TRANSITION SERIES Topics for the Advanced EMT CHAPTER Issues in Airway Management, Oxygenation, and...
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Transcript of TRANSITION SERIES Topics for the Advanced EMT CHAPTER Issues in Airway Management, Oxygenation, and...
TRANSITION SERIESTRANSITION SERIES
Topics for the Advanced EMTTopics for the Advanced EMT
CHAPTERCHAPTER
Issues in Airway Issues in Airway Management, Oxygenation, Management, Oxygenation, and Ventilationand Ventilation
1313
ObjectivesObjectives
• Review pathophysiological changes that occur with upper and lower airway dysfunction.
• Differentiate respiratory distress from respiratory failure.
• Discuss current treatment guidelines for oxygenating and ventilating patients.
IntroductionIntroduction
• Failure to oxygenate a patient will doom all other interventions to failure.
• Assessment and treatment of respiratory distress and failure remains constant.
• Immediate identification and action for respiratory issues is more important than differential diagnosis.
EpidemiologyEpidemiology
• Dyspnea accounts for 2 percent of ED visits.
• The use of certain respiratory interventions is very common:– Oxygenation adjuncts– Airway adjuncts– Ventilatory adjuncts
PathophysiologyPathophysiology
• Respiratory dysfunction is typically due to:– Obstruction of airflow– Changes to pulmonary structures– Occasionally both
• Classification by type– Upper airway– Lower airway
Pathophysiology (cont’d)Pathophysiology (cont’d)
• Upper airway dysfunction– Above glottic opening– Reduces the passage of inhaled gas– Multiple reasons
Pathophysiology (cont’d)Pathophysiology (cont’d)
• Lower airway dysfunction– Structures below trachea– Bronchoconstriction– Alveolar damage
Provide oxygen via a nonrebreather mask to the patient who is breathing adequately but with difficulty (respiratory distress).
Assessment FindingsAssessment Findings
• Recognition of respiratory distress supersedes a need to determine the cause.– Primary assessment– Minute ventilation and alveolar
ventilation
Assessment Findings (cont’d)Assessment Findings (cont’d)
• Respiratory distress– Tachypnea– Accessory muscle use– Tachycardia– Alveolar breath sounds– Speech pattern still good
Assessment Findings (cont’d)Assessment Findings (cont’d)
• Respiratory failure– Absent alveolar sounds– Poor speech patterns– Altered mental status– Low pulse oximeter– Cyanosis
The continuum of breathing ranges from normal, adequate breathing to no breathing at all. It is essential to recognize the need for assisted ventilations even before severe respiratory distress develops.
Assessment Findings (cont’d)Assessment Findings (cont’d)
• Respiratory arrest– No spontaneous effort
Emergency Medical CareEmergency Medical Care
• Airway– If not open, employ techniques to do so.
• Breathing– Prevent respiratory failure.– Administer high-flow oxygen.– Evaluate need for PPV.
Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)
• Continuous positive pressure ventilation– “Back pressure” to help ease breathing
effort.– Helps with diffusion of gases in alveoli.– Commonly used in acute pulmonary
edema.
Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)
• Applying CPAP– Patient must be spontaneously
breathing.– Use carefully in patients with low B/P.– Coach patient to keep device on.– Will need separate training to use
at AEMT level.
Continuous positive airway pressure (CPAP) is used for the awake and spontaneously breathing patient who needs ventilatory support. (© Ken Kerr)
Case StudyCase Study
• You are called to assist an elderly male with respiratory distress. When you arrive, the patient is found sitting up in his bed with obvious respiratory distress.
Case Study (cont’d)Case Study (cont’d)
• Scene Size-Up– There is only one patient.– BSI precautions are taken.– Male patient, 68 years old, 190 lbs.– Sitting upright, objective respiratory
distress.– You see multiple meds on table beside
bed.
Case Study (cont’d)Case Study (cont’d)
• Given this patient's age, what could be at least three common pathologies causing respiratory distress?
• Following the scene size-up, what would be at least three questions you would initially ask?
Case Study (cont’d)Case Study (cont’d)
• Primary Assessment Findings– Patient responds to verbal stimuli.– Airway patent and maintained by
patient.– Respirations fast with accessory muscle
use.– Speaking in 4-5 word sentences.– Peripheral pulse is present, skin cool
and clammy, skin is slightly pale.
Case Study (cont’d)Case Study (cont’d)
• Is this patient a high or low priority? Why?
• What care should be provided immediately?
• Is this patient in respiratory distress or failure?
Case Study (cont’d)Case Study (cont’d)
• Medical History– Three heart attacks, high blood pressure
• Medications– Nitro PRN, lasix, enalapril
• Allergies– None per the patient
Case Study (cont’d)Case Study (cont’d)
• Pertinent Secondary Assessment Findings– Pupils reactive to light– Breath sounds present bilaterally with
inspiratory rales– Peripheral perfusion is intact
Case Study (cont’d)Case Study (cont’d)
• Pertinent Secondary Assessment Findings– Pulse ox 94% on 100% oxygen– Skin cool, diaphoretic, pale– Peripheral edema noted to lower legs– B/P 168/88, Pulse 110, Respirations 26
Case Study (cont’d)Case Study (cont’d)
• Interventions provided prior to transport:– Oxygen maintained via NRB– Patient placed in high-Fowler position– Patient packaged and transported to
ambulance
Case Study (cont’d)Case Study (cont’d)
• After transport has started, you find the following with reassessment:– Airway still patent– Breathing slightly more tachypnic– Pulse ox now 92%– Patient conscious, but is starting to
become sleepy
Case Study (cont’d)Case Study (cont’d)
• You have decided to apply CPAP to the patient. After instructing the patient on how it works, you apply it and allow it to work for about 3-4 minutes.– What would be indications of patient
improvement?– What would be indications of further
patient deterioration?
SummarySummary
• Airway, oxygenation, and ventilation skills are some of the most important the Advanced EMT will ever use.
• Always try to prevent respiratory failure first rather than waiting for it to occur in order to be aggressive with your interventions.