ABC’s Speech Pattern Obvious Respiratory Noise Patient Position
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General Assessment (cont’d)
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Secondary Assessment SAMPLE history Chief Complaint
Pertinent Negatives Chest Pain (pleuritic vs cardiac) Cough History Edema Vitals
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Respiratory Assessment
Confusion, Agitation, Orientation Cyanosis (late sign) Diaphoresis Retractions Accessory Muscle Use Jugular Venous Distention Nasal Flaring / Pursed Lip Breathing
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Palpation Skin Pulse Chest Wall Pain Tracheal Deviation Turgor Color
Temperature Diaphoresis Pulse Rate Rhythm Quality Chest Wall Pain Tracheal Deviation
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Assessing Lung Sounds Methods Hand Out
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Lung Sounds Normal Wheezes Rales (Crackles) Stridor Rhonchi
Pleural Rub Listen on every patient End of Expiration End of Inspiration During both phases Expiration
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Respiratory Diseases COPD Asthma Pneumonia Pulmonary Edema
Pulmonary Embolus Trauma
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COPD
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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
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Asthma
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Asthma Bronchiole Constriction & Mucous Production Lung Sounds
Wheezes Diminished None Usually Diagnosed
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Pneumonia
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Pneumonia Fever Productive Cough General Illness
Colored Sputum General Illness Elderly & Pediatric most at risk Lung Sounds Rhonchi, Rales, Wheezes
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Pulmonary Edema
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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
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Pulmonary Embolus
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Pulmonary Embolus Lung Sounds History
Surgery Bed Confined Long trip Rapid Transport & High Flow Oxygen
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Trauma
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Trauma Maintain spinal control Airway Management High Flow Oxygen
Rapid Transport Seal Chest Wounds Stabilize Impaled Objects
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Respiratory/Cardiac Arrest Basic Airway Management
Lesson 4 Respiratory/Cardiac Arrest Basic Airway Management
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Respiratory & Cardiac Arrest
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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
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Combitube
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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
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Airway Management – The Basics
Manual Maneuvers Chin Lift Jaw Lift Jaw Thrust Head Tilt – Chin Lift Modified Jaw thrust
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Airway Management – The Basics
Mechanical Airways NPA’s OPA’s Description Advantages Disadvantages Indications Contraindications Methods of Insertion
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Airway Management – The Basics
Ventilation Mouth to Mask BVM Description Advantages Disadvantages Indications Contraindications Methods of Use
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Evaluation of Effectiveness
How do I know I am ventilating? Chest movement Lung Sounds Epigastric sounds/Abdominal distention Patient Response
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Lesson 5 Suctioning
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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!
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Oh, That Sucks! Vomitus Aspiration damage Food
Protein dissolving enzymes Hydrochloric Acid Aspiration damage Alveolar Damage Increased fluid Obstruction Aspiration Pneumonia
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Oh, Go Spit on It Saliva Aspiration Damage Digestive enzymes Bacteria
Fills alveoli Pneumonia
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Food Clogs airways Interferes with ventilation Pneumonia
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Blood Contents Aspiration Damage Protein Fibrin Water Electrolytes
Clog small airways Creates chemical reaction
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Suction Catheters Rigid Advantages Disadvantages Indications
Contraindications Methods of Use Flexible Advantages Disadvantages Indications Contraindications Methods of Use
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Dual-Lumen Airway Devices
Lesson 6 Dual-Lumen Airway Devices
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Combitube©
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Description Other Similar Devices What we use
Pharyngeal tracheal lumen airway (PTLA) EGTA EOA What we use Combitube©
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Indications for Combitube©
Respiratory Arrest Cardiac Arrest Unconscious, without a gag reflex
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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
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Advantages for Combitube©
Rapid Insertion Limits regurgitation, aspiration & distention Blind insertion High oxygen delivery Less training required Inserted in neutral position
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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
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Demonstration
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When Can I Remove the Combitube?
Patient returns to full consciousness Patient able to maintain own airway Orders from OLMC
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Procedure for Removing
SUCTION READY! Deflate Tube #2 Deflate Tube #1 Tell patient to exhale Pull out quickly and in-line SUCTION
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Demonstration
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Skills Labs Basic Airway Management Advanced Airway Management
Manual Maneuvers and Simple Adjuncts Supplemental Oxygen Ventilation Suctioning Advanced Airway Management Combitube
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Questions?
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