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At the same time, _______ _______ is produced by tissue, and carbon dioxide is moved to the _____ _____ to leave the body during exhalation.
What is the main function of the respiratory structure?
Lips and mouth form the opening entrance to the ______ ______ which serves as an entrance for the _______ ________ and digestive system as well.
Adams apple (Thyroid cartilage):
Cricoid cartilage (cricoid ring):
Glottis/ Glottic opening:
space in between the vocal cords and the narrowest portion of the adult’s airway. The lateral borders of the glottis are the vocal cords.
the narrow cartilaginous lower tip of the sternum
lines the inside of the thoracic cavity.
The boundaries of the thoracic cavity are the rib cage ______, _______ and _________ and the diaphragm inferiorly
space between the lungs surrounded by tough connective tissue. This space contains the heart, the great vessel, esophagus, trachea, major bronchi, and many nerves.
Carry deoxygenated blood back to the heart and into the right atrium.
Oxygenated blood travels through the _______vein to the left _______ through the _______ valve and into the left ventricle where it is again pumped to the rest of the body.
Diaphragm is both ______ and an _______ muscle.
second muscles for respiration.
the term used to describe the amount of gas in air or dissolved in fluid, such as blood.
the portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange.
also referred to as minute volume is the amount of air moved through the lungs in 1 minute minus dead space.
Ex. 12 breaths/min, Tidal Vol. 500 ml per breath, dead space 150 ml. minute volume would equal 4,200 ml.
Vital Capacity: the amount of air that can be forcibly expelled from the lungs after breathing deeply.
the air that remains after maximal expiration
does not normally require muscular effort, therefore it is a passive process.
Patients with chronic obstructive pulmonary disease (COPD) have difficulty eliminating ______ ______ through ________ causing a higher than normal level of carbon dioxide in their system.
chronic obstructive pulmonary disease
based on levels of oxygen dissolved in plasma.
Late signs of hypoxia:
is the process of loading oxygen molecules into hemoglobin molecules in the bloodstream.
Must ventilate with adequate level of oxygen.
Metabolism/ cellular respiration:
External respiration (pulmonary respiration)-
reduce surface tension within the alveoli and keeps them expanded, thus making it easier for the gas exchange between oxygen and carbon dioxide to take place.
in the presence of oxygen, the mitochondria of the cells concert glucose into energy.
Without adequate oxygen, the cells do not completely convert glucose into energy and lactic acid and other toxins accumulate in the cell.
Many conditions can inhibit the body’s ability to effectively deliver oxygen to the cells. Disruption of:
monitor the levels of oxygen, carbon dioxide, hydrogen ions and the pH of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time.
Dorsal respiratory group
Ventral respiratory group
Both the _______ and the ______ respiration group is affected by the _______ center and the ________ center of the pons.
Pneumotaxic center -
V/Q ratio (ventilation and perfusion) mismatch-
_______ and _______ nervous systems play a key role in regulation of breathing.
May suffer from asphyxiation due to swelling. May have a decrease in pulmonary ventilation from bronchoconstriction.
Conditions that ______ the surface area for gas exchange also _______ the body’s oxygen supply leading to inadequate tissue perfusion.
What kind of medical conditions disturb cellular metabolism?
pneumonia, pulmonary edema, COPD
inhibit the diffusion of oxygen and carbon dioxide.
Obstruction of blood flow to individual cells and tissue
These conditions may include: (all of these conditions limit the ability for gas exchange at the tissue level as a result of their effects on the respiratory and circulatory systems. (5)
Should be a smooth flow of air moving into and out of the lungs. You should not be able to see or hear the chest rising or falling.
Patients who are breathing less than 12 respirations per minute, shallow breathing, or working hard to breath should be evaluated for inadequate breathing
breathing that requires effort and especially among children may involve the use of accessory muscles.
Opening the Airway
Emergency medical care begins with ensuring an open airway.
With an unconscious patient you must first assess if the patient has a pulse and is has adequate breathing.
Unconscious patients without witnesses to rule out trauma should be log rolled to avoid twisting and turning head or back.
Head Tilt-Chin Lift Maneuver
Basic Airway Adjuncts
Function of airway adjunction is to prevent obstruction of the upper airway by the tongue and allow the passage of air and oxygen to the lungs.
Skill Drill 9-3 INSERTING AN ORAL AIRWAY
Oropharyngeal (oral) Airway:
Indications of oral airway include:
Contradictions of oral airway include:
For patients who have had a _____ or ______ injury, you should consult with medical control before inserting a ________ airway.
Indications for nasal airway:
Contradictions for nasal airway:
Skill Drill 9-5 INSERTING A NASAL AIRWAY
You must keep airway clear, if not clear you will force the fluid into the lungs and possibly cause a complete airway obstruction.
Suctioning is the next priority!
IF YOU HEAR GURGLING THE PATIENT NEEDS SUCTIONING.
Portable, hand- operated, and fixed (mounted) suctioning equipment is essential for resuscitation.
A fixed suctioning unit should generate airflow of more than ____ L/Min and a vacuum of more than ____ mm Hg when the tubing is clamped.
A portable or fixed suctioning unit should be fitted with the following
hollow, cylindrical device that is used to remove fluids from the patient’s airway.
Tonsil tip catheters are the best catheters to suction fluids from the ________ in adults and preferred for infants and children.
Do not touch the back of the airway with a suction catheter, it may trigger the gag reflex and increase the chances of aspiration.
When checking to see if you suctioning device works, vacuum must generate more than ____ mm Hg.
Never suction the mouth of nose more than:
Skill Drill 9-6 SUCTIONING A PATIENT’S AIRWAY
removes oxygen from the airway as well as obstructive materials and can result in hypoxia.
Some objects cannot be removed with the ______ ______, in these cases log roll patient and take out with gloved finger.
Maintaining the Airway
You should always give oxygen to patients who are hypoxic because they are not getting enough oxygen to the tissue and cells of the body.
When ventilating patients in cardiac or repertory arrest, you must use high-concentration supplemental oxygen.
Oxygen tanks are green steel or aluminum cylinders with a valve stem on top.
Check the letters and the numbers stamped at the top of the cylinders, these are the date of last test date.
Liquid oxygen lasts longer and weighs less.
Need to be kept upright and have specific requirements for filling large-volume storage and cylinder transfer.
The tanks are filled with pressure, a puncture or a hole can cause the tank to be a deadly missile.
During transportation must be secured to prevent the tank from falling and to prevent damage to the valve-gauge assembly.
American Standard System:
Be sure that the pin holes on the cylinder match exactly the corresponding ____ on the ______.
Final attachment for delivering the gas to the patient:
Usually permanently attached to pressure regulators on emergency medical equipment.
Two types of flowmeters are:
Hazards of Supplemental Oxygen
Keep any source of fire away from the area while oxygen is in use.
Make sure are is well ventilated.
Never leave an oxygen tank unattended.
Oxygen-delivery equipment used in the field are nonrebreathing masks, bag-mask devices, and nasal cannulas.
Nasal cannula delivers oxygen through ____ small, tube like prongs that fit into the patient’s ____.
Device provides 24-44% inspired oxygen when flowmeter is set at 1 to 6 L/min. (rates above are not recommended with nasal cannulas)
When going for a long ride consider the use of humidification (bessie’s oxygen).
Partial Rebreathing Mask
Similar to nonrebreathing mask but no one way valve.
Patients inhale a small amount of exhaled air.
This is the ideal mask to use for a patient who is hyperventilating 80-90% oxygen 2-3% Carbon dioxide.
Venture principle: .
Masks are designed to fit the tracheostomy hole and have a strap that goes around the neck.
Usually available in intensive care units and may be unavailable in emergency situations.
Assisted in Artificial Ventilation
Patients with inadequate breathing are typically unable to speak in complete sentences.
Irregular breathing patterns will require artificial ventilation to assist the patient in maintaining adequate minute volume.
Two options for a patient who has a severe respiratory distress
In normal ventilation
In Positive-Pressure Ventilation
Positive pressure ventilation may cause ______ output to drop. EMT’s must regulate the rate and volume of artificial _______ to help prevent this drop.
Skill Drill 9-8 PERFORMING MOUTH-TO-MOUTH VENTILATION
The Bag-Mask Device
With an oxygen flow of 15 L/min and a good seal, a bag-mask device with an oxygen reservoir can deliver nearly 100% oxygen.
Provides less tidal volume than mouth to mask ventilation, but it delivers a much higher concentration of oxygen.
Bag-mask device holds
Manually Triggered Ventilation Devices:
Manually Triggered Ventilation Devices
They allow the care provider to maintain a seal using both hands while providing positive-pressure ventilation
Reduces rescuer fatigue
Finding show this type of ventilation causes gastric distention and can cause damage to the thorax
Should not be used on patients with COPD, cervical spinal injuries or chest injuries
Automatic transport ventilator (ATV):
a manually triggered ventilation device attached to a control box that allows the variables of ventilation to be set.
Can cause a patient to hyperventiliate due to compliance
CPAP increases pressure in the lungs, opens collapsed alveoli’s pushing oxygen across the membrane and forcing interstitial fluid back into the pulmonary circulation.
CPAP is composed of a generator,mask,circuit that contains corrugated tubing, bacteria filter, and a one-way valve.
Positive end-expiratory pressure (PEEP):
Skill Drill 9-9 USING THE CPAP
If you cannot ventilate a patient with a ____, suction the ____, before trying to _______ the mouth/nose.
Mild Airway Obstruction:
Good air exchange:
production of whistling sound during respiration.
Poor air exchange:
Severe Airway Obstruction:
cannot breathe, talk or cough may grip neck with both hands.
Dental appliances such as ______, _____ or even ______ can cause airway obstructions.
If loose, these appliances should be removes before causing further damage to the patient.
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