Four sounds of obstructed airway
1) Stridor: high pitched whistling sound; indicative of severely narrowed air passage
2) Hoarseness: raspy change in voice; indicative of swelling around the vocal cords
3) Snoring: similar to a snore during sleep; indicative of diminished muscle tone
4) Gurgling: bubbling sound; indicative of bodily fluid in the airway
Airway adjuncts
Oropharyngeal airway (OPA)
* Only use on patients without gag reflex
Nasopharyngeal airway (NPA)
* Used when there is gag reflex
* Not used in patients with nose or head injuries
- Keeps the tongue from blocking the airway
- When inserting any airway adjuncts, be ready with suction
Supraglottic airway
- Isolate the glottic opening by occupying space in the larynx and hypopharynx
- Used if basic methods fail and airway must be maintained over a long period
Pulmonary respiration
Diffusion of oxygen and CO2 between the alveoli and the circulating blood
Hypoxia
Low levels of oxygen
Hypercapnia
High levels of CO2
Cyanosis
Skin becoming blue with inadequate respiration and blood flow
Positive pressure ventilation
Form of respiratory therapy that involves the delivery of air or a mixture of oxygen combined with other gases by positive pressure into the lungs
- Method applies higher air pressure to the lungs
3 methods of positive pressure ventilation
Mouth to mask
Two rescuer bag valve mask (BVM)
One rescuer bag valve mask (BVM)
- Watch the chest rise and fall with each ventilation
- Ensure the rate of ventilation is sufficient
When ventilating a patient who is breathing slowly
Add ventilation in between the patient’s own to increase the rate to 12 per minute
Artificial ventilation of a stoma breather
- Clear mucus plugs or secretions from stoma
- leave the head/neck in the neutral position
- Use a pediatric sized mask to establish a seal around the stoma
- Ventilate at the appropriate rate for the patient’s age
- If unable to ventilate through stoma, seal the stoma and attempt ventilation through the mouth and nose
Adults and child ventilation rate
Adults should be ventilated 10-12 times per minute
Children should be ventilated 12-20 times per minute
Too slow ventilation can cause ________
hypoventilation and hypoxia
Too fast ventilation can cause ________
hyperventilation and vasoconstriction
Too much pressure causes __________
gastric distention
Too much volume can cause _________
lung tissue trauma
Automatic transport ventilator (ATV)
provides positive pressure ventilations during respiratory arrest
Oxygen tank:
D cylinder
E cylinder
M cylinder
G cylinder
H cylinder
350 L of oxygen
625 L of oxygen
3000 L of oxygen
5300 L of oxygen
6900 L of oxygen
Safe working pressure of oxygen
30-70 psi
2 types of low pressure oxygen flowmeters
*** High pressure flowmeters may be needed for oxygen powered devices or respirators and ventilators
Pressure compensated flow meters are used for larger cylinders in the ambulance
Constant flow selector valve can be used with any size cylinder
Supplemental oxygen for patients with chest pain
For mild distress, administer low concentration oxygen via nasal cannula (24-44% oxygen)
For moderate/severe distress, administer high concentration oxygen via nonrebreather mask (80-90% oxygen)
- Partial rebreather mask: allows the patient to rebreathe about one-third of the exhaled air. This is useful to preserve CO2 levels to stimulate breathing. (40-60% oxygen at 9-10 L per minute)
- Venturi mask: delivers specific concentrations of oxygen by mixing oxygen with inhaled air. Used in COPD patients.
- Tracheostomy mask: placed over a stoma or tracheostomy tube to provide supplemental oxygen (8-10 L per minute of oxygen)
Oxygen delivered by the cannula should not exceed _________
4-6 L per minute
