The document discusses airway management and ventilation, which are critical steps in assessing patients. It covers anatomy and physiology of the respiratory system, respiratory problems, and assessment techniques. Key points include the importance of establishing a patent airway and adequate breathing. Manual maneuvers like head-tilt chin-lift are described. Basic airway devices like oropharyngeal airways are presented. Methods of ventilation including bag-valve masks are covered. Advanced techniques like endotracheal intubation are discussed in detail, including indications, equipment, techniques, and verification of proper placement. Continuous monitoring of the airway is emphasized.
2. Airway management
and ventilation are the first
and most critical steps in the
initial assessment of every
patient you will encounter.
3. Topics
Anatomy of the Respiratory System
Physiology of the Respiratory
System
Respiratory Problems
Respiratory System Assessment
Airway Management
17. The Pediatric Airway
Smaller and more flexible than an
adult.
Tongue proportionately larger.
Epiglottis floppy and round.
Glottic opening higher and more
anterior.
Vocal cords slant upward, and are
closer to the base of the tongue.
Narrowest part is the cricoid cartilage.
19. Total Lung Capacity (TLC)
Maximum lung capacity
Average adult male TLC—6 liters
20. Tidal Volume (VT)
Average volume of gas inhaled
or exhaled in one respiratory cycle.
Average adult male:
VT = 500 ml (5-7 cc/kg)
21. Dead Space Volume (VD)
Amount of gases in tidal volume
that remains in the airway.
Approximately 150 ml in adult male.
22. Alveolar Volume (VA)
Amount of gas that reaches the
alveoli for gas exchange
VA = (VT - VP)
23. Minute Volume (Vmin)
Amount of gas moved in and out of
the respiratory tract in one minute.
Vmin = VT x respiratory rate
24. Residual Volume
(RV)
The amount of air remaining in
the lungs at the end of maximal
expiration.
25. Inspiratory Reserve Volume
(IRV)
The amount of air that can be
maximally inhaled after normal
inspiration.
26. Expiratory Reserve Volume
(ERV)
The amount of air that can be
maximally exhaled after a normal
expiration.
27. Functional Residual
Capacity (FRC)
The volume of gas that remains in
the lungs at the end of normal
expiration.
FRC = ERV + RV
28. Forced Expiratory Volume
(FEV)
The amount of air that can be
maximally expired after maximum
inspiration.
29. Introduction
Respiration is the exchange of
gases between a living organism
and its environment.
Ventilation is the mechanical
process that moves air into and
out of the lungs.
33. Measuring Oxygen and
Carbon Dioxide Levels
Partial pressure is the pressure
exerted by each component of a
gas mixture.
Partial pressure of a gas is its
percentage of the mixture’s total
pressure.
36. Diffusion
Movement of a gas from an area
of higher concentration to an area
of lower concentration.
Diffusion transfers gases
between the lungs and the blood
and between the blood and
peripheral tissues.
37. Oxygen Concentration
in the Blood
Oxygen saturation =
O2 content/ O2 capacity x 100%
38. Factors Affecting Oxygen
Concentration in the Blood
Decreased hemoglobin concentration.
Inadequate alveolar ventilation.
Decreased diffusion across the
pulmonary membrane when diffusion
distance increases or the pulmonary
membrane changes.
Ventilation/perfusion mismatch occurs
when a portion of the alveoli collapses.
40. Factors Affecting Carbon
Dioxide Concentrations in
the Blood (1 of 2)
Hyperventilation lowers CO2 levels
due to increased respiratory rates
or deeper respiration.
Causes of increased CO2
production include:
Fever, muscle exertion, shivering,
metabolic processes resulting in
the formation of metabolic acids.
41. Factors Affecting Carbon
Dioxide Concentrations in
the Blood (2 of 2)
Decreased CO2 elimination results
from decreased alveolar
ventilation.
Respiratory depression, airway
obstruction, respiratory muscle
impairment, obstructive diseases.
43. Respiratory Rate
Involuntary; however, can be
voluntarily controlled.
Chemical and physical mechanisms
provide involuntary impulses to
correct any breathing irregularities.
46. Nervous Impulses from the
Respiratory Center
Main respiratory center is the medulla.
Neurons within medulla initiate impulses
that produce respiration.
Apneustic center assumes respiratory
control if the medulla fails to
initiate impulses.
Pneumotaxic center controls respiration.
48. Chemoreceptors
Located in carotid bodies, arch of
the aorta, and medulla.
Stimulated by decreased PaO2,
increased PaCO2, and decreased
pH.
Cerebrospinal fluid (CSF) pH is
primary control of respiratory
center.
49. Hypoxic Drive
Hypoxemia is a profound stimulus
of respiration in a normal
individual.
Hypoxic drive increases respiratory
stimulation in people with chronic
respiratory disease.
55. Initial Assessment
Is the airway patent?
Is breathing adequate?
Look, listen, and feel.
If patient is not breathing, open
the airway and assist ventilations
as necessary.
66. Palpation
Palpate chest wall for tenderness,
symmetry, abnormal motion,
crepitus, and subcutaneous
emphysema.
Assess compliance of lungs.
67. Focused History
Onset
Symptom development
Associated symptoms
Past medical history
Recent history
Does anything make symptoms
better or worse?
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73. Oxygen Supply and
Regulators
To calculate how long an oxygen tank
will last:
tank life in minutes =
(tank pressure in psi x .28)
liters per minute
92. Ventilation of
Pediatric Patients
Mask seal can be more difficult.
Bag size depends on age of child.
Ventilate according to current
standards.
Obtain chest rise and fall with
each breath.
Assess adequacy of ventilations by
observing chest rise, listening to lung
sounds, and assessing clinical
improvement.
93. Direct visualization of the
larynx with a laryngoscope
may enable the removal of an
obstructing foreign body.
96. Suctioning
Anticipating complications
when managing an airway is
the key for successful
outcomes.
Be prepared to suction
all airways to remove blood
or other secretions and for
the patient to vomit.
97.
98.
99. Suctioning Techniques
Wear protective eyewear, gloves,
and face mask.
Preoxygenate the patient.
Determine depth of catheter insertion.
With suction off, insert catheter.
Turn on suction and suction while
removing catheter (no more than
10 seconds).
Hyperventilate the patient.
111. Disadvantages of
Endotracheal Intubation
Requires considerable training and
experience.
Requires specialized equipment.
Requires direct visualization of vocal
cords.
Bypasses upper airway’s functions
of warming, filtering, and humidifying
the inhaled air.
112. Endotracheal Intubation
Indicators
Respiratory or cardiac arrest.
Unconsciousness.
Risk of aspiration.
Obstruction due to foreign bodies, trauma,
burns, or anaphylaxis.
Respiratory extremis due to disease.
Pneumothorax, hemothorax,
hemopneumothorax with respiratory
difficulty.
114. Advantages of Endotracheal
Intubation
Isolates trachea and permits
complete control of airway.
Impedes gastric distention.
Eliminates need to maintain a mask
seal.
Offers direct route for suctioning.
Permits administration of some
medications.
160. Nasotracheal intubation may
be useful in some situations:
Possible spinal injury
Clenched teeth
Fractured jaw, oral injuries, or recent
oral surgery
Facial or airway swelling
Obesity
Arthritis preventing sniffing position
185. Patients with Stoma Sites
Patients who have had a laryngectomy
or tracheostomy breathe through a
stoma.
There are often problems with excess
secretions, and a stoma may
become plugged.
Brain death occurs within 6 to 10 minutes Practice good basic interventions, proper mask seal and positioning. Reassess
The upper airway warms, filters and humidifies incoming air.
Right mainstem is straight Right side 3 lobes
Alveoli are the site of gas exchange and are lined with surfactant which decreases surface tension and facilitates ease of expansion. Atelectasis – alveoli colapse
Also, ribs are soft so children depend more heavily on diaphram to breath. In addition, neonates are obligate nasal breathers.
Anatomic dead space – trachea, Bronchi Physiologic – formed by disease such as COPD and atelectasis