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AIRWAY -5th thoracic vertebra

UPPER AIRWAY Main stem bronchi

NOSE -Generation 1

-responsible for ½ to 2/3 of total airway resistance during -Right main stem bronchus angles of at 20 to 30 degrees
the nasal breathing. from the midline

Moth breathing predominates during stress. -left main stem 45-55 degrees sharply from the midline

PHARYNX (THROAT) Airway Divisions

-space behind the nasal cavity and mouth serves as the -each main stem bronchus divides the left and right
passage bronchi

 Nasopharynx Lobar bronchi


 Oropharynx
-Generation 2
 Laryngopharynx
-Secondary bronchi
Larynx (voice box)
-5 lobar bronchi
-A box-like structure made of cartilage connected by
extrinsic and intrinsic muscle and ligaments. The right main stem bronchi trifurcates right upper and
middle lower lobar bronchi
-It is lined internally by mucous membrane.
Left main stem bronchi – left lower and middle lobar
Epiglottis
bronchi
-a plate-like cartilage that extends from the base of the
Segmental bronchi
tongue backward and upward
-Generation 3
-serves as the trapdoor, covers the trachea while
swallowing. -Tertiary bronchi

=Glottis 18 segmental bronchi

=Valecula Sub segmental?

Nose, Pharynx, Larynx Generation 4

-serves as the key frontline defense of the lungs Bronchioles 10-15


vibrissae = hair in the nose
Terminal bronchioles
LOWER AIRWAY
-Generation 16
1. Conduction of respiratory gases
-Cilia are absent from the epithelium located at TB
2. Exchange of gases with the blood
responsible in the production of mucus
Trachea (wind pipe)
Transitional and respiratory zones
-Generation 0
-Respiratory bronchioles
-marks the beginning of the conducting system
Gen 17-19
(tracheobronchial tree)
Alveolar
-superios part of lower airway system
Gen 20-22
Carina-trecheal bifurcation
Alveolar Sacs
-Gen 23 -Accidental inhalation of a foreign substance into
the airway
-last generation of airways is blind passageways
possible causes of obstruction in airways 4. Crushing o penetrating airway injury trauma
“emergency” caused by impaction of the nose,
Airways obstruction
mouth, larynx, or trachea and possible
-blockage in the passage of air aspiration of blood.
5. Mucus and other body fluid.
Types -dangerous in large volume (aspiration)
Partial airway obstruction -dangers
o Infection
a. Stridor glottis obstruction Characterized as high o Complete obstruction
pitched respiratory sounds 6. Improperly placed artificial airway
Complete airway obstruction o Tracheal tubes
7. Retained secretions
a) Sternal, intercostal, and epigastric retraction 8. Structural changes such as edema, tumors, or
b) Conscious: will appear distress and extremely trauma.
anxious
c) Unconscious: patients may appear dusky\ Signs of airway obstruction
d) Ventilatory attempts may become violet Manifestation factor
Two types of obstruction a. Location
Partial – Inadequate gas exchange (diminish gas flow) b. Severity
c. Type
Complete – no gas exchange
1.Visual sign (look)
Causes of airway obstruction
a. Increased RR
1. Soft tissue obstruction b. Gasping effort
 most common upper airway obstruction c. Exaggerated use of inspiration muscle
>Diaphragm
causes >intercostal
a) loss of muscle tone (pulling back of d. Retraction of soft thoracic tissues during
tongue) inspiration
b) space occupying lessions – edema e. Cyanosis, diaphoresis excessive sweating
bleeding tumor f. Fear anxiety, trashing, of arms and legs
c) foreign substance (vomitus, false teeth) g. Unconsciousness
>carbon monoxide, phlegm 2.Audible signs/vocal sounds (hear)
2. Blockage of a. Diminished or abnormal breath sounds with
a) Nasopharynx chest excursion (oxcultation)
-enlargement of pharynx tonsil or b. Complete absence of sound
adenoid ( in children ) c. Partial absence of sound
b) Oropharynx -occur in the upper airway of the sound is
-due to enlargement of palatine tonsil o Crowning
c) Hypopharynx or laryngopharynx o Gasping
-from relaxation of the base of the o Snoring
tongue into the hypopharynx ( soft o Stridor
tissue obstruction ) o Gurgling
3. Aspiration o Wheezes
o Rales
o Rhonchi react an emergency in a methodic manner
rather than in disorganized panic
LOWER AIRWAY SOUNDS
c. Must be initiated quickly and accurately
a. Wheezes because time is the enemy of a victim and
b. Rales cardiac compression even when performed
c. Rhonchi perfectly, is only 30 to 33% as efficient as the
human heart.
3.Tactile signs (feel/touch)
TERMINOLOGY
a. Rapid pulse (>120 bpm)
b. Very slow pulse Basic life support (BLS)
c. Irregular pulse
 External cardiac compression combined with
d. Clammy, wet skin
artificial ventilation (with a patent airway)
Circumstantial signs;  Administered to sustain patient’s vital function
until ACLS can be initiated or until patient’s are
1. Place and time the patient was initially seen
able to provide their owns spontaneous life
(eating, drinking)
support.
2. Physical evidence
a. Reddening or swelling of the area Advance Cardiac Life Support
concerned
Vital Function – breathing and cardiac support.
b. Soot around the mouth and nostrils
c. Vomits in the mouth Advance Cardiac Life Support
3. Relative’s information through rapid
questioning to determine the type of treatment  Procedures and equipment used to stabilize a
patient through definitive application of drugs,
Simplest, quickest, less traumatic, most effective 4- defibrillation, airway management and
6 minutes my cause brain damage or a death transportation.
Elimination of airway obstruction External Cardiac Compression
Things to consider  The technique of compressing the external
chest during CPR
1. Method must be quick, simple, and effective
2. Care must be taken the cure will not cause  This procedure causes blood to be pumped out
trauma than the initial problem of the heart as the compression is delivered.

Ways Mouth to mouth resuscitation

 Suctioning  A method of expired air resuscitation where the


rescuer exhales into the victim’s mouth as the
 Removal of foreign body obstruction
routes of providing artificial ventilation to
 Head positioning
victims
 Bronchoscopy
 Use of pharyngeal airway Ways
 Application of tracheal tubes
a. By expired air technique
 Abdominal thrust
b. Manal resuscitation bag/ bag valve system
Emergency cardiovascular support c. Mechanical ventilation system

CardioPulmonary Resuscitation (CPR) Circulation (perfusion)

a. Important skills that can be acquired by health  Movement of blood throughout the body
care practitioners and by general public
Death
b. Combination of knowledge and skills that can
be memorized and practiced, enabling one to
 A physiologic and biologic process that begins 4. Monitor immediately before, during and after a
immediately after cessation of the heart beat cardiac arrest
1. Clinician Death
In the community
2. Biologic Death
1. As instructors, educators
Biologic Death
Sudden Cardiac Arrest (SCA)
 Periodic of time after a CP arrest
 Leading cause of death
Clinical Death
PREVENTION:
 Describes the interval of time passing between
cessation of breathing and circulation and the 1. Immediate CPR
beginning of biologic death. 2. Delivery of a shock before pulseless ventricular
 Usually 4-6 minutes at normal temperature rhythm deteriorate into systole
levels. 3. CPR before the shock is critical in cases of SCA
 Victims usually do not suffer permanent brain related to asphyxia, secondary to trauma, drug
damages because of hypoxia overdose, or upper airway obstruction.

Heart attack Health Burden of SCA

 Describes as damage heart muscles caused by 1. Almost 80% of out-hospital cardiac arrest occur
blocked coronary blood vessels at home.
2. 4-6% of SCA victims survive because most of the
Cardiac Arrest witness of the arrest do not know how to
 Cessation of an effective heartbeat perform CPR.

Respiratory Arrest SCA

 Cessation of breathing 1. Unpredictable and can happened to anyone,


anywhere, and anytime
Myocardial Infraction (MI) 2. Risk increased with age
3. Pre-existing heart disease.
 Death of heart tissue
Basic Life Support
Emergency Medical Service
Goal: to restore ventilation and circulation to victims of
 Consist of rescue personnel
airway obstruction
Emergency Medical Technician – Paramedic (EMT-P)
Done by:
 Advanced – level allied health person who
 Single rescuer
responds to emergency call
 Double rescuer
Emergency Medical Technician Ambulance (EMT-A)  Team

 Entry level allied health person, provides basic BLS


emergency care at the scene Step 1

Roles of RT’s  Determining unresponsiveness


(in the hospital) px exhibits decrease level of
In Hospital
consciousness carefully assessed the patient
1. Manage the airway
2. Provide ventilation and circulation support (outside the hospital)
3. Provide drug and electrical therapy 1. Check area safety
2. Call for help
Step 2  Should not be ceased for more than 5 seconds
and 30 seconds if the patient is intubated
 Restoring circulation
 Determining pulselessness Children:
Adult >Femoral, carotid
a. Who have reached puberty, same as adult
Infant >Radial, Femoral
b. For younger patient 1 year old to puberty
 No pulse within 10 seconds proceed with chest
c. Supine position on a firm surface
compression
 Pulse checking should be limited to 5 seconds to Lower half of sternum (one hand only)
avoid delaying chest compression
 Use only one hand to compress (heel)
 Pulse check should not be done by lay rescuer
 Use the other hand to maintain head
 Pulse and rhythm check should not be done
position and maintain an airway
after a shock until five cycles of CPR have been
completed 1 cycle 30 compression Infants (<1 year of age)
How? Hand placement:
 By palpating a major atery  Lower half of the sternum
 Middle and index finger
Assessment findings
 Use the other hand to maintain the head
(+) pulse but no breathing (ventilate immediately) position and airway
8-10 bmp every 6 to 8 seconds (appropriate rate) Compression:
 Providing chest compression  Approximately 1.5(4cm)
a. Restore circulation in a pulseless victim  At least 100 compression/min
b. To compress the lower half of the
sternum (for an adult patient) Neonates
Baby – 2 fingers  Chest compression are indicated if the
 100 compressions/ min neonate’s heart rate decreases to less than 60
KEYPOINTS beats/min despite adequate oxygen with 100%
oxygen for 30 secs.
 Have a complete upstroke
Compressions
 So as not increased intrathoracic pressure
during diastolic phase  Optimal ventilation first
 To ensure rescuer take his hand slightly off the  Lower third of the sternum
chest between compression  Depth of approximately one third of the
Adult: supine position in a firm surface anteroposterior diameter of the chest
 Approximately 100 compression/min
If in bed or stretcher place a cardiac arrest board or a
removable bed piece or food tray Two techniques

Hand position- lower half sternum, center of the chest 1. Wrap-around techniques
between nipples 2. Two fingers

Place the heel of your hand on the sternum with your Two methods
other hand on top and lock your elbows. 1. Wrap-around technique – thumbs below the
Compression: victim’s intermammary line *not to compress
the xiphoid process
 2 in (5cm) 2. Two fingers technique – when access to the
 At a rate of 100 compression /min umbilicus is required
KEYPOINTS: Breathlessness

The compression phase of the cycle should not be equal a. No sign of chest movement
in duration to the upstroke phase and delivered b. No breath sound
smoothly 1:1 ratio (relaxation) c. Only gasping is present

Chest compression under special conditions KEYPOINT

Unique circumstances requiring modification of normal  Evaluation should take no longer than 3 to 5
procedures seconds to complete
1. Near drowning PROVIDING ARTIFICIAL VENTILATION
2. Electrical shock
KEYPOINT
3. Patients with implanted pacemakers or
defibrillators  During respiratory arrest the victim must be
STEP 3 provided with oxygen within 4 to 6 mins or
biologic death follows
RESTORING THE AIRWAY
Ways to restore oxygen to victims lungs
 After calling for help and activating EMS
1. Quickly inspect for any neck or facial  By exhaling to the victims mouth or nose or
trauma tracheal stoma (w/ appropriate modification for
2. Place patient supine position *manual the patients age)
in-line spinal motion restriction should MOUTH TO MOUTH VENTILATION
not be employed when moving patient.
3. Check for presence airway obstruction  Can restore adequate oxygenation
*loss of muscle tone – the most HOW:
common cause due to falling back of
tongue  Rescuer will take a slightly deeper than normal
breath (700-1000) and exhale directly into the
WAYS: victim chest rise.
 Head tilt/chin lift method *primary procedure Exhaled air provides approximately
recommended for lay person when spinal
trauma is suspected a. 16% O2 essential to achieve an arterial oxygen
 Jaw thrust method *used mainly by trained tension (PaO2) or 50-60 mmHg
clinicians when spinal/ neck injuries is b. Tidal Volume between 700mL and 1000mL
suspected (ideal for adult) *children require proportionally
smaller volume
KEYPOINT:
KEYPOINT
 Opening the airway may be the only lifesaving
measure required  During resuscitation of a victims of cardiac
 Rescuer must immediately assess the victims arrest 2 breaths should be given over a period
ventilation after airway is closed and opened of 1 seconds each.
 A tidal volume of 500mL should be delivered
STEP 4 when chest compression are being
RESTORING VENTILATION administered
 Hazards of excessive volumes (>500ml) or an
 Assess for the presence of breathing inspiratory rate (8>10 breaths/min)
 Rescuer places his or her ear over the victims 1. Gastric inflation
mouth and the nose while simultaneously 2. Increase intrathoracic pressure
observing the spontaneous chest movement
MOUTH TO NOSE VENTILATION
Indications:  to avoid fatigue 3 healthcare, provide can be
assigned for compression. Switch every 5 cycles
1. Trismus or lock jaw – involuntary contraction of
of 30:2
the jaw
2. Traumatic jaw and mouth injury Early defibrillation
MOUTH TO STOMA  the 4th step for the treatment of cardiac arrest
early defibrillation after CPR has been initiated
 Patient with tracheostomy and laryngotomy
(absence of a cardiac activity)
One rescuer two rescuer adult CPR outside the (irregular cardiac arrhythmia heartbeat)
hospital
Reason:
One rescuer
1. the most common initial rhythm in witnessed
Don’t panic, stay calm sudden cardiac arrest is ventricular fibrillation
2. the treatment for VF is electrical defibrillation
1. Assess the patient 3. The probability of successful defibrillation
2. Call for help diminishes rapidly overtime
3. Begin CPR w/o assistance
4. VF tends to convert systole within few minutes
4. Give only compressions and AED arrives
-defibrillation should be given or initiated 2 mins of
Two rescuer
when CPR is begun
1st- administers cardiac compression. Pauses after 30 to
Rule of Thumb:
given the 2 ventilations
Patient in VF or pulseless VT cardiac arrest should
2nd- ventilates and evaluates the effectiveness of CPR
receive only one shock followed immediately by five
Position: opposite sides of the victim (adult and child) cycles of CPR before the pulse and rhythm are
rechecked
Single rescuer: compression to ventilation ratio 3:2
Asystole evaluate: compression ventricular fibrillation
Timing for compressions
AED – made available to individuals expected to
‘’one and two and three and four and five’’ respond to emergencies
A rate of 100 times/min EVALUATING EFFECTIVENESS OF CPR
In Infants 1. Victim’s response
 Two rescuer should use a compression to Ventilation
ventilation ratio of 3:1 with 90 compression and -observing the visible rise and fall of the victims
30 breaths delivered per minute (120 chest during mouth to mouth resuscitation
events:min) Hazards and complications
Goal: psh hard, push fast at 100/min w/o fatigue Common:
diminishing the goal
1. Worsening of existing neck and spinal injuries
 To provide rest for the individual delivering 2. Gastric inflation and vomiting
cardiac compression, the rescuer should chnge 3. Trauma to internal structure and during
positions every 5 cycle (approx..2 mins) “we will compression
change next time “ 4. Problem associated with the removal of foreign
 Shall be accomplished in less than 5 seconds objects to clear the obstructed airway
Team Rescuer Head and neck and spine injuries

 Carefully assess the victim


 Carefully support the head side to side motion
must be avoided jaw-thrust maneuver to open
the airway or try a slight-head-tilt

Gastric inflation

 During prolonged mouth to mouth ventilation

Effects

1. Puts pressure in the diaphragm restricting lung


expansion
2. Can increase vagal tone and cause reflex
bradycardia and hypotension
3. Prompts regurgitation

The new chain of survival

 Early access: immediate recognition and


activation
 Early CPR
 Early defibrillation
 Early advance care
 Integrated post cardiac arrest care