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Basic Airway Mastery – Module 1 - Mary Makris & Kevin Burgess EMS Educators PFA/PVHS 2010 In order to complete this training and earn authorization to utilize the King tube, participants must complete and pass each module, in the following order: 1. Anatomy & Physiology Review 2. Respiratory Emergencies 3. King Tube Facts and Utilization 4. Written Competency Exam 5. Practical Training – 4 stations You can progress through the slides by clicking the space bar. Anything text that is yellow and underlined is a hyperlink and if you click on it, will take you to description or video of that subject. Click the X in the upper right hand corner to go back to the slides. All links require a system that connects to the internet and Speakers(audio) This presentation will help provide a review of the A&P that you learned in EMT Basic school with additional depth to help you make the best clinical decisions in airway assessment and management in the pre-hospital setting Mouth and Nose – Shapes, Angles & Obstructions Mouth, Tongue, Oropharynx Foreign Body? POSITION!! Infection? Swelling? THROAT and Neck Click on the underlined text to see the video Allergic Reactions in which the trachea or throat swell closed, including allergic reactions to a bee sting, peanuts, antibiotics (penicillin), and blood pressure medications (ACE inhibitors) Chemical burns and reactions Croup Epiglottitis (infection of the structure separating the trachea from the esophagus) Fire or burns from breathing in smoke Foreign bodies -- such as peanuts and other breathed-in foods, pieces of a balloon, buttons, etc Viral or bacteria infections Most infections are successfully managed by the body’s immune system and resolve in a few days. Bacterial Infections that continue are treated with antibiotics. Viral Infections may be treated with anti-viral medications but must be administered early in the disease. Peritonsillar or Retropharyngeal abscess Throat cancer Tracheomalacia Trauma Vocal cord problems Symptoms vary depending on the cause, but some symptoms are common to all types of airway blockage. They include: Agitation or fidgeting Bluish color to the skin (cyanosis) Changes in consciousness Choking Confusion Difficulty breathing Gasping for air Panic Unconsciousness Wheezing, crowing, whistling, or other unusual breathing noises indicating breathing difficulty Physical examination may show: Decreased breath sounds in the lungs Rapid, shallow, or slowed breathing Stridor or high pitched whistling “NORMAL Sounds” Abnormal Lung Sounds Wheezing Stridor (noisy breathing from air forced through narrowed breathing passages Stridor II Rhonchi (coarse crackles – or a “more continious “sound”… stick to coarse and fine crackles for descriptive if you are unsure. Rales (fine crackles) Mechanical • Nares/OralPharynx Obstructed? • Position of Head/Jaw? • Swelling in Trachea or Larynx • Bronchial Blockage (swelling or FB?) • Alveoli full or collapsed? • Muscles functioning? (Diaphragm/Intercostals) • Nerves triggering muscle movement? • C-3,C-4,C-5 and Phrenic More Mechanical… • Tension Pneumo, Flail chest….(everything is smushed) • CHF, Pneumonia, Toxins (fluid in alveoli) • Air is going in and out BUT Blood is not going round & round (no CO2/O2 Exchange) And even more Mechanical • Abdominal Distention • Muscular “splinting” (it hurts when it moves) What Could be Wrong? CHEMICAL CO2/O2 Levels in the blood “normal” trigger: CO2 gets too HIGH…. (get the “toxin” OUT) “Hypoxic” Trigger: O2 gets too low (COPD patients) Drugs : Narcotics, suppressive agents…. Acid/Base Disruption (pH levels): electricity (nerve stimulation of muscles) doesn’t work “right” outside What do you see? ?Anxiety? Position? Effort? Equal Expansion? What do you hear? Full Sentences? Lung Sounds? What do you feel? Crepitis? Swelling? Fractures? Does the situation/patient make SENSE? What is “normal”? Pulse Oximetry 92-100% (with good perfusion) CO2 : 35-45 and don’t forget to look at the waveform! Are you comfortable with the information reviewed in this module? If not, please contact your EMS Educator for additional resources. The objective of this module is to help improve your understanding of the Anatomy and Physiology of the Respiratory System and how it may relate to your assessment of the patient with Respiratory Distress. Was it met?
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