Chapter 8 Respiratory Support. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview Breathing Assessment.

Chapter 8

Respiratory Support

2

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Breathing Assessment Oxygen Therapy Oxygen Delivery Systems Oxygen Delivery Devices Artificial Ventilation

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Breathing

Breathing is a complex activity Some illnesses impair the body’s ability to

utilize oxygen Hypoxia means insufficient body stores of

oxygen– Increased respiratory rate – Shortness of breath

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Breathing

Severe difficulty with breathing can lead to respiratory failure

Untreated respiratory failure can lead to death

The EMT must assess the patient’s ventilation and respiration

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Assessment

Initial steps– Look– Listen– Feel

Determination of level of consciousness– Verbal stimuli– Physical stimuli

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Assessment

Quick check– Key to the initial assessment of the unconscious

patient– Look for the chest to rise and fall– Listen and feel for air movement– Check for the presence of a carotid pulse

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Assessment

Look– Visual cues provide a lot of information about the

patient’s breathing– Position

• The tripod position allows the patient to expand his lungs and draw in more air

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Assessment

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Assessment

Look– Color

• Blood lacking oxygen gives the skin a bluish color, known as cyanosis

– Respiratory rate• Can be too fast, too slow, or about normal• Tachypnea is an increased rate of breathing• Hypoventilation is a decreased rate of breathing

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Assessment

Look– Effort

• Any exertion seen with breathing is abnormal• Nasal flaring • Mouth breathing• Pursed lips• Accessory muscle use

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Assessment

Look– Pulse oximetry

• Measures the percentage of red blood cells that are saturated with oxygen

• Helps assess a patient with respiratory distress • Average oxygen saturation is 96–100%• Below 95%: Oxygen administration required • Below 92%: The patient is significantly hypoxic

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Assessment

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Assessment

Listen– Note what is said and how it is said – Document the chief complaint– The feeling of respiratory distress is called

dyspnea

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Assessment

Listen– Speech

• The EMT should note the patient’s ease of speech• Full sentences without frequently stopping—severe

distress is not likely• Short sentences or monosyllabic answers—severe

respiratory distress is present

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Assessment

Listen– Obvious noise

• Note noises associated with breathing• Noticeable noise is a sign of a respiratory problem

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Assessment

Listen– Breath sounds

• On auscultation, air movement should be evident in both lungs

• The absence of sounds indicates lack of air movement• Diminished breath sounds may indicate poor airflow or

lung abnormality

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Assessment

Feel– Palpate the chest wall for tenderness, deformity,

and equality of movement– With the hands under the armpits, apply pressure

to the rib cage

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Stop and Review

List the signs of adequate breathing.

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Oxygen Therapy

The most common medication administered by the EMT

Be familiar with its indications, contraindications, and administration

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Oxygen Therapy

Indications– Primary indication—to reverse hypoxia

– Physical signs of hypoxia • Restlessness

• Anxiety

• Confusion

• Tachypnea or hypoventilation

• Tachycardia or bradycardia

• Cyanosis

– Always rely on clinical judgment

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Oxygen Therapy

Contraindications– No absolute reason not to administer oxygen

except:• Oxygen toxicity in premature infants

– Do not withhold oxygen from a patient who needs it

– Careless administration can have potential complications

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Oxygen Therapy

Oxygen humidification– Oxygen can dry the mucous membranes over

long period of time – Humidification of oxygen can help prevent injury – Two means of administering

• Use standard volume nebulizer• Attach to standard non-rebreather mask

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Oxygen Delivery Systems

Two types of oxygen delivery systems– Fixed systems

• On board ambulance• May hold 3,000 liters• Filled to about 2,000 psi

– Portable systems• Easily moveable• May hold 350 liters• Refill before below 200 psi

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Oxygen Delivery Systems

Anatomy of an oxygen delivery system

– Cylinder holds oxygen under pressure • Must be hydrostatically tested every five years

– Regulator controls the flow of oxygen• Flow rates should be from 2 lpm to 15 lpm

– T-piece mates cylinder with the regulator– Washers ensure an airtight fit

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Oxygen Delivery Devices

Simple facemask– Percentage of oxygen delivered is a function of the

patient’s respiratory rate

Venturi mask– Designed to deliver a specific percentage of

oxygen regardless of the patient’s respiratory rate

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The partial non-rebreather mask (NRB)– Provides high concentrations of oxygen – Prevents rebreathing of exhaled air– Liter flow should be between 10 and 15 lpm – Patient must be breathing effectively to ensure

delivery– Must monitor patient to ensure that the respiratory

status is not changing

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NRB and Nasal Cannula

Watch this clip demonstrating the use of the non-rebreather and nasal cannula

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Tracheostomy mask– Variation of an oxygen facemask– Fits over the tracheostomy opening

and provides oxygen

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Nasal cannula (NC)– Two small prongs attached to a length of tubing – Flow rates vary from 1 to 6 lpm – Generally restricted to patients who are already on

low-flow oxygen at home or cannot tolerate NRB

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Artificial Ventilation

Providing ventilation to a patient who is not breathing at all (apnea) is called artificial ventilation (rescue breathing)

When performing artificial ventilation, EMT must use a barrier device

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The pocket mask– Most effective ventilation method used by an

individual EMT– Is both barrier device and ventilation device– Mouth-to-mask ventilation can deliver 16% oxygen

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Pocket Mask

Watch this clip demonstrating the use of the pocket mask

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The bag valve mask– Primary device used to ventilate

nonbreathing patients– Outstanding feature is the self-inflating bag– Many have attached oxygen reservoirs – Delivery valve ensures one-way flow of

oxygen-rich air– Facemask of a BVM is very similar to the

pocket mask

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Ventilation technique– Air volume

• Overaggressive ventilation can lead to distention and vomiting

• Insufficient ventilation can lead to hypoxia• EMT must be familiar with age-appropriate ventilation

rates• Overly slow or fast ventilations can result in

inappropriately high or low CO2 levels

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Ventilation technique– Two-person ventilation

• Most effective method of ventilating nonbreathing patient• First EMT is the airway person; must be prepared to

suction• Second EMT is the breathing person; focus is on

ventilation• In cardiac arrest, a third EMT is the circulation person

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Ventilation technique – Cricoid pressure

• When possible, gentle cricoid pressure is applied • The cricoid is a cartilaginous ring that supports and holds

open the trachea • Compresses the esophagus, preventing air from entering

easily

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Bag Valve Mask

Watch this clip demonstrating the use of a bag valve mask

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Flow-restricted oxygen-powered ventilation device (FROPVD)– Downsides

• Easy to overinflate the patient’s stomach with this device • The EMT cannot feel the resistance created by the

patient’s lungs

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Single-person BVM ventilation– Pocket mask– FROPVD– Bag valve mask alone (last resort)

• Insufficient volume of oxygen often generated • Efficiency can be improved by pressing the bag against

the patient’s face

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Ventilation of the breathing patient– Patients with extreme difficulty breathing can be

assisted with BVM– Patient may stop breathing and allow EMT to

ventilate him – By assisting ventilations, the EMT can avoid

periods of hypoxia

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Ventilation of the surgical airway– Tracheostomy

• The tracheostomy tube will fit onto the BVM connector • Less air is needed to ventilate the tracheostomy patient

– Stoma • EMT should size the stoma’s opening for a properly fitting

mask

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Stop and Review

Identify the parts of a non-rebreather facemask and state the oxygen flow requirements needed for its use.

Chapter 8 Respiratory Support. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview Breathing Assessment.

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assessment slide

breathing breathing

air slide

dyspnea slide

respiration slide

hypoxic slide