Transcript AEMT Transition - Unit 13 - Airway and Respiratory

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
13
Issues in Airway
Management, Oxygenation,
and Ventilation
Objectives
• 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.
Introduction
• 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.
Epidemiology
• Dyspnea accounts for 2 percent of ED
visits.
• The use of certain respiratory
interventions is very common:
– Oxygenation adjuncts
– Airway adjuncts
– Ventilatory adjuncts
Pathophysiology
• 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)
• Upper airway dysfunction
– Above glottic opening
– Reduces the passage of inhaled gas
– Multiple reasons
Anatomy of the upper airway
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 Findings
• Recognition of respiratory distress
supersedes a need to determine the
cause.
– Primary assessment
– Minute ventilation and alveolar
ventilation
Patient suffering respiratory distress, indicated by his tripod position.
Assessment Findings (cont’d)
• Respiratory distress
– Tachypnea
– Accessory muscle use
– Tachycardia
– Alveolar breath sounds
– Speech pattern still good
Barrel chest in an emphysema patient
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)
• Respiratory arrest
– No spontaneous effort
Emergency Medical Care
• Airway
– If not open, employ techniques to do so.
• Breathing
– Prevent respiratory failure.
– Administer high-flow oxygen.
– Evaluate need for PPV.
Two rescuers deliver bag-valve-mask ventilation.
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)
• 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 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)
• 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)
• 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)
• 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)
• 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)
• Medical History
– Three heart attacks, high blood pressure
• Medications
– Nitro PRN, lasix, enalapril
• Allergies
– None per the patient
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)
• 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)
• 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)
• 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)
• 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?
Summary
• 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.
Summary (cont’d)
• Ensure first that the patient is
ventilating and oxygenating prior to
developing differentials.