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Chapter 9 Airway. Respirations. Every cell of the body requires _______________________ to survive Oxygen must come in and carbon _______________________ must go out. Metabolism. Metabolism --Process where the body’s cells convert food to _______________________
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Respirations • Every cell of the body requires _______________________ to survive • Oxygen must come in and carbon _______________________ must go out
Metabolism • Metabolism--Process where the body’s cells convert food to _______________________ • Adequate _______________________ required • Carbon dioxide produced as a _______________________ product
Oxygen Requirements • Normal air consists of ____________% oxygen • Exhaled air consists of ____________% oxygen • All cells require oxygen to live • CPR produces only ____________% of the normal cardiac output
Respiratory Anatomy • Nose: The _______________________ pathway • _______________________ : Secondary pathway • Pharynx: The _______________________ • Larynx: Connects the pharynx and trachea • voice box • _______________________ cartilage • _______________________ : leaf shaped flap that covers trachea to prevent food from entering lungs
Respiratory Anatomy • _______________________ : Windpipe • Bronchial Tree: Branching of trachea • Bronchi • Bronchioles • Lungs -Left lung has ___________ lobes -Right lung has ____________ lobes • _______________________ : Tiny air sacs where gas exchange occurs
Respiratory Anatomy • Diaphragm: _______________________ that controls breathing • Upper Airway: nasopharynx to just below larynx • Lower Airway: Larynx to _______________________
Diaphragm • Has characteristics of both voluntary and _______________________ muscles • _______________________ -shaped muscle • Divides thorax from abdomen • _______________________ during inhalation • _______________________ during exhalation
Breathing Process: Inhalation • _______________________ part of breathing • Diaphragm and intercostal muscles contract, allowing the lungs to _______________________ . • The decrease in pressure allows lungs to fill with air. • Air travels to the _______________________ where exchange of gases occurs.
Tidal and Minute Volume • Tidal Volume: the amount of air, in _______________________ , that is moved in and out of the lungs with each breath • ___________ to ___________ mL per kilogram • ___________ mL is average for an adult male • Minute Volume: the amount of air moved through the lungs in one _______________________ • Tidal volume X respiratory _______________________
Breathing Process: Exhalation • Does not normally require _______________________ effort • Diaphragm and intercostal muscles _______________________ . • The thorax _______________________ in size, and ribs and muscles assume their normal positions. • The increase in pressure forces air out.
Gas Exchange • Inhalation delivers oxygen-rich air to alveoli. • Oxygen diffuses into the _______________________ • The body does not use all the inhaled _______________________ .
Control of Breathing • Brain _______________________ controls breathing • Stimulus for breathing is one of the following: • _______________________ Drive: Breathing regulated by the amounts of carbon dioxide in arterial blood - _______________________ Stimulus -As CO2 levels increase, rate increases • _______________________ Drive: Breathing regulated by the amount of oxygen in the arterial blood - _______________________ system -As O2 levels increase, rate decreases
Normal Breathing Characteristics • Normal rate and _______________________ • Regular _______________________ • Good breath _______________________ in both lungs • Regular rise and fall movements in the chest • Easy, not labored
Hypoxia • Hypoxia is the lack of _______________________ • Signs • _______________________, irritability, and fear • Tachycardia • Mental status changes • Use of _______________________ muscles for breathing • Difficulty breathing, possible _______________________ pain
Conditions Resulting in Hypoxia • Myocardial _______________________ • Pulmonary edema • Acute narcotic overdose • Smoke inhalation • _______________________ • Chest injury • Shock • Lung disease • _______________________
Normal Respiration Rates • Adults: ____________ to ____________ breaths/min • Children: ____________ to ____________ breaths/min • Infants: ____________ to ____________ breaths/min
Recognizing Inadequate Breathing • _______________________ breathing • Use of accessory muscles • Pale or _______________________ skin • Cool, _______________________ skin • Irregular respirations • _______________________ lung sounds
Opening the Airway • Head tilt-chin lift • _______________________ patients, medical patients • Jaw-thrust • Suspected _______________________ injury
Assessment of the Airway • _______________________. • _______________________. • _______________________.
Basic Airway Adjuncts (1 of 6) Oropharyngeal airways • Keep the _______________________ from blocking the upper airway • Allow for easier suctioning of the airway • Used in conjunction with _______________________ device • Used on unconscious patients without a _______________________ reflex
Basic Airway Adjuncts (2 of 6) Inserting an oropharyngeal airway • Select the proper _______________________ airway. • _______________________ the patient’s mouth. • Hold the airway upside down and insert it in the patient’s mouth. • Rotate the airway ___________° until the flange rests on the patient’s lips.
Basic Airway Adjuncts (4 of 6) • Nasopharyngeal airways • Used on _______________________ patients who can’t maintain an airway • Can be used on patients _______________________ a gag reflex • Should not be used on patients with possible _______________________ injuries or nose bleeds
Basic Airway Adjuncts (5 of 6) Inserting a nasopharyngeal airway • Select the proper size airway. • _______________________ the airway. • Gently push the _______________________ open. • With the bevel turned _______________________ the septum, insert the airway.
Suctioning Technique (1 of 2) • Check the unit and turn it on. • Select and _______________________ proper catheter to be used. • Open the patient’s mouth and _______________________ tip. • Suction as you _______________________ the catheter. • Never suction for more than ___________ seconds.
Supplemental Oxygen • All patients in _______________________ arrest should get oxygen. • Any patient with a _______________________ or cardiac emergency needs oxygen. • Never withhold oxygen from anyone who may _______________________ from it.
Supplemental Oxygen Equipment Oxygen cylinders • Available as a compressed ____________-____________________________ gas • Available in several sizes • Pin-indexing safety system • Oxygen _______________________ • _______________________ oxygen
Oxygen Flowmeters • _______________________ -compensated flowmeter • Affected by gravity; must be kept upright • _______________________ -gauge flowmeter • Not affected by gravity; can be used in any position
Using Supplemental Oxygen (1 of 2) • Inspect cylinder and markings. • “_______________________ ” the cylinder. • _______________________ the regulator/flowmeter. • _______________________ the cylinder. • Attach proper delivery _______________________ to flowmeter.
Using Supplemental Oxygen (2 of 2) • Adjust flowmeter to desired _______________________ rate. • _______________________ the oxygen device to the patient. • When done, _______________________ the delivery device. • Turn off the flowmeter. • Replace bottle if below ___________ psi (safe residual)
Hazards of Oxygen • Oxygen supports _______________________ . • Keep possible _______________________ sources away from the area. • Oxygen tanks are under high _______________________ .
Oxygen Delivery Equipment • _______________________ mask • Provides up to ___________% oxygen • Used at ___________ to ___________ L/min • Nasal cannula • Provides ___________% to ___________% oxygen • Used at ___________ to ___________ L/min
Calculating Oxygen Duration • (Amount in Bottle (psi)--200 PSI) X Factor Flow (LPM) • 200 PSI is the safety factor to allow for gauge inaccuracy • Answer is in _______________________ of usage • Factor is determined by the _______________________ of the bottle. • D cylinder: 0.16 • E cylinder: 0.28 • M cylinder: 1.56 • H cylinder: 3.14
Calculating Oxygen Duration Example: You are delivering oxygen to a patient using a NRB flowing at 10lpm. The bottle is a E cylinder (factor of 0.3). The bottle has 1,500psi remaining. How long will the bottle last?
Calculating Oxygen Duration • (Amount in Bottle (psi)--200 PSI) X Factor Flow (LPM) • (1,500-200) X 0.3 10 • 1,300 X 0.3 10 • 390 10 • 39 minutes
Methods of Ventilation • Mouth to _______________________ • Two-person _______________________ device • Flow restricted, _______________________ powered device • One-person BVM device
Rate of Artificial Ventilations • Adult — 1 breath every __________ to ___________ seconds • 10 to 12 per minute • Children — 1 breath every __________ to ___________seconds • 12 to 20 per minute • Infants — 1 breath every __________ to ___________seconds • 12 to 20 per minute
Artificial Ventilation • Mouth to _______________________ (Not Recommended) • pinch nose closed • take a deep breath • seal your mouth over patients mouth • Mouth to _______________________ (Not Recommended) • use chin lift to hold mouth closed • take a deep breath • seal your mouth over patients nose
Mouth-to-Mask Technique (1 of 2) • _______________________ at patient’s head and open airway. • Place the mask on the patient’s face. • Take a deep breath and breathe into the patient for____________ second. • Remove your mouth and watch for patient’s chest to fall.