Anatomy Review and S.A.L.T.â„¢ Overview

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Transcript of Anatomy Review and S.A.L.T.â„¢ Overview

  • 1. Anatomy Reviewand

2. Respiratory Review and S.A.L.T.In-Service 3. Objectives Name the major components of the upperand lower airways Describe the functions of the upper andlower airways Describe the process of ventilation Describe the process of respiration Identify the S.A.L.T. device Demonstrate use of the S.A.L.T. device Explain the SMO for the S.A.L.T. device 4. Terminology Air Nasal Turbinates Alveoli Nasopharynx Bronchial Tree Oropharynx Bronchiole Paranasal sinuses Bronchus Pharynx Capillaries Respiration Carina Rima glottidis Conchae S.A.L.T. Cribriform plate Sphenoid Corniculate cartilage Surface tension Diffusion Surfactant Epiglottis Tidal Volume Ethmoid Trachea Glottis Ventilation Minute Volume Vibrissae Mucosa Vocal folds 5. Upper and Lower Airways 6. Upper Airway Anatomy 7. Upper Airway Anatomy Anterior Nares Vestibule Mucosal Lining Septum Nasal Turbinates Posterior Nares Nasopharynx Oropharynx Pharynx Larynx Epiglottis Vocal Folds Glottis 8. Upper Airway Anterior Nares - These are the holes in the nose on the front of theface through which air is entrained for the purpose of ventilation. Vestibule This space is the area just inside the nose that serves as acollection area as air enters the respiratory system through the nose.The Vibrissae (nose hair) are located here and this is where largeparticulate matter is trapped in the first step of filtering and purifyingthe air we breathe. Mucosal lining The lining of the entire respiratory tract all the waydown to the smallest of the bronchioles is made of mucosalepithelium which is rich with goblet cells that produce mucus. Alsonoteworthy is that these cells have cilia. This important structure is veryvascular as well. It serves multiple functions includingwarming, adding moisture, further filtering the air. The rich bloodsupply warms the air. The mucus it produces serves to moisten the airand to trap the smaller particulate matter to further purify the air. Thecilia move the mucus. Septum This structure forms the middle ridge line of the nose dividingit into left and right halves. The majority of the septum is made ofcartilage which is attached to the septal bone of the nose. 9. Upper Airway Nasal turbinates / Conchae There are three sets of turbinates(a.k.a., Conchae). The inferior are the largest and have the mostsurface area in which to warm and moisten the air. Then there arethe middle and the superior turbinates. The mucosal lining becomesthinner and less vascular as it goes up and in the superior turbinates itis more yellow than red. It is here that the olfactory nerve endingsextend through the Ethmoid bone and air is gathered for the sense ofsmell. The Conchae are located on the lateral walls of the interior ofthe nose. Posterior nares The posterior nares are the openings of the posteriornose into the Nasopharynx. Nasopharynx The superior portion of the throat that is directly behindthe nose and extends down to the opening of the oral cavity at theposterior soft palate. Oropharynx The portion of the throat directly behind the oral cavityfrom the soft palate down to the superior rim of the hyoid bone. Pharynx - Is about 12.5 cm long extending from the base of the skull tothe esophagus encompassing the Nasopharynx and the oropharynx. 10. Upper Airway Larynx (a.k.a., voice box) serves as the entry point into thetrachea and extends from the base of the tongue to the topof the trachea using the third the sixth vertebrae as areference in adult men. It is typically higher in women andchildren. Epiglottis Is a cartilaginous structure that is the superiorportion of the larynx. It serves as a flap to cover the glottisduring swallowing since the oropharynx is a passage way forboth food and air. Vocal folds There are two sets of vocal folds. The false vocalfolds, so called because they do not make actualvocalization, are the two white appearing lines of the vocalcords that vibrate as air passes through them to make sound. Rima glottidis The space between the two true vocal folds(cords). Glottis - The entirety of the false and true vocal folds and therima glottidis. 11. Flow of Air in the Upper Airway Flow of Air Anterior nares Vestibule Vibrissae Nasal turbinates(conchae) Inferior Middle Superior Posterior nares Nasopharynx Oropharynx Epiglottis Glottis Vocal folds Rima glottidis 12. Upper and Lower Airways 13. Lower Airway Anatomy Trachea Mucous membrane C-shaped cartilaginousrings Carina Left main bronchus Right main bronchus Bronchial Tree Bronchioles Alveolar ducts Alveolar sacs Alveoli 300,000,000 Capillaries 14. Lower Airway Trachea Sometimes referred to as the wind pipe, the trachea thefirst structure of the lower airway. It is, as noted earlier, lined with thesame type of mucus membrane as the rest of the airways. It extendsfrom the inferior edge of the larynx to the carina. C-Shaped cartilaginous rings As the name suggests, these structuresare C shaped with the opening in the posterior and they are madeof cartilage. The serve to provide shape, support and protection tothe trachea. Without these rings, the trachea could collapse shuttingoff the vital supply of air. They are not complete rings so as to allowexpansion and contraction of the trachea as its smooth musclesrespond to the ever-changing conditions of the human body. Carina This is the inferior wall of the trachea that sits at thebifurcation of the trachea into two main bronchi. Right main bronchus This is the right branch of the trachea and isoften larger and has a less acute angle to the trachea. Its size andposition make it the more common path of endotracheal tubes thatare placed too deep. It serves as the primary branch for all otherbranches of the bronchial tree in the right lung. 15. Lower Airway Left main bronchus The primary branch of the bronchial treethat supplies the left lung. Its angle to the trachea is typicallymore acute and it is often smaller in diameter than its rightcounterpart. Bronchial Tree This term is used to describe the branching ofthe bronchi down to the innumerable bronchioles that serveto transmit air into the alveoli. As the branches getsmaller, the cartilaginous rings become more irregularlyshaped and complete so as to support the small airways andprevent collapse. Bronchioles These are the smallest airways of the lowerairway anatomy. They terminate into the alveolar ductswhich are the connection to the alveoli. At this level, the ringsof cartilage have disappeared. Alveolar ducts These are the small, acartilaginous airwaysthat transmit air into the alveolar sacs. 16. Lower Airway Alveolar sacs The terminal of gas exchange is thealveolar sac. These are often said to look like abunch of grapes. These tiny (microscopic) sacs areenveloped in capillaries that are in contact withtheir surface. The grape-like structure provides alarge surface area for efficient gas exchange. Alveoli This is the term applied to the bunches ofgrapes and it has been estimated that there arearound 300,000,000 alveoli in the human lungs. Capillaries The capillaries are the smallest of bloodvessels and are typically only one cell thick. Thisallows for efficient exchange of gases, glucose, andwaste products between individual cells and theblood. 17. Ventilation vs. Respiration Ventilationis the Respiration is said tomechanical be the processesmovement of airthat result in theinto and out of theabsorption, transport,and utilization orbody. exchange of respiratory gases between an organism and its environment.We can produce artificial ventilation but we cannot produce artificial respiration! 18. Respiration Respiration begins at the anterior nares and ends atthe anterior nares and it includes everything thathappens in between. Ventilation moves the oxygen rich air in and displacesthe carbon dioxide rich air out. It is in the alveoli that gas exchange takes place andthe airways are the transmission pathways for thegases. As mentioned before, the walls of the capillaries are incontact with the walls of the alveoli and this contact isthe point at which CO2 trades places with O2 making itpossible for the body to remain homeostatic. Keeping in mind that all of this occurs at the cellularlevel, remember that our job is keeping as many cellsalive as we can for as long as we can. 19. the lungs serve the alveoli justas the circulatory system servesthe capillaries. 20. Alveolar Function Gas exchange easilytakes place in thealveoli Alveoli are thin-walled Each alveolus is incontact with thecapillaries thatsurround it Capillary walls at thislevel are only 1 cellthick 21. Supraglottic AirwayLaryngopharangeal Tube The S.A.L.T. is aunique single patientuse oropharyngealairway which can beutilized to facilitateblind, endotrachealintubation. TheS.A.L.T. can also beutilized to reduceaccidentalendotracheal tubeextubation. 22. S.A.L.T. Supraglottic Airway Laryngopharangeal Tube The S.A.L.T. is a unique singlepatient use oropharyngeal airway which can be utilized to facilitateblind, endotracheal intubation. The S.A.L.T. can also be utilized to reduceaccidental endotracheal tube extubation.(Though this is not grammaticallycorrect, it is a direct quotation and so was not changed.) This device will be used as an adjunct to open the airway and to facilitateendotracheal intubation in the difficult airway patients. We, here at National EMS, will use it after two (2) attempts at intubation via directlaryngoscopy or when patient access is compromised making directlaryngoscopy unreasonable. This device can be inserted using the tongue blade method the same waystandard OPAs are inserted or by direct laryngoscopy. Remember that good BLS is a prerequisite to any ALS procedure. Always beginwith simple airway maneuvers such as the head-tilt/chin-lift or jaw-thrust thenbag-valve-mask ventilation if required. Once the decision has been made to move on to advanced airwaymanagement, we will start with endot