Slower than Normal Rates or Shallow depth of breath Pg. 400
Adults 12-20 breaths/min
Children 15-30 breaths/min
Infant 25-50 breaths/min
What are the respiratory rates when we
should consider a BVM? How do we
- The BVM should be used when you need to deliver high concentrations of oxygen to
determine adequate respirations?
patients who are not ventilating adequately, in respiratory arrest, cardiopulmonary
arrest and respiratory failure. Pg. 428
- The volume of air(oxygen) delivered to the patient is based on chest rise and fall Pg.
429
Wheezing Lower airway obstruction high pitch sound, most prominent on exhalation
Congested breath sounds may suggest the presence of mucus in the lungs. Expect to
hear low pitched, noisy sounds that are most prominent on expiration. The patient often
Ronchi
reports a productive cough associated. Snoring due to upper airway obstructions
(Snoring) (Ronchi is lower airway)
Fluid build in lungs air passes through fluid from the alveoli to the capillaries (wet lung
Crackles(Rales)
sounds). Usually on both inspiration and expiration.(Lower Airway)
Seal bark cough. Often heard before listening with a stethoscope and may indicate the
patient has an airway obstruction in the neck and upper part of the chest. Expect to
Stridor
hear a brassy, crowing sound that is most prominent on inspiration.(More seen in
Pediatrics)(Upper Airway)
-Check mask seal
Corrective action if we no longer see visible
-Reposition the head or use airway adjunct
chest rise while performing PP ventilation.
-Check for airway obstruction; if not obstructions present try alternative ventilation
Pg. 431.
method such as mouth-to-mask technique
, 8/14/24, 4:49 AM
Airway obstruction knowledge: 1) check for ABC's; see if you can fix airway right away
1) Witness patient collapse ..... what should 2) -Are you choking?
your first objective be? -If you hear noise or are able to communicate just encourage to cough it out if you see
signs of blue or hand in choking position and unable to communicate start with
2) What to ask and how to approach a abdominal thrust... back slaps in infants
patient who is possibly choking?
3) As long as the patient can breathe, cough forcefully, or talk Pg. 440/542
3) When do we simply encourage them to
cough?
-If the patient has a Tracheostomy Tube, ventilate through the tube with a BVM(The
standard 15/22-MM adapter on the BVM will fit onto the tube in the tracheal stoma) and
100% oxygen attached directly to BVM.
How to treat a patient with a STOMA that is -If there is no tube in place, use an infant or child mask with BVM to make a seal over
not with adequate respirations? the stoma. Seal the patient's mouth and nose with one hand to prevent a leak of air
during ventilation. Release mouth and nose for exhalation.
-If unable to ventilate, try suctioning the stoma and the mouth with a French or soft-tip
catheter before giving the patient artificial ventilation through the mouth and nose
-long transports is a perfect time to use humidified oxygen
When to treat a patient with humidified
oxygen?
-swollen/infected airways such as croup can also benefit through humidified oxygen
Limit questions to patients in respiratory distress, to prevent waste of air.
How to ask questions to a patient with
SAMPLE Question Set
extreme SOB(Shortness of Breath), what to
ask and when......
make sure patient is code 4 ("situation under control"/"no further assistance necessary")
before asking to complex questions.
OPA(Oropharyngeal Airway)
Indications:
- Unresponsive patient w/o gag reflex(breathing or apneic)
- Any apneic patient being ventilated with BVM
Contraindications:
-Conscious patients
-Any patient(conscious or unconscious) who has gag reflex intact
-Damage to throat
NPA vs. OPA (when they are indicated and
contra-indicated?)Pg. 412-414
NPA(Nasopharyngeal Airway)
Indications:
-Semiconscious or unconscious patients w/ intact gag reflex
-Patient who otherwise will not tolerate OPA
-Patients with an altered mental status or who have just had a seizure may also benefit
Contraindications:
-Severe head injury with blood draining from nose
-History of fractured nasal bone
-suction when airway is compromised with fluids
When to suction a patient and what suction
catheter would be best for oropharynx Pg. -when suctioning the oropharynx a rigid curved tip catheter is best to use (tonsil tip)
408-410
-suction of the nose is best done with a non rigid plastic catheter (french or whistle tip)
OCEMT Final Exam
2/10
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