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Airway Decisions Module

Airway Decisions Module. Gaining control of the airway is an essential goal in caring for patients. EMS House of DeFrance By Steve Cole, CCEMT-P. Airway control can be a challenge and it requires solid preparation, staying focused, the right tools and the right decisions. Do I have an airway?.

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Airway Decisions Module

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  1. Airway DecisionsModule

  2. Gaining control of the airway is an essential goal in caring for patients.

  3. EMS House of DeFrance By Steve Cole, CCEMT-P Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  4. Airway control can be a challenge and it requires solid preparation, staying focused, the right tools and the right decisions.

  5. Do I have an airway? http://www.trauma.org/imagebank/imagebank.html Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  6. Is the chest rising evenly? http://www.trauma.org/imagebank/imagebank.html Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  7. Is he breathing? Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  8. Are his respirations shallow? http://www.trauma.org/imagebank/imagebank.html Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  9. Are we ventilating? Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  10. What are her breath sounds like? Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  11. Is the Combitube placed correctly? Do we need to assist her breathing? What is the respiratory pattern? Is the oral airway the right size? Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  12. Is this patient in respiratory distress? Tripod position Decreased tidal volume Increased work of breathing Shortness of breath Restlessness Irregular breathing Coughing Increased pulse rate Abdominal breathing Retractions Poor skin color Difficulty speaking Noisy breathing Increased respiratory rate Decreased respiratory rate Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  13. Noisy Breathing • Crowing • Wheezing • Gurgling • Snoring • Stridor Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  14. Decision making and airway management are addressed in a separate module.

  15. Answers are, in part, founded in understanding of anatomy and physiology • Role of CO2 • Mechanics of breathing • Aerobic metabolism Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  16. Principles of Clinical Decision Making

  17. Principles of Clinical Decision Making • History • Assessment • Anticipated Outcomes • Complications Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  18. Principles of Clinical Decision Making • Past History (AMPLE) • Underlying medical • conditions (COPD) • Present History • Onset • Provocation • Quality • Radiation • Severity • Time • Interventions • Trauma? • Access? • Team airway ability? • History • Assessment • Anticipated Outcomes • Complications Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  19. Principles of Clinical Decision Making • History • Assessment • Anticipated Outcomes • Complications Assess for signs of ADEQUATE breathing Reassess often Reassess at any deterioration of patient condition Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  20. Principles of Clinical Decision Making Experience with similar patients Patient prediction Assessment findings “Charted course” of deterioration History or MOI • History • Assessment • Anticipated Outcomes • Complications Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  21. Principles of Clinical Decision Making • History • Assessment • Anticipated Outcomes • Complications What will happen if nothing is done? What are the risks to procedures being considered? What is the likelihood of a poor outcome? Assess for procedural effectiveness Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  22. Decision Making Algorhythm • Patient is: • Responsive/adequate breathing • Oxygen may be indicated Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  23. Decision Making Algorhythm • Patient is: • Responsive/inadequate breathing • Oxygen is indicated • Open airway • Use NPA • Assist ventilations • Mouth to mask, BVM, Manually triggered ventilator Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  24. Decision Making Algorhythm • Patient is: • Responsive/inadequate breathing • Oxygen is indicated • Open airway • Use NPA/OPA • Suction as needed • Reassess Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  25. Decision Making Algorhythm • Patient is: • Unresponsive/adequate breathing • Oxygen is indicated • Use NPA • Assist ventilations • Mouth to mask, BVM, Manually triggered ventilator • Reassess Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  26. Decision Making Algorhythm • Patient is: • Unresponsive/inadequate or no breathing • Oxygen is indicated • Open the airway • Use NPA/OPA • Suction as needed • Assist ventilations • Mouth to mask, BVM, Manually triggered ventilator • Reassess Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  27. Considerations inDifficult Ventilation Situations • Patient positioning • Suctioning • Manual airway maneuvers • Two person mask seal Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  28. Considerations inDifficult Ventilation Situations • Oral and nasopharyngeal airways • ECT/PTL • Agents to treat swollen airways • Verify no obstruction Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  29. Approach to Airway • Trauma • Non Trauma Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  30. Airway Decisions • To oxygenate or not • Trauma versus nontrauma • Ventilate versus oxygenate only • Adjunctive device application • Effectiveness of patients own respiratory efforts OR of care team’s ventilations Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  31. Assess for adequate breathing Consider History Assessment Anticipated Outcomes Complications To Oxygenate or Not Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  32. Decide early/reconsider throughout care Assess for force involved Medical conditions may lead to trauma Trauma may complicate medical conditions History Assessment Anticipated Outcomes Complications Trauma versus Nontrauma Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  33. Reduction in minute volume Respiratory arrest Need to eliminate CO2 Reduced tidal volume History Assessment Anticipated Outcomes Complications Ventilate versus Oxygenate Only Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  34. Progressive 02 BVM OPA/NPA ECT/PTL History Assessment Anticipated Outcomes Complications Adjunctive Device Application Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  35. Assess for improvement in patient condition Verify device effectiveness/placement Use end tidal C02 detectors Assess for adequate ventilation History Assessment Anticipated Outcomes Complications Effectiveness of Patients Own Respiratory Efforts OR of Care Team’s Ventilations Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  36. Assessment“of our breathing for them” • Effort of breathing • Compliance • Chest rise • Evenness • Depth • Intercostal bulging • Skin Color Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  37. Assessment“of our breathing for them” • CO2 detector • Lung sounds • Epigastric sounds • General condition Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  38. Assessment“of their breathing” • Effort of breathing • Number of ventilations per minute • Pattern of breathing • Frequency of breathing • Plus assessment of items under our breathing for them Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  39. How bad is he? Is the patient better or worse? What can I do to improve the patient’s condition? Experience and assessment Compare one assessment to another Ensure adequacy of airway/ventilation Key Airway Decisions Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  40. Case Number One • A 17 year old female involved in a car accident (see next slide). She is unresponsive and has gurgling respiration on removal from the car. She is immobilized in a supine position on a spine board. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  41. Case Number One Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  42. Case Number Two A 22 year old male has been stabbed in the throat. First responders tell you he was conscious and could not speak beyond a whisper. He said he felt like his airway was blocked and it was hard to breath. He was struggling to breath. Minutes later, on your arrival he has stopped breathing. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  43. Case Number Two http://www.trauma.org/imagebank/imagebank.html Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  44. Case Number Three A tractor has rolled over a 54 year old male. He is conscious and complaining of shortness of breath. He has diminished breath sounds on the right side and uneven chest rise. There is no JVD. HR is 150. RR is 28. BP is 148/88. Skin is pink, warm and dry. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  45. Case Number Four • An 18 year old male was beaten by several men after an argument. His LOC is responsive and breathing is irregular and shallow. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  46. Case Number Four http://www.defrance.org/photogallery.htm Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  47. Case Number Five • A 7 year old boy drowned in a backyard pool. There is gurgling on ventilation attempts. He is pulseless and not breathing. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  48. Case Number Five http://www.defrance.org/photogallery.htm Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  49. Case Number Six • A 20 year old was holding a firecracker in his mouth when in exploded. He is short of breath. RR is 26. HR is 140. He feels like there is swelling in his throat. He is wheezing and has a history of asthma. He does not have his inhaler. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

  50. Case Number Six http://www.defrance.org/photogallery.htm Kansas Airway Supplement Kansas BEMS EMS Educator Task Force

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