NREMTP Review-Lara R. 🚒🚑 Airway/Ventilation
Airway/Respiratory/Ventilation
You arrive on scene, for a 35 y/o m, who was involved in a propane tank explosion. pt. was in close proximity to the tank, he is unresponsive and you see 2nd/3rd degree burns to his chest and neck. pt. has a history of asthma and morbid obesity and he weighs 375 lbs.
Difficult Airway Assessment
LEMON Rule
3-3-2 Rule
Mallampati score
Laryngeal Spasms-Forceful & aggressive upward pressure of the jaw!!!
Sellick's maneuver=Cricoid Pressure
Sellick's maneuver=Cricoid pressure
Help to visualize the vocal cords (larynx)
3 Stages
Respiratory Distress
Respiratory Failure
Respiratory Arrest (No breathing/Apneic)
Respiratory Distress (Anxiety, Tachycardia, tachypnea, low spo2, SOB, Dyspnea, adventitious breath sounds)
Respiratory Failure (AMS, tachycardia, severe hypoxemia)
Respiratory Arrest (Breathing Stops)
Nasal Intubation
Used when the pt. needs a definitive & secured airway, but direct visualization cannot occur
They must still be BREATHING!!!!
Contraindications-Skull fracture, nasal trauma, facial trauma
Upper Respiratory Tract
Nasopharynx
Oropharynx
Pharynx
Larynx
Epiglottis
Upper trachea
Lower Respiratory Tract
Lower trachea
Carina
Left & Right mainstem bronchus
Lungs
Pleura
bronchioles
Alveoli
Pneumonia
COPD
Emphysema
Chronic Bronchitis
Asthma
Bronchiectasis
Adventitious Lung Sounds (Abnormal LS)
Stridor
Wheezing
Rhonchi
Rales=Crackles=Pulmonary Edema
Pleuritic friction rub
Stridor (Upper)
High pitched whistling sound heard on inhalation, indicates a partial upper airway obstruction
Croup
Epiglottitis
Anaphylaxis
Choking
Inhalation/Chemical burns
Tracheal trauma
Wheezing (Lower)-Bronchioles
A high-pitched whistling sound most often heard on exhalation
Indicates Bronchoconstriction/Bronchospasms
Asthma
Allergic Reaction
Anaphylaxis
Bronchiolitis
Bronchiectasis
COPD=Chronic bronchitis, Emphysema
Inhalation burns
Pneumonia
TB-Mycobacterium Tuberculosis
Rales=Crackles=Pulmonary Edema
Accumulation of fluid in the alveoli
Left sided CHF
Pneumonia
Aspiration (When a pt. inhales foreign matter (vomit, fluid, blood, food) into the lungs
Drowning
HAPE=High altitude pulmonary edema
ARDS (acute respiratory distress syndrome)
Pulmonary Contusion
TB
Rhonchi (Lower)
Accumulation of thick mucus in the bronchi & Bronchioles. Causes a productive cough. Often due to an infection & inflammation
Chronic bronchitis
Asthma
Pneumonia
Bronchiolitis
Pleuritic Friction Rub
A sandpaper type high-pitched grating sound
Presents w/ Pleuritic CP (Chest pain on inhalation)
Pneumonia
Pleuritis
Pleurisy
Pulmonary Embolism
Waveform Capnography
Box like or square waveform is NORMAL!!!!!
4 Phases
Causes of a shark fin waveform
Foreign body or airway obstruction
Mucus or heavy secretions in the airway
Patient is biting on the ET Tube (Increase sedation)
A kink in the tubing
Bronchospasms
Bronchoconstriction
Atmospheric Oxygen
21% (Fio2)
Vent Settings
MODE (AC (Assist/Control), SIMV-Synchronized intermittent mechanical ventilation)
Respiratory Rate (RR)
tV (VT) or (TV)-6-8 ml/kg
Fio2 (Fractional Inspired O2)-30%-100%
PEEP (Positive end-expiratory pressure)-back pressure at the end of exhalation, used to prevent the alveoli from collapsing, and keeps the alveoli open (Atelectasis)
Adjustments
If the Spo2 decreases and indicates hypoxia=Adjust the Fio2
If the ETCO2 is abnormal=Adjust the RR
If the chest R/F is inadequate=Adjust the TV
If the pt. has crackles, drowning, inhalation burns=Adjust the PEEP, increase
ALL HUMANS NATURALLY BREATH AT A PEEP AT 5 cm
High Pressure Alarm
Airway obstruction
Mucus
Blood
Biting on the ET Tube
Bronchoconstriction
Kink in the tubing
Low pressure alarm
Extubated
Tubing is disconnected somewhere
Cuff is losing air
CPAP (Continuous positive airway pressure)
Every time a pt. inhales, it gives positive pressure on INHALATION
BiPap
Gives positive pressure on Inhalation & exhalation
CPAP + PEEP
ABG (Arterial Blood gases)
Blood pH-7.35-7.45
CO2/PCO2/PaCO2/ETCO2
Carbon Dioxide=Carbonic ACID!!!!!!!!
35-45
PaO2/PAO2-Partial pressure of oxygen (amount of oxygenated arterial blood in the alveoli)
Normal-80-100
Anything less than 60=Severe Hypoxemia!!!!
Spo2 (Pulse oximetry)
94-100%
Oxyhemoglobin Disassociation curve
When do we do PPV w/ a BVM vs High flow O2 via NRB mask
Shallow *****
Decreased tidal volume (Amount of air in ml we inhale/exhale)
Decreased Chest R/F
RR <10/min
RR >36/min
Unresponsive (Unable to protect the airway)
Tidal Volume
The amount of air we breathe in and out in mL
6-8 mL/kg
Example=Me=200 lbs. (91 kg) 91 x 6=546-728 mL
On scene you have a 2-year-old in severe respiratory distress w/ impending failure. Mom states he has been coughing, has had a poor appetite, and a fever x 3 days. The pt. has a history of cystic fibrosis, no allergies, and weighs 32 lbs. You have decided to intubate. What size tube would you use and how much tidal volume will you use to ventilate
32/2.2=15 kg
15 x 6=90 mL=Tidal Volume
16 + 2=18/
Uncuffed 4.5
CO2=Carbon Dioxide=Carbonic ACID!!!!!!!!
>45=Respiratory Acidosis
Bohr Effect
CO2=Carbon Dioxide=Carbonic ACID!!!!!!
When CO2 increases, the pH level goes down. The more CO2 that builds up, the less affinity for oxygen hemoglobin has, thus leading to severe hypoxia
The more ACID (CO2) that builds up, the less oxygen RBCs are carrying
RBC (Erythrocyte)
Hgb molecule must attach to the RBC in order for the RBC to carry oxygen
Peds ET Tube size
16 + Age/4
Cuffed vs Uncuffed
Cuffed
9.0
8.5
8.0
7.5
7.0
6.5
6.0
5.5
5.0 may be cuffed or uncuffed, but if the child is at or above 8 yrs old=Cuffed
Aspiration=Leads to dangerous Aspiration Pneumonia=Sepsis=Shock
When a pt. inhales any foreign matter into the lungs
Vomiting
Blood
Water
Food