Emt-B: Section 7 Airway

Front 1

Name the three body planes

Back 1

1) Sagitall
2) Axial
3) Coronal

Front 2

When a patient is in shock, they should be placed in the following position to remove blood from the extremities back to the vital organs.

Back 2

Trendelenberg: (Head lower than the feet)

Front 3

Describe the Fowler Position and why it is used.

Back 3

Fowler's Position
A person in the Fowler's position is sitting straight up or leaning slightly back. Their legs may either be straight or bent.

Front 4

What is the Coracoid Cartilage used to prevent?

Back 4

Clinical significance
When intubating a patient under general anesthesia prior to surgery, the anesthesiologist will press on the cricoid cartilage to compress the esophagus behind it so as to prevent gastric reflux from occurring: this is known as the Sellick manoeuvre.

Anterior Cricoid Pressure was considered the standard of care during Rapid Sequence Intubation for many years.[1] The American Heart Association still advocates the use of cricoid pressure during resuscitation using a BVM, and during emergent oral endotracheal intubation.[2] However, recent research increasingly suggests that cricoid pressure may not be as advantageous as once thought. The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning, and barbiturate anesthesia were the rule.[3]

Cricoid pressure may frequently be applied incorrectly.[4] [5] [6] [7] [8] Cricoid pressure may frequently displace the esophagus laterally, instead of compressing it as described by Sellick.[9] [10] Several studies demonstrate some degree of glottic compression [11] [12] [13] reduction in tidal volume and increase in peak pressures.[14] Based on the current literature, the widespread recommendation that cricoid pressure be applied during every rapid sequence intubation is quickly falling out of favor.


Gastric reflux could cause aspiration if this is not done considering the general anesthesia can cause relaxation of the gastroesophageal sphincter allowing stomach contents to ascend through the esophagus into the trachea.

A medical procedure known as a cricoidectomy can be performed in which part or all of the cricoid cartilige is removed. This is commonly done to relive blockages within the trachea

Front 5

What is the largest, involuntary muscle?

Back 5

The cardiac muscle

Front 6

Perfusion is defined as:

Back 6

The body moves oxygen.
Symptoms include, but are not limited to: Pallor, sweting, cyanosis and low body temperature.

Front 7

A basline is also called:

Back 7

Within Normal Limits (WNL)

Front 8

What does the acronym O.P.Q.R.S.T. stand for?

Back 8

Onset
Provokes
Quality
Radiates
Severity
Time

Front 9

What is PulseOxyimetry used for and what is a potential problem in it's use?

Back 9

Used to detect the amount of oxygen in the blood.

Not 100% effective due to many causes, such as nail polish

Front 10

Name the two structures responsible for breating.

Back 10

1. Diaphragm
2. Lungs

Front 11

What is the diaphram responsible for?

Back 11

Diaphragm
The diaphragm is the dome-shaped sheet of muscle that separates the chest from the abdomen. It is attached to the spine, ribs and sternum and plays a very important role in the breathing process. The lungs are enclosed in a kind of cage in which the ribs form the sides and the diaphragm, an upwardly arching sheet of muscle, forms the floor. When we breathe, the diaphragm is drawn downward until it is flat. At the same time, the muscles around the ribs pull them up like a hoop skirt. The chest cavity becomes deeper and larger, making more air space. The muscle fibers of the diaphragm converge on the central tendon, which is a thick, flat plate of dense fibers. There are openings in the diaphragm for the esophagus, the phrenic nerve (which controls the movements of the diaphragm to produce breathing), and the aorta and vena cava blood vessels, which lead to and from the heart. When air is drawn into the lungs, the muscles in the diaphragm contract, pulling the central tendon down. This enlarges the chest, and air then passes into the lungs to fill the larger space. The diaphragm sometimes contracts involuntarily because the controlling nerves are irritated by eating too fast (or for some other reason). At this time, if air is inhaled, the space between the vocal cords at the back of the throat close suddenly, producing the clicking noise we call "hiccups."

Front 12

The upper airway is made up of:

Back 12

From the Superior aspect of the nose, and in descending order the nasopharynx, bucal cavity, oropharynx, pharynx and the epliglottis.

Front 13

The lower airway is made up of:

Back 13

Larynx, thryoid cartidlage/cricoid cartilage, trachea, carina, bronchi, bonchioles and the aveoli; where ox and co2 are exchanged.

Front 14

What is the Brain Strem responsible for?

Back 14

It senses high levels of Carbon dioxide in the blood for normal breathing.

Front 15

Tidal volume is defined as:

Back 15

The amount of air in ml that is moved into or out of the lungs in a single breath. Usually checked by watching the chest rise and lower.

Front 16

What is diffisuion?

Back 16

A passive process in which molecules move from an area of higher concentratin to an ara of lower concentratin and is how o2 and co2 andexchanged through the walls of the aveloli and capillaries.

Front 17

Hypoic drive?

Back 17

The back-up drive in COPD patients in whcih the brain stem senses low levels of Ox in the blood required for adequate breathing.

Front 18

What is Hypoxia?

Back 18

is when body tissues and cells do not have enough oxygen; early signs are jittery, anxiousness, combative, restlessness, irritability; tachycardia; late signs are mental status changes, weak (thready pulse), and cyanosis (turning blue). All patients with hypoxia get oxygen

Front 19

Toleration without Oxygen

Back 19

Heart seconds; Brain 4-6 minutes (6-10 minutes brain damage is very likely); Kidney (renal) 45 minutes; muscle 2 hours; skin longest. NEVER withhold oxygen from anyone who could possible benefit from it.

Front 20

Non Rebreathers

Back 20

give 90% Oxygen at 15L/M. Fill bag first by covering hole with gloved finger, then place over nose and mouth. Minimum flow rate for a non-rebreather is 10L/M. If bag is deflating, increase liter flow rate. If you have a long transport time, you should use HUMIDIFIED OXYGEN to help prevent drying of the air passages from the oxygen. The non-rebreather is the preferred method for giving oxygen in the pre-hospital setting IF the patient is adequately breathing

Front 21

Nasal Canulas

Back 21

give 24% Oxygen at 1L/M up to 44% Oxygen at 6L/M (maximum flow rate).

Front 22

Bag-Valve

Back 22

When using a BVM, squeeze the bag only until the chest begins to rise and over the course of 1 second with a 5-6 second pause between ventilations. If gastric distention is observed, RECHECK AND REPOSITION the airway, apply cricoid pressure (see below), and watch for rise and fall of the chest.

Front 23

Adequate Breathing

Back 23

is 8-24 respirations per minute for an adult, BUT 12-20 (adults), 15-30 (children), 25-50 (infants) is normal breathing. If respirations are not normal but are adequate (8-11 or 21-24), use a non-rebreather mask at 15 liters/minute. You should look, listen and feel for adequate breathing.

Front 24

Inadequate Breathing

Back 24

for an adult is (i) respirations greater than 24 per minute or less than 8 per minute or if the patient (ii) has shallow breathing, (iii) has irregular breathing, (iv) has inadequate or shallow chest rise or reduced tidal volume, (v) is unable to speak in complete sentences, or (v) is cyanotic (turning blue). For inadequate breathing you MUST assist ventilations AND use an airway adjunct [oral (CANNOT use if conscious or has a gag reflex – if not drooling, patient has gag reflex) or nasal (but CANNOT use nasal with head trauma)].

Front 25

Assisting Ventilations

Back 25

means to use (i) mouth to mask, (ii) positive pressure ventilations, (iii) a flow-restricted oxygen powered device, or (iv) a bag-valve mask. You CANNOT use a non-rebreather because the oxygen will not reach the alveoli. The PREFERRED METHODS of assisting ventilations in order of priority are: (1) mouth to mask with oxygen connected, (2) two-person bag-valve mask, (3) flow-restricted oxygen powered device (CANNOT be used for children, infants, COPD patients or suspected cervical spine or chest injuries), or (4) one person bag valve mask.

Front 26

Cheyne-Stokes

Back 26

is irregular breathing with increasing rate and depth followed by apnea (not breathing) for head trauma & stroke.

Front 27

Ataxic respirations

Back 27

irregular ineffective respirations without a pattern after a head injury.

Front 28

Airway Obstruction

Back 28

must be cleared before giving oxygen.
SNORING - MOST COMMON airway obstruction in an unconscious patient is the TONGUE and usually causes snoring respirations (use head tilt chin lift if no trauma or spinal injury suspected or jaw thrust if trauma or spinal injury suspected).
GURGLING is caused by fluids in the airway and MUST BE SUCTIONED BEFORE giving oxygen.

Front 29

Suctioning:

Back 29

Never suction for more than 15 seconds for an adult (10 for child and 5 for infant) and only suction on the way out. If patient requires assisted ventilations and is producing frothy secretions, ALTERNATE suctioning for 15 seconds and then ventilating for 2 minutes and continue this pattern until all secretions have been cleared from the patient’s airway.

Front 30

Yankauer or Tonsil Tip Catheter

Back 30

Catheter is a plastic rigid catheter and is the BEST king of catheter for suctioning the oropharyx in adults and is preferred in infants and children. They have a large diameter and are rigid so they do not collapse.

Front 31

French (Soft Tip) or Whistle Tip Catheters

Back 31

are used to suction the nose or liquid secretions in the back of the mouth and in situation where you cannot use a rigid catheter such as for a patient with a stoma.

Front 32

Tracheostomy Tube

Back 32

if a patient has a tracheostomy tube, ventilate through the tube with a BVM. If the tube gets clogged, suction the tracheostomy tube.

Front 33

Stoma:

Back 33

Place and infant or child mask over the stoma (if no tube is present) to make a seal over the stoma. If the stoma gets clogged, suction it with a French or soft tip catheter.

Front 34

Nasal Airway

Back 34

use only if NO suspected head trauma. CONTRAINDICTIONS: CANNOT use if patient fell on head or has other suspected severe head or face trauma because if the skull or nasal bones are fractured the airway could go into the brain.

Front 35

Oral Airway

Back 35

use only if NO gag reflex (if patient is not drooling, patient has a gag reflex). CONTRAINDICTIONS: CANNOT use in conscious patient or if has gag reflex. If using and patient starts to gag or vomit, REMOVE IMMEDIATELY and SUCTION as needed. If a patient has a gag reflex and has a head injury, you CANNOT use an oral or nasal airway.

Front 36

Dyspnea

Back 36

shortness of breath or difficulty breathing.

Front 37

Pulmonary Edema

Back 37

Accumulation of fluid between alveoli and capillaries caused by build up of pressure typically from congestive heart failure or inhaled poison. Often causes pink frothy sputum because lungs drowning in fluid.

Front 38

Asthma

Back 38

is an acute spasm of the bronchioles associated with narrowing passageways, excessive mucous and swelling of mucous linings.

Front 39

Hyperventilation

Back 39

is overbreathing to the point that carbon dioxide levels fall below normal (no lung abnormalities). Calm the patient and provide supplemental Oxygen

Front 40

Alkalosis

Back 40

is the buildup of bases and lack of acids due to excessive breathing (hyperventilation).

Front 41

COPD

Back 41

Chronic Obstructive Pulmonary Disease - start patient with Oxygen at 2L/M and increase by ones (up to 15L/M) until symptoms have improved.

Front 42

Recovery Position (Left Lateral Recumbent Position)

Back 42

EncyclopediaThe recovery position, more technically the lateral recumbent position, is an airway managementAirway managementIn cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:# there is an open pathway between a patient’s lungs and the outside world, and...
technique for assisting people who are unconsciousUnconsciousnessUnconsciousness, more appropriately referred to as loss of consciousness or lack of consciousness, is a dramatic alteration of mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Being in a comatose state or coma is an illustration...
, or nearly so, but are still breathing. It is frequently taught alongside CPRCardiopulmonary resuscitationCardiopulmonary resuscitation is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest...
in first aidFirst aidFirst aid is the provision of initial care for an illness or injury. It is usually performed by a lay person to a sick or injured casualty until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid...
.

An unconscious person (GCS <8) cannot be trusted to maintain his or her own breathing. Many fatalities occur where the original injury or illness which caused unconsciousness is not inherently fatal, but where the unconscious person suffocates for one of these reasons. This is a common cause of death following unconsciousness due to excessive consumption of alcohol.

When an unconscious person is lying face upwards, there are two main risk factors which can lead to suffocation: Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the person to drown. When a person is lying face up, the esophagusEsophagusThe esophagus or oesophagus , sometimes known as the gullet, is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. The word esophagus is derived from the Latin œsophagus, which derives from the Greek word oisophagos , lit...
tilts down slightly from the stomach toward the throat. This, combined with loss of muscular control, can lead to the stomach contents flowing into the throat, called passive regurgitation. Fluid which collects in the back of the throat can also flow down into the lungs; stomach acid can attack the inner lining of the lungs and cause aspiration pneumoniaAspiration pneumoniaAspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree, usually oral or gastric contents...
.

It's possible to achieve limited protection of the airway by tilting the head back and lifting the jaw. An unconscious person will not remain in this position unless held constantly, and crucially it does not safeguard against risks due to fluids. In the recovery position, the force of gravity will allow any fluids to drain. The chest is also elevated from the ground, making breathing easier.

When to use the recovery position

The recovery position is recommended for any unconscious person who does not need CPRCardiopulmonary resuscitationCardiopulmonary resuscitation is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest...
, those who are too inebriated to assure their own continued breathing, victims of drowningDrowningDrowning is death from suffocation caused by a liquid entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia and myocardial infarction...
, and also for victims of suspected poisoning (who are liable to become unconscious).

Front 43

Bourdon-Gauge Flowmeter

Back 43

Flowmeter is the flowmeter we use on our portable tanks because it is NOT affected by gravity.

Front 44

Pressure Compensated Flowmeters

Back 44

are the ones in the rigs and hospitals with a floating ball that ARE affected by gravity.

Front 45

Oxygen Cylinders

Back 45

come in various sizes. The “D” cylinders are the portable cylinders that we use on our rigs and they hold 300 liters. At 15L/M flow rate, the oxygen will last about 20 minutes in a D cylinder. When full, ALL oxygen cylinders are at approximately 2000 psi.

Front 46

Pin-Indexing System

Back 46

is a standardized system of pins on all regulators for all tanks (oxygen, carbon dioxide, etc.) to ensure that the wrong regulator will not be placed on an oxygen tank or vice versa. Each type of gas cylinder has a specific number of holes and pattern for the pins on the regulator to fit into so that only the correct regulator can attach to it.

Front 47

Xiphoid Process

Back 47

is near the diaphram in the center of the chest and an injury to it causes trouble with breathing.

Sternum
The "sternum" is the medical name for the breastbone, a long, narrow, flat plate that forms the center of the front of the chest. It develops in three parts: an upper portion, or "manubrium," a middle "body," and a lower "xiphoid process" that projects down. The xiphoid process begins as a piece of cartilage. It slowly hardens into bone until, by middle life, it is usually fused to the body of the sternum. The sides of the manubrium and the body are notched where they unite with costal cartilages. It also joins the clavicles (shoulder blades) on its upper border. It usually remains a separate bone until middle age or later, when it fuses to the body of the sternum. The sternum is very strong and requires great force to fracture. The main danger in this type of injury is not the fracture itself, but the chance that the broken bone may be driven into the heart, which lies just behind it.

Front 48

Apex

Back 48

is the point on the top of the lung or the bottom of the heart.

Front 49

Airway Obstructions

Back 49

Mild or Moderate (can breath, talk, or cough forcefully), do NOT interfere and just encourage the patient to cough.
Severe (Cannot breathe, talk or cough), give abdominal thrusts (until unconscious or obstruction is removed) after asking the patient if they are choking and getting consent.
Unconscious: Any unconscious patient shall be treated as if they have an obstructed airway and you must open the airway with a head-tilt chin-lift or a jaw thrust as indicated and give 2 rescue breaths if not breathing and move on to CPR if indicated.

Front 50

Inserting Oropharangeal Airway

Back 50

1. Measure from corner of mouth to tip of earlobe.
2. Open mouth with cross finger technique and insert curled upwards until hits roof of mouth.
3. Rotate 180 degrees and continue inserting until flange is flush with lips.
4. If patient start gagging, quickly remove and prepare to suction and insert nasopharangeal airway.

Front 51

Inserting Nasopharangeal Airway

Back 51

1. Measure from tip of nose to tip of earlobe.
2. Vocalize lubricating with water-soluble lubricant.
3. Gently insert in right nare with bezel pointing towards septum (the right nare is usually bigger and the preferred nare)
4. If inserting in left nare, insert curled upwards until resistance met and then rotate 180 degrees
5. Continue inserting until flange is flush with nose. If resistance or obstruction, try other nostril.

Front 52

Suctioning

Back 52

1. Turn on suctioning unit and test and lubricate on bottle of water.
2. Measure catheter from corner of mouth to tip of earlobe and mark correct spot with finger.
3. With suction off or tube kinked, insert catheter to depth measured
4. Apply suction in circular motion as you withdraw, but do not suction for more than 15 seconds (10 seconds for kids and 5 seconds for infants).

Front 53

In Oxygen Tanks, what is the purpose of the pin-Indexing System?

Back 53

To prevent an oxygen regulator from being from being connected to a carobondioxide cylinder and so on. Always make sure the pins are aligned properly.

Front 54

The Safety System for Large Cylinders is known as the ______________.

Back 54

American Standard System

Front 55

The pressure of gas in a full oxygen cylinder is is approx 2,000 pai. This is far too much pressure. Regulators are used to reduce the flow of o2 to a useful range of ____ to ____ psi

Back 55

40-70

Front 56

Humidifcation: Some ESM Systems provide humidified oxygen to patient during transport. When is it important to use humified air?

Back 56

During long transports.

Front 57

Oxygen Flow Meters:
-2 Two types commonly used. Which is more accurate?

Back 57

1. Pressure compensated flowmeters
2. Bourdon-gauge flowmeter.

The pressure compensated flowmeter is less accurate because it relies on a float ball within a taperd tube. The cylinder must be kept upright to be read properly. This also increases the risk of the cylinder falling.

Front 58

Describe the Operating Instructions for placing an oxygen cylinder into service:

Back 58

1. Inspect the cylinder. Does it have plastic seal? Slowly crack the seal to remove dirt.

2. Attach the flow meter to the valve sterm after clearing the opening. Align the pins.

3. Place regulator collar over the cylinder valve. Tighten the regulatory securely

4. With the regulator firmly attached, open the cylinder and check for air leaking from the regulator-oxygen connection and the read the pressure level on the gauge.

5. Attached the selected oxygen device to the flowmeter by connecting the oxygen device to the christmas tree.

Front 59

What ar the two Oxygen Delivery Systems and the amount of oxygen each supply the patient.

Back 59

Most commonly used are the:Nonbreathing mask which contains flappers valve ports at the cheek areas of the mask to prevent the patient from rebreathing exhaled gas.Provides up to 90% of oxygen.

Nasal canulal to be used only if the patient is claustrophic. This yeals about 24 to 44 percent o2

Front 60

List the methods of ventilation in the order of prefernce:

Back 60

1. Mouth to mouth, with one-way valve stop.

2. Two person BVM device with reservoir and supplemental oxygen

3. Flow restricted oxygen-powered ventilation device

4. One person BVM device with oxygen reservoir and supplemental oxygen.

Front 61

Ventiation Rates:
-Adult
-Child
-Infant

Back 61

Adult: 1 breath per 5-6 seconds

Child: 1 breath per 3-5 seconds

Infant: 1 breath per 3-5 seconds.