1. Patient Assessment: Airway Evaluation Dr Aqeela Bano EMS 352

2. Patient Assessment: Airway Evaluation Quality of care depends on assessment Adequate breathing – Patient is responsive, alert, able to speak – Rate between 12 and 20 breaths/min – Adequate depth – Regular pattern of inhalation and exhalation – Clear and equal breath sounds – Tendency toward stability in the body – Requires balance between acids and bases Acid in the body can be expelled as carbon dioxide from the lungs.

3. Acid-Base Balance Acidosis can develop if respiratory function is inhibited. Alkalosis can develop if the respiratory rate is too high. – Respiratory acidosis/alkalosis – Metabolic acidosis/alkalosis

4. Recognizing Inadequate Breathing Breathing rate of less than 12 breaths/min or more than 20 breaths/min Cyanosis: indicator of low blood oxygen Note the following: – Position – Chest rise/fall – Flared nostrils – Pursed lips – Retractions – Use of accessory muscles – Quick breaths, long exhalation – Labored breathing

5. Recognizing Inadequate Breathing Airway management steps: – Open the airway. – Clear the airway. – Assess breathing. – Provide appropriate intervention(s). Evaluation includes: – Observe – Palpate – Auscultate

6. Inadequate Breathing Feel for air movement. Observe chest for symmetry. Note any paradoxical motion. Assess for pulsus paradoxus. – Systolic blood pressure drops more than 10 mm Hg during inhalation.

7. Inadequate Breathing Ask about history of present illness – Onset, trigger, duration? – Other symptoms? – Interventions, previous hospitalization? – Medications and overall compliance? – Risk factors?

8. Protective Airway Reflexes Evaluate protective reflexes. – Coughing, sneezing, gagging

9. Assessment of Breath Sounds Auscultate breath sounds with stethoscope. – Should be clear and equal

10. Assessment of Breath Sounds

11. Duration: length of time for inspiratory and expiratory phases – Normal I/E ratio: 1:2 – Expiration is prolonged with lower airway obstruction. – Expiration is short with tachypneic patients.

12. Assessment of Breath Sounds Pitch: higher or lower than normal (stridor or wheezing). – Intensity of sound depends on: Airflow rate Constancy of flow throughout inspiration Patient position Site selected for auscultation

13. Pulse Oximetry Pulse oximeter: measures oxygen saturation of hemoglobin (Hb) – Normal: SpO 2 of greater than 95%

14. Pulse Oximetry Erroneous readings may result from: – Patient motion – Poor perfusion – Nail polish – Venous pulsations – Abnormal hemoglobin

15. Arterial Blood Gas Analysis Blood is analyzed for pH, PaO 2, HCO 3 −, base excess, and SaO 2. – pH, HCO 3 − : acid- base status – PaCO 2 : effectiveness of ventilation – PaO 2 and SaO 2 : oxygenation

16. End-tidal Carbon Dioxide (ETCO 2 ) Assessment Detects carbon dioxide in exhaled air – Adjunct for determining ventilation adequacy – Confirms advanced airway placement – ETCO 2 detector types: Digital Waveform Digital/waveform Colorimetric

17. End-tidal Carbon Dioxide (ETCO 2 ) Assessment Capnometer – Numeric reading of exhaled CO 2 Capnographer – Graphic representation of exhaled CO 2 – Three types: Waveform Digital/waveform Colorimetric

18. End-tidal Carbon Dioxide (ETCO 2 ) Assessment Waveform capnography – Exhaled carbon dioxide level displayed as a graphic waveform – Includes contour, baseline level, rate, and rise of carbon dioxide level

19. End-tidal Carbon Dioxide (ETCO2) Assessment Waveform capnography (cont’d) – Phase A–B: initial stage of exhalation – Phase B–C: expiratory upslope – Phase C–D: expiratory or alveolar plateau – Phase D–E: inspiratory down stroke

20. End-tidal Carbon Dioxide (ETCO 2 ) Assessment Capnography can: – Indicate effectiveness of chest compressions – Detect return of spontaneous circulation Use is limited with cardiac arrest

21. SUMMARY OF PATIENT ASSESSMENT Clinical examination of patient – Assessment of respiration rate rythym – Clinical signs of adequate respiration – Assessment of breath sounds Pulse oximetre Acid base balance end tidal CO 2 assessment