Interactive Ready for Review: Interactivities

Interactive Ready for Review for Chapter 9 - Airway Management and Ventilation

The system includes the diaphragm, the muscles of the chest wall, and the accessory muscles of breathing.

The term "" usually means the upper airway, which includes the respiratory structures above the vocal cords.

Clearing the airway means removing obstructing material; maintaining the airway means keeping it open.

Patients who are breathing inadequately show signs of , a dangerous condition in which the body's tissues and cells do not have enough oxygen.

Adequate breathing features a normal rate of 12 to 20 breaths/min, a regular pattern of inhalation and exhalation, bilateral clear and equal lung sounds, regular and equal chest rise and fall, and adequate volume.

Patients with inadequate breathing need to be treated immediately. Emergency medical care includes airway management, supplemental oxygen, and ventilator support.

Basic techniques for opening the airway include the head tilt-chin lift maneuver and the jaw-thrust maneuver.

One basic airway adjunct is the or oral airway, which keeps the tongue from blocking the airway in unresponsive patients with no gag reflex. If the oral airway is not the proper size or is inserted incorrectly, it can actually push the tongue back into the pharynx, causing an obstruction.

Another basic airway adjunct is the or nasal airway, which is usually used with patients who have a gag reflex.

Suctioning is the next priority after opening the airway. Rigid tonsil tips are the best catheters to use when suctioning the pharynx; soft, plastic catheters are used to suction the nose and liquid secretions in the back of the mouth.

The position is used to help maintain the airway in patients without traumatic injuries who are breathing adequately on their own.

You should always give supplemental oxygen to patients who are not breathing on their own or who have inadequate breathing. Handle compressed gas cylinders very carefully; their contents are under pressure.

Always make sure the correct pressure regulator is firmly attached before transporting a cylinder.

The features a series of pins on a yoke that must be matched with the holes on the valve stem of the gas cylinder.

Pressure regulators reduce the pressure of gas in an oxygen cylinder to between 40 and 70 psi. Pressure-compensated flow meters and Bourdon-gauge flow meters permit the regulated release of gas measured in liters per minute.

When oxygen therapy is complete, disconnect the tubing from the flow meter nipple and turn off the cylinder valve, then turn off the flow meter. As long as there is a pressure reading on the regulator gauge, it is not safe to remove the regulator from the valve stem.

Keep any possible source of fire away from the area while oxygen is in use.

Nasal cannulas and the far more effective are used most often to deliver oxygen in the field; always try to use the latter with patients you suspect may have hypoxia. %%9%% can provide more than 90% inspired oxygen.

Pulse oximetry, an assessment tool to evaluate the effectiveness of oxygenation, does not take the place of a good assessment. This measurement depends on adequate perfusion to the capillary beds and is inaccurate when the patient is cold or in shock or has been exposed to carbon monoxide.

The methods of providing artificial ventilation include a one-, two-, and three-person BVM device, mouth-to-mask ventilation, and a flow-restricted, oxygen-powered ventilation device. The flow-restricted, oxygen-powered ventilation device, however, is not a recommended ventilation device by many standards.

Combined with your own exhaled breath, mouth-to-mask ventilation with supplemental oxygen attached will give your patient up to 55% oxygen; a BVM device with an oxygen reservoir can deliver nearly 100% oxygen.

Patients with altered mental status or those who are unable to maintain their own airway should be considered candidates for definitive airway management. These devices include esophageal airways, multilumen airways, and endotracheal tubes.

It is imperative to be familiar with indications, contraindications, advantages, disadvantages, and special considerations when choosing the appropriate device. This is especially important when dealing with pediatric patients. Regardless of the method, aggressive airway management is essential to a positive patient outcome.

When you are providing artificial ventilation, remember that ventilating or blowing too forcefully can cause . Slow, gentle breaths during artificial ventilation and use of cricoid pressure can help to prevent %%10%%.

Also consider patients who have a tracheal stoma or a tube. You will need to ventilate these patients through the tube or the stoma.

Foreign body airway obstruction usually occurs during a meal in an adult or while a child is eating, playing with small objects, or crawling about the house.

The earlier you recognize any airway obstruction, the better. You must learn to recognize the difference between airway obstruction caused by a foreign object and that caused by a medical condition.

The Heimlich maneuver, finger sweeps, manual removal of the object, and attempts to ventilate can remove a complete airway obstruction.

Treat patients with a partial airway obstruction and poor air exchange as if they had . Patients with partial airway obstruction and good air exchange should be closely monitored.

Check for loose dental appliances in a patient before assisting ventilation. Loose appliances should be removed to prevent them from obstructing the airway.