EMT Basic

Advanced Airway
Management
Pharyngeal Esophageal Airway Device
(PEAD)
A.K.A. Combitube


PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer
West Valley Fire District, Willamina, OR

The Cat Fan (No Pun Intended)
Agenda
Review Objectives
Lesson 1
Respiratory Anatomy & Physiology
Lesson 2
Respiratory Volume and Management
Lesson 3
Assessing Respiratory Problems




Agenda contd
Lesson 4
Respiratory/Cardiac Arrest
Basic Airway Management
Lesson 5
Suctioning
Lesson 6
Dual-Lumen Airway Devices
Agenda contd
Demonstration
Practical Stations
Basic Airway Management
Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Combitube Insertion
Practical
Testing must be done with the Physician
Advisor (or another Physician of his / her
choosing)

Objectives
Describe the anatomy and function of the upper
and lower airways
Describe respiratory volumes and capacities in
relationship to the need for assisted ventilations
Identify the specific observations and physical
findings commonly found in patients presenting
in respiratory and/or cardiac arrest.
Identify the basic principles of airway
management
Objectives (contd)
Describe the indications for suctioning.
Identify rigid and flexible suction catheters
and the indications for use.
Identify indications and contraindications
for use of the PEADs.
Identify the advantages and disadvantages
of using PEADs.
Objectives (contd)
Identify those situations in which PEADs
may be removed.
Demonstrated placement of PEADs.
Demonstrate methods of assuring and
maintaining correct placement of PEADs.
Demonstrate re-ventilation for missed
placement of PEADs.
Objectives (contd)
Demonstrate on a manikin the proper
technique for the use and maintenance of
the following airway adjuncts:
Nasal cannula
Non-rebreather mask
Bag-Valve-Mask
Demonstrate sterile suctioning techniques
on a manikin with a PEAD in place.
Lesson 1
Respiratory Anatomy & Physiology
Respiratory Anatomy & Physiology
Function of the Respiratory System
Removes carbon
dioxide from the blood
Transfers oxygen to
the blood
The Upper Airway
Epiglottis
Mandible
Frontal Sinus
Soft Palate
Trachea
Glottis
Esophagus
Vocal Cords

A
B
C
D
E
F
G
H

The Upper Airway
Other Structures
Nasopharynx
Oropharynx
Hypopharynx
Larynx
Functions

Functions of the Upper Airway
Passageway for air
Warm
Filter
Humidify
Protection
Gag Reflex
Cough
Speech
The Lower Airway
Primary Bronchi
Hyoid Bone
Right Lung
Secondary Bronchi
Tracheal Ligament
Trachea
Larynx
Esophagus
Left Lung
Trachea
A
B
C
D
E
F
G
H
I
J
Alveoli
Gas Exchange
Lungs
Structure
Lobes
Pleura
Physiology of Respiration
Define Respiration
The exchange of gases between a living
organism and the environment
Define Ventilation
Mechanical Process that moves air in and out of
the lungs
Muscles of Breathing
Intercostal Muscles
Diaphragm
Regulation of Respiration
Where is the Respiratory Center Controlled?
Brainstem
Medulla
Apeustic Center (pons)
Pneumotaxic center (pons)
Stretch receptors
Hering-Breuer reflex
Chemoreceptors
CSF
Blood
Voluntary or Involuntary
Both
Humans can override bodys urge to breathe
But only for so long
Respiratory Cycle
Inspiration
Active phase
Lasts 1-2 seconds


Expiration
Passive phase
Lasts 5 seconds
Lesson 2
Respiratory Volume and
Management
Drinking Straw Exercise
Breathe through
straws for 1 minute

Carbon Dioxide & The Respiratory
System
High CO2
Increases respiratory rate
Low CO2
Decreases respiratory rate
Hypoxic Drive
Chronic COPD patients
Normal Respiratory Rates
Adult
Children
Infants
Newborns
12 20 / min
18 24 / min
22 36 / min
40 60 / min
Factors Affecting Respiratory Rate
Fever
Depressant Drugs
Anxiety
Insufficient Oxygen
Stimulant Drugs
Sleep

Respiratory Volumes
Lung Capacity
Tidal Volume
Dead Space
Alveolar Air

6000 mL of air
500 mL at rest
150 mL
350 mL
Minute Volume
Total air moved per minute
Rate X Volume = Minute volume
Important Assessment Item
Factors Affecting Minute Volume
Head, neck, chest injury
Shock
Diabetes
CO2 / O2 rapid changes
Maintaining the A in ABC
Patient positioning
Suctioning
Supplemental Oxygen
Mechanical Assistance

Pulse Oximetry
Measures amount of oxygen in the blood.
Gives percent of hemoglobin saturated
Tool only, do not rely on totally
Why?
Normal Values
95% - 100% Normal
90% - 95% - Mild Normal for COPD
< 90 % Moderate High Flow Oxygen
End-Tidal CO2 Detection
Measured
Colorimetric and Digital
Tool to aid in determining correct
placement
Lesson 3

Assessing Respiratory Problems
Patient Assessment
General Patient Assessment
Primary Survey
LOC
ABCs
Speech Pattern
Obvious Respiratory Noise
Patient Position

General Assessment (contd)
Secondary Assessment
SAMPLE history
Chief Complaint
Pertinent Negatives
Chest Pain (pleuritic vs cardiac)
Cough History
Edema
Vitals
Respiratory Assessment
Confusion, Agitation, Orientation
Cyanosis (late sign)
Diaphoresis
Retractions
Accessory Muscle Use
Jugular Venous Distention
Nasal Flaring / Pursed Lip Breathing
Palpation
Skin
Turgor
Color
Temperature
Diaphoresis
Pulse
Rate
Rhythm
Quality
Chest Wall Pain
Tracheal Deviation
Assessing Lung Sounds
Methods
Hand Out

Lung Sounds
Normal
Wheezes
Rales (Crackles)
Stridor
Rhonchi
Pleural Rub
Listen on every patient
End of Expiration
End of Inspiration
During both phases
Expiration
End of Inspiration

Respiratory Diseases
COPD
Asthma
Pneumonia
Pulmonary Edema
Pulmonary Embolus
Trauma
COPD
Chronic Obstructive Pulmonary
Disease
Pink Puffers and Blue Bloaters
Frequently on Home oxygen
Assessment
Typical Lung Sounds
Common Medications
May or May not be Hypoxic Drive
Asthma
Asthma
Bronchiole Constriction & Mucous
Production
Lung Sounds
Wheezes
Diminished
None
Usually Diagnosed
Pneumonia
Pneumonia
Fever
Productive Cough
Colored Sputum
General Illness
Elderly & Pediatric most at risk
Lung Sounds
Rhonchi, Rales, Wheezes
Pulmonary Edema
Pulmonary Edema
Congestive Heart Failure
Acute Flash Pulmonary Edema
Chronic Heart Failure
Medications
Orthopnea, PND
Lung Sounds
Keep them upright with legs dangling
Pulmonary Embolus
Pulmonary Embolus
Lung Sounds
History
Surgery
Bed Confined
Long trip
Rapid Transport & High Flow Oxygen
Trauma
Trauma
Maintain spinal control
Airway Management
High Flow Oxygen
Rapid Transport
Seal Chest Wounds
Stabilize Impaled Objects
Lesson 4
Respiratory/Cardiac Arrest
Basic Airway Management
Respiratory & Cardiac Arrest
Assessing the Patient
First Steps of CPR
Annie, Annie You Okay?
Other Signs and Symptoms
Unconsciousness
Cardiac Seizure
Agonal respirations or apnea
Cyanosis, Ashen, Mottled
No signs of spontaneous respiration or circulation
No Pulse
Combitube
When to Use the Combitube
CPR
Remember to do CPR!
Attach AED!
Respiratory Arrest
Agonal Respirations without intact gag reflex
Respiratory Arrest leads to Cardiac Arrest

Airway Management The Basics
Manual Maneuvers
Chin Lift
Jaw Lift
Jaw Thrust
Head Tilt Chin Lift
Modified Jaw thrust
Airway Management The Basics
Mechanical Airways
NPAs


OPAs

Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Insertion
Airway Management The Basics
Ventilation
Mouth to Mask



BVM
Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Use
Evaluation of Effectiveness
How do I know I am ventilating?
Chest movement
Lung Sounds
Epigastric sounds/Abdominal distention
Patient Response
Lesson 5
Suctioning
Reviewing Suctioning
BSI Scene Safety
Equipment
Suction device
Rigid or Soft Tip
Insert with Suction Off
Withdraw while
Suctioning
No more than 15
seconds before
ventilating!
Oh, That Sucks!
Vomitus
Food
Protein dissolving
enzymes
Hydrochloric Acid
Aspiration damage
Alveolar Damage
Increased fluid
Obstruction
Aspiration Pneumonia
Oh, Go Spit on It
Saliva
Digestive enzymes
Bacteria
Aspiration Damage
Fills alveoli
Pneumonia

Food
Clogs airways
Interferes with
ventilation
Pneumonia
Blood
Contents
Protein
Fibrin
Water
Electrolytes
Aspiration Damage
Clog small airways
Creates chemical
reaction
Suction Catheters


Rigid
Advantages
Disadvantages
Indications
Contraindications
Methods of Use


Flexible
Advantages
Disadvantages
Indications
Contraindications
Methods of Use
Lesson 6
Dual-Lumen Airway Devices
Combitube

Description
Other Similar Devices
Pharyngeal tracheal lumen airway (PTLA)
EGTA
EOA
What we use
Combitube

Indications for Combitube

Respiratory Arrest
Cardiac Arrest
Unconscious, without a gag reflex
Contraindications for Combitube

Gag Reflex
Conscious
Breathing Adequately
Caustic Ingestion
Known esophageal disease or varices
Under 16 y/o
Under 5 feet or over 6 feet 8inches
Advantages for Combitube

Rapid Insertion
Limits regurgitation, aspiration & distention
Blind insertion
High oxygen delivery
Less training required
Inserted in neutral position
Disadvantages for Combitube

Patient must be unresponsive without gag
reflex
Some are difficult to obtain adequate seal
Some do not totally protect against
aspiration
Most responsive patients will vomit when
removed
May damage esophagus
Demonstration
When Can I Remove the Combitube?
Patient returns to full consciousness
Patient able to maintain own airway
Orders from OLMC
Procedure for Removing
SUCTION READY!
Deflate Tube #2
Deflate Tube #1
Tell patient to exhale
Pull out quickly and in-line
SUCTION
Demonstration
Skills Labs
Basic Airway Management
Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Advanced Airway Management
Combitube
Questions?