AIRWAY & HEART ANOTOMY

Transcription

1 Objectives I CAN T BREATH Respiratory Emergencies Review of anatomical structures related to heart & lungs Differentiate differences between adult and pediatric airways Identify the need for airway assistance & management Review of patient assessment skills & pearls Identify interventions with case studies Normal Breathing We Must Have: AIRWAY & HEART ANOTOMY Patent airway Intact System Ventilatory Musculoskeletal Pulmonary Blood Flow Neurological Stimulation Anatomy of the Upper Airway Nasal Cavity Oral Cavity Pharynx Nasopharynx Oropharynx Laryngopharynx Anatomy of Lungs & Heart 1

2 Anatomy of the Lower Airway Anatomy of the Heart Carina Bronchi Bronchioles Alveoli Adult vs. Pediatric Airway Difference Size Cone Shaped Larynx Anterior Position Epiglottis Rounder and Floppy Cricoid Ring is the Narrowest Section Decision Making PATIENT ASSESSMENT g 2

3 Assessment General Impression Mental Status AVPU GCS Airway Patent/Non Patent Breathing Rate Quality SpO2 & ETCO2 Assessment Circulation Pulses, Hemorrhage, Skin Color, Temperature & Condition Vascular Access ECG & NIBP Disability Exposure Remove clothing to visualize Work of Breathing What you Hear Stridor Snoring Gurgling Grunting Muffled/Hoarse Voice Respiratory Assessment What you See Tripoding Sniffing Position Accessory Muscle Use Pursed Lip Breathing Nasal Flaring Head Bobbing Seesaw Respirations Prolonged Expiratory Effortless Tachycardia Inspection Auscultation Palpation Percussion Physical Exam Focused History OPQRST & Associated Symptoms Allergies Medications Past Medical History History of Present Illness Non-Invasive Airway Monitoring Pulse Oximetry Normal % <93-95% = Mild Hypoxia 85-90% = Moderate Hypoxia <85% = Severe Hypoxia Variation in Probe Locations SpO2 reflects oxygenation, NOT ventilation 3

4 Non-Invasive Airway Monitoring Capnography (ETCO2) Quantitative & Waveform Qualitative Normal mmhg Measurement of Ventilation, NOT Oxygenation AIRWAY MANAGEMENT MOANS AIRWAY MANAGEMENT RODS MOANS Difficult Bag-Valve-Mask Ventilations Mask Seal Obesity Age No Teeth Stiff LEMONS SMART TWO Thumbs up technique Rules of 2 s SKILL 1 provider maintains seal 1 provider ventilates Airways NPA & OPA Inches Raise patient (sniffing position) Seconds Ventilation slow & gentle PSI Minimum pressure 4

5 RODS Difficult Extraglotic Device Placement Restricted Mouth Opening Obstruction/Obesity Distorted/Disrupted Airway Stiff LEMONS & SMART Difficult Intubation Look Evaluate Mallampati Obstruction Neck Mobility Difficult Cricothyrotomy Surgery Mallampati Anatomy Radiation Tumor CARDIAC OR RESPIRTORY MI (Myocardial Infarction) CHF (Congestive Heart Failure) Chest Discomfort Dyspnea Diaphoresis EKG changes Nausea & Vomiting Radiated pain 12 Lead ASA Pain Management Nitro Fentanyl Morphine Rapid Transport to PCI Non specific fatigue Dyspnea With exertion While flat (orthopnea) Edema Coughing Rales, Wheezing BS S3 Gallop JVD NIPPV Medications Nitro Bronchodilator Lasix 5

6 PUEMOTHORAX BRONCHITIS (acute or chronic) Altered LOC Severe Dyspnea Diminished or Absent BS One Side Low BP Tachycardia Needle Decompression Chest Tube Chest Discomfort Dyspnea Productive Cough Rhinorrhea BS-Rhonchi; Wheezing BS reduced Nebulized Medication Intubation? Antibiotic Anti-inflammatory Corticosteroid EMPHYSEMA PULMONARY EMBOLISM Chest Discomfort Progressive Dyspnea SOB worse in AM Cough worse in AM Tachypnea Accessory muscle use Hyperinflation Decreased BS Nebulized Medication Intubation? Antibiotic Anti- inflammatory Corticosteroid Shortness of Breath Agitation Mild to Sudden Dyspnea Chest pain Hypoxemia Hyperventilation Nebulized Medication Epi Intubation? Anti-inflammatory Corticosteroid PNEUMONIA ASTHMA Shortness of Breath Dry cough Increased Temperature Productive cough Green/brown/rust colored Tachycardia Tachypnea Nebulizer Medication Antibiotics Intubation? Shortness of Breath Wheezing Cough Agitation Speech Dyspnea Chest Tightness Pulsus Paradoxus Tachycardia Nebulized Medication Epi Intubation? Anti-inflammatory 6

7 Shortness of Breath/tightness in Throat Agitation Mild to Sudden Dyspnea Urtiicaria Angioedema Hypoxemia Hyperventilation ANAPHYLAXIS Epi More epi Nebulizer Medication Corticosteroid Benadryl Case #1 62 year old Male Progressive SOB over 18 months Increased over 4-5 days Productive Cough Accessory Muscle Use Hyperinflated Vitals A- patent, B- 30 bpm; minor wheezing 85% RA C- 120 bpm D- speaks in full sentences; GCS-15 E- No Trauma noted Skin- warm and dry but pale Treatment? qoqi/aaaaaaaaab4/f5nitu0epgu/s320/bluebloater.jpg.jpeg 7

8 Case #2 22 year old Female Four Wheeler Accident Ejected Off Wheeler Hit Face & Head on Roof of Razor Patient is seated on ground leaning forward Airway Vitals A- As seen B- 30 bpm; minor wheezing 85% RA C- 140 bpm D- can answer yes & no GCS-13 E- Only facial trauma Skin- pink and dry Treatment? Case #3 8

9 3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Dy82dL8QAUF8&psig=AFQjCNFULFv5Kl1XLSSHliXxKRRkCzkGww&ust= year old Male Increased SOB over 3 hours Nebulizer did not help Accessory Muscle Use Hyperinflated Vitals A- Patent B- 40 bpm; minor wheezing 80% RA C- 140 bpm D- Speaks in 1-2 word sentence GCS-12 E- Barrel chest, ribs visible Skin- dry and pale Treatment? Case #4 35 year old Female Sudden onset of SOB for last 3 days Productive cough for 7 days Left side chest pain Vitals A- Green sputum B- 22 bpm; BS-left side crackles bilateral dullness SpO2 90% C- 120 bpm BP 155/72 D- GCS-15 E- no noted trauma Skin- hot, flushed 9

10 Treatment? 10