EMERGENCY MEDICAL

RESPONDER FIELD
GUIDE

MODULE I

Introduction to Emergenc
Medical Services

INTRODUCTION TO EMERGENCY MEDICAL

SERVICES

DEFINITION: EMS- System consists of a

team of health care professionals who,
are responsible for and provide
emergency care and transportation to
the sick and injured.
A system that provides the many
prehospital and hospital components
required for the delivery of proper
emergency medical care.

 Since EMS providers respond to all kinds

of emergencies and all kinds of hazards,
they often work shoulder-to-shoulder
with public safety colleagues in law
enforcement and fire services. But their
primary mission is emergency medical
care.
The organizational structure of EMS, as
well as who provides and finances the
services, varies significantly from
community to community. Prehospital
services can be based in a fire
department, a hospital, an independent
government agency (i.e., public health
agency), a non-profit corporation (e.g.,
Rescue Squad) or be provided for by
commercial for-profit companies. But,
regardless of provider, the essential

 The organizational structure of EMS, as

well as who provides and finances the
services, varies significantly from
community to community. Prehospital
services can be based in a fire department,
a hospital, an independent government
agency (i.e., public health agency), a nonprofit corporation (e.g., Rescue Squad) or
be provided for by commercial for-profit
companies. But, regardless of provider, the
essential components of an EMS System
remain the same.
Individuals who worked in an ambulance
are categorized into four training levels;
EMR, EMT, AEMT, Paramedic
The National Highway Transportation
Safety Administration (NHTSA) recognized

MODULE II
Brief History of
Emergency Medical
Services

THE STAR OF LIFE

This history of the Star of Life starts in

1973. Up to that time, many ambulances
displayed a "Red Cross" on the side of the
ambulance. The American Red Cross naturally
complained that this implied that they
approved of the ambulances. This is not an
activity that the American Red Cross engages.
However the use of the Red Cross symbol
can still be seen on military vehicles, hospital
tents and buildings to protect wounded
civilian and military personnel as per the
Geneva Convention in times of war.
The Star of Life was designed by Leo
Schwartz (EMS Branch Chief at the National
Highway Traffic Safety Administration ( NHTSA
) United States of America. ) The star of life
was to help identify common emergency

The six barred blue symbol was

adapted from the medical identification
symbol and was registered on February 1,
1977 with the commission of patents and
trademarks in the name of the NHTSA. The
trade mark expired in 1997. Each bar on
the Star of Life represents one of six
functions:

1.
2.
3.
4.
5.
6.

Detection
Reporting
Response
On Scene Care
Care in Transit
Transfer to Definitive Care

The snake and staff in the

symbol portray the staff of
Aesculapius, son of Apollo; the
staff represents medicine and
healing. The Star of Life
symbol can be seen as a
means of identification on
ambulances and ambulance
equipment worldwide. Its use
on EMS patches in the US and
other countries signifies the
wearer has been trained to
meet National or State Training

MODULE III
Roles and
Responsibilities of an
Emergency Medical
Responder

Roles and Responsibilities of an EMS

Personnel:
Keep vehicles and equipment ready for
an emergency.
Ensure the SAFETY at all times.
Be an on-scene leader.
Perform an evaluation of the scene.
Call for additional resources as
needed.
Gain patient access.
Perform a patient assessment.
Give emergency medical care.
Avoid unnecessary movements to
patient to preserve life.

 Maintain continuity of care by

working with other medical
professionals.
Resolve emergency incidents.
Uphold medical and legal standards.
Ensure and protect patient PRIVACY
at all times.
Give emotional support to the
patient, patients family and other
responders.
Constantly continue your professional
development.
Cultivate and sustain community
relations.
Give back to profession. SHARE your
knowledge to others.

MODULE IV
Phases of
Ambulance Call

Phases of Ambulance Call

1. Preparation Phase
Contingency planning
Cleaning of Ambulance units (inside
and outside)
Checking of Ambulance, medical
equipment and supplies.
Replenish of used supplies.
Communication system (Portable
Radio fully charged)
2. Monitoring and Dispatch Phase
Nature of call
Name and callback number of caller
Location of patient and landmark
Number of patients and severity.
Other special problems

3. En Route to the scene Phase

Use of seat belt
Coordinate to the dispatch
center
Wear gloves and mask
Safety helmet as necessary
The crew should already be
oriented regarding their task
based on the contingency plan.
Safe Driving
Lights and Sirens

4. At the scene phase

TL first doing the scene size up.

SAFETY FIRST
Coordination
Prioritization of care according
to severity in case of Multiple
Patients.
Assessment of ABC
Management of the problems
on ABC
Decision making

5. En Route to the receiving

facility
Notify dispatch.
On-going assessment should
be continued.
Additional vital sign
measurements should be
obtained.
Notify receiving facility and
provide info as appropriate.
Reassure patient.
Complete pre-hospital care
reports.

6. At the receiving facility

Notify dispatch.
Proper endorsement to attending
Physician on duty.
7. En Route to station
Notify dispatch.
Prepare for the next call.
Clean and disinfect the ambulance
as needed.
Clean and disinfect ambulance
equipment.
Restock the disposable supplies.

8. Post Run Phase

Refuel unit.
File reports.
Complete cleaning and disinfection
procedures.
Notify dispatch.
TYPE OF AMBULANCE

1. NORTH AMERICAN TYPE 1

2. NORTH AMERICAN TYPE 2

3. NORTH AMERICAN TYPE 3

4. EUROPEAN AMBULANCE

MODULE V
Ethical Issues in
EMS

ETHICAL ISSUES AND LEGALITY

Ethics- it is the science of right
and wrong, of moral duties, and of
ideal behavior.
Medical Ethics the part of ethics
that deals with the health care of
human beings.
Legal Duties:

Duty to Act It is the obligation to

provide care.
ON DUTY you are legally obligated
to assist within your formal scope of
practice.
OFF DUTY you may stop or help;
you may pass the scene and make no
attempt to call for help.
Good Samaritan Law
Protect a person from liability for acts
performed in good faith unless those
acts constitute gross negligence.

The Patients Bill of Rights

RIGHT TO CONSIDERATE AND
RESPECTFUL CARE
RIGHT TO REFUSE TREATMENT
RIGHT TO CONFIDENTIALITY
RIGHT TO EXPECT CONTINUITY
OF CARE

Medical Direction

This legal right to function as an EMS

practitioner is contingent upon a Medical
Control advice.

OFF-LINE DIRECTION Follow

standing orders and protocols.
ON LINE DIRECTION Establish
telephone and radio communications.
Communicate clearly and completely
and follow orders given in response.
Consult medical direction for any
question about the scope and
direction of care.

Ethical Responsibilities

Serve the needs of the patient with respect

for human dignity, without regard to
nationality, race, gender, statues.
Maintain skill mastery.
Keep alongside changes in EMS that affect
patient car.
Critically review performances.
Report with honesty.
Work harmoniously with others.

Issues of Patient Consent and

Refusal

Advance Directives Living Will

and DNR Do Not Resuscitate Order.
Instructions written in advance
documenting the wish of the
chronically or terminally ill
patient not to be resuscitated
and legally allows the
responder to withhold the
resuscitation.
SUPPORTED BY DOCTORs
written instructions.

Types of Consent:
VERBAL

VERBAL or NON

EXPRESSED CONSENT
IMPLIED CONSENT Minor, no
guardian, very ill or critically
injured, impaired level of
consciousness
REFUSING TREATMENT

COMPETENCY - a competent adult is

defined as one who is capable of making
an informed decision.

 Try again to persuade the patient to

accept treatment or transport to a
hospital.
Make sure that the patient is able to
make a rational informed decision.
Consult a medical direction
required by local protocol.

as

If the patient still refuses, have him

sign a refusal form.
Encourage the patient to seek help if
certain symptoms develop.

OTHER
LEGAL
ASPECTS
OF
EMERGENCY CARE:

ABANDONMENT means that one

stopped providing care for the patient
without ensuring that equivalent of
better care would be provided.
NEGLIGENCE it is the care of one
provider DEVIATES FROM THE ACCEPTED
STANDARD OF CARE and results in
FURTHER INJURY TO THE PATIENT.
CONFIDENTIALITY- PRIVACY
ORGAN DONOR
- Legal signed document required

- Communicate with medical

direction regarding the possibility
of organ donation.
- Provide emergency care that will
maintain the vital organs.
MEDICAL INDENTIFICATION
INSIGNIA with serious medical
condition

 DYING AND OBVIOUSLY DEAD

PATIENTS
You may be required to leave the
body at the site if there is any
possibility that the POLICE WILL
HAVE TO INVESTIGATE (S.O.C.O.).
In other scenarios; you may require
to arrange for transport of the body
so that a physician can officially
pronounce the patient dead.

 CRIME SCENE
Touch only what you need to touch.
Move only what you need to move.
Do not use the phone unless authorized by
police.
Observe and document anything unusual at
the scene.
If possible, do not cut through holes in the
patients clothing.
Do not cut through any knot in a rope or tie.
If the crime is RAPE, DO NOT ALLOW THE
PATIENT TO WASH, CHANGE CLOTHING, USE
THE BATHROOM OR TAKE ANYTHING BY

CODE OF ETHICS FOR EMS PRACTITIONERS

AS AN EMERGENCY MEDICAL SERVICES

PROFESSIONAL, I _________________ HEREBY
SOLEMNLY PLEDGE MY SELF TO FOLLOWING
CODE OF PROFESSIONAL ETHICS:
To conserve life, alleviate suffering, promote
health, do no harm, and encourage the quality
and equal availability of emergency care to all.
To provide services based on human need with
COMPASSION AND RESPECT for human dignity,
unrestricted by considerations of nationality,
race, creed, color, gender, socioeconomic
status, or political affiliation.

 To respect the rights and strive to protect

the best interests of their patients,
particularly, the most vulnerable and
those unable to make treatment choices
due to diminished decision making
capacity.
To not judge the merits of my patients
request for service.
To not use professional knowledge and
skills in any enterprise considered to be
detrimental to the public wellbeing or the
practice of emergency pre-hospital care.

 To respect patient privacy and disclose

confidential information only with patient
consent or when required by an overriding duty
such as the duty to protect or to obey the law.
Act as responsible stewards of the health care
resources entrusted to them.
To use social media in a responsible and
professional manner and does not discredit,
dishonor, or embarrass an EMS community.
As a citizen, to understand and uphold the law
and perform the duties of citizenship; as a
professional, to work with concerned citizens and
other health care professionals in promoting high
standard of emergency medical care to all
people.

 To maintain professional competence,

striving always clinical excellence and
development in the delivery of patient
care.
To assume responsibility in upholding
personal standards of professional
practice and education.
To assume responsibility for individual
professional actions and judgment, both
in
dependent
and
independent
emergency functions and to know and
uphold the laws which affect the EMS
practice.
To be fully aware of and participate in

 To work cooperatively with other EMS

groups.
To refuse participation in unethical
procedures.
Deal
fairly
and
honestly
with
colleagues and take appropriate action
to protect the public and patients from
health care providers who are impaired
or incompetent, or who engage in
fraud.
Support societal efforts to improve
public health and safety,
reduce
the effects of injury and illness, and
secure the access to emergency and

MODULE VI
Overview of the Human
Anatomy and Physiology

Significance of Human Anatomy and

Physiology in Pre Hospital Care:
To have a better communication
between the Emergency Medical
Responder and the Hospital Care
Professional.
It is essential tool and guide in the
patient assessment process.

THE ANATOMICAL
POSITION
- This is a
position
of
reference
in
which
the
patient stands
facing
you,
arms
at
the
side, with the
palm
of
the
hands forward.

BODY SYSTEMS:

1. SKELETAL
SYSTEM
. Gives us our
recognizable
human form and
protect
our vital Internal
organs.
. Allows motion of
the
body/Essential
for movements
. Stores Mineral

STRUCTURES: Bones; Joints

AXIAL SKELETON - Runs straight line

from head to pelvis
APPENDICULAR - Made up of the
Arms and Legs.

SKELETAL COMPONENTS: Face/Skull

CRANIUM - protects the brain
4 major bones make up the
cranium.
1. Frontal
2. Occipital
3. Temporal
4. Parietal

 Face composed of 4 BONES

1. Maxillae-upper non movable jawbone
2. Zygomatic Bone- cheek bone
3. Mandible- lower movable jaw
4. Orbit- eye socket

 Spinal Column
Central supporting structure
33 vertebrae
a. Cervical Spine- 7
b. Thoracic Spine- 12
c. Lumbar Spine - 5
d. Sacrum - 5
e. Coccygeal-tailbone - 4

Thorax
12 pairs of ribs
Upper 7 pairs of ribs (true ribs) attached to
sternum
The next 3 pairs of ribs (false ribs) are
attached to the rib above.
The last 2 pair (floating ribs) are not attached
anteriorly.
Contains the Hearts and Lungs
Mechanism of Respiration

Pelvis
- composed of:
1. Acetabulum
2. Ischium- ischial
tuberosity
3. Iliac crest
4. Ilium
5. Sacrum
6. Pubis- Pubic
symphysis
7. Consists of left and
right hip bones
8. Coccyx
9. Maximum Blood
Loss 3000 cc

Upper
Extremities
- composed of:
1. Scapula
2. Humerus
3. Radius
4. Ulna
5. Carpals
6. Metacarpals

 Lower Extremities

1.
2.
3.
4.
5.
6.
7.
8.

Femoral head
Femur
Patella
Fibula
Tibia
Tarsal
Metatarsal
Phalanges

2. MUSCULAR SYSTEM
Function:

Provides
Movements
Establishes
Shape
Protects
Organs
Generates
Warmth
Types:
Skeletal/Voluntar
y
Smooth

3. RESPIRATORY SYSTEM FUNCTION

Functions:
Ventilation
Diffusion
Cellular
Respiration
AcidBase(ph)
Perfusion

UPPER AIRWAYS

Nasal Cavity
Oral Cavity
- Mouth
- Teeth
- Tongue
Pharynx
- Nasopharynx
- Oropharynx
- Laryngopharynx
Jaw
Epiglottis
Larynx

LOWER AIRWAYS

Trachea
Bronchioles
Bronchi-alveoli

SUPPORTIVE STRUCTURE
Intercostal Muscle
Diaphragm
Chest Wall
Phrenic Nerve
Pleura
Pulmonary Capillaries

Pediatric Airways
Smaller mouth and nose
Larger tongue
Cricoid cartilage (less develop)
Narrow trachea

4. CIRCULATORY SYSTEM

Transport
System
Infectious
Response
Blood
Reservoir
Coagulati
on
Acid-Base
Balance

HEART CHAMBERS

Pulmonary Valve
Aortic Valve
Right/Left Atrium
Right/Left Ventricle
Mitral valve
Tricuspid Valve

CORONARY ARTERY
Right/Left Coronary Artery
ARTERIAL BLOOD SUPPLY
Aorta
Pulmonary Artery

ARTERIES
Carotid
Brachial
Radial
Femoral
Posterior Tibial
DorsalisPedis
VENA CAVA AND PULMONARY VEIN
Superior Vena cava
Inferior Vena cava
Pulmonary Vein

PATHWAY OF BLOOD TO THE HEART AND

LUNGS:
The blood from the superior and inferior vena
cava goes to:
1. Right Atrium
2. Tricuspid Valve
3. Right Ventricle
4. Pulmonic Semilunar Valve
5. Pulmonary artery
6. Goes to lungs for oxygenation
7. Pulmonary veins
8. Left Atrium
9. Bicuspid Valve
10.Left Ventricle
11.Aortic Semi-Lunar Valve
12.Aorta

5. NERVOUS SYSTEM
CENTRAL NERVOUS SYSTEM
Brain
Spinal Cord

6. INTEGUMENTARY SYSTEM
FUNCTION:
Protection
Temperature Control

PARTS:
Epidermis
Dermis
Subcutaneous

COMMON DIRECTIONAL
TERM
TERM
Frontal
Anterior (ventral)
Back
Posterior (dorsal)

Right
Left
Top
Bottom
Closest

Farthest

Middle
Side
In

Out

Right
Left
Superior
Inferior
Proximal

Distal

Medial
Lateral
Superficial

Deep

DEFINITION
Front surface of the
body.
Back surface of the
body.
Patients right.
Patients Left
Closest to the head.
Closest to the feet.
Closest to the point of
attachment.
Farthest to the point of
attachment.
Closest to the middle.
Farthest from middle.
Closest to the surface of the
skin.
Farthest from the surface of the
skin.

VITAL SIGNS:
BLOOD PRESSURE
SYSTOLIC PRESSURE (NUMERATOR)
- pressure of the blood during cardiac
contraction.
DIASTOLIC PRESSURE (DENOMINATOR)
- pressure when the ventricle at rest.
PULSE PRESSURE
- difference between the systolic and the
diastolic pressure.
KOROTKOFFS SOUND
- sound heard when taking BP

CLASSIFICATION OF
BLOOD PRESSURE

SYSTOLIC

DIASTOLIC

ADULT

90-140 mmHg
80-100 mmHg
70-90 mmHg
>60 mmHg

60-90 mmHg

CHILD
INFANT
NEONATE

PULSE RATE
- Wave of blood created by Left
ventricle contraction.
RHYTHM/QUALITY
- Regular, Irregular/ Rapid, Weak.

PULSE SITES:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Temporal artery
Carotid Artery
Brachial Artery
Radial Artery
Ulnar Artery
Femoral Artery
Popliteal Artery
Tibial Artery
Dorsalis Pedis

PULSE RATES (normal values)

ADULT

60-100bpm

CHILD
INFANT
NEONATE

80-100bpm
100-120bpm
120-160bpm

RESPIRATORY
RATE
- Normal, shallow,
labored, noisy.

ADULT
CHILD
INFANT
NEONAT
E

TEMPERATURE

HYPOTHALAMUS
- temperature center.
ROUTES:
1. ORAL- 3-5mins
2. RECTAL- 2-3 mins
3. TYMPANIC MEMBRANE

12-20bpm
15-30bpm
25-50bpm
30-60bpm

OXYGEN SATURATION (SPO2)

RANGE
NORMAL
MILD HYPOXIA
MODERATE
HYPOXIA
SEVERE
HYPOXIA

VALUE
95-100%
94-90%
75-89%

TREATMENT
None
Give Oxygen
Give 100 % oxygen

Below
75%

Give 100 % oxygen w/

positive
pressure

GLASGOW COMA SCALE

EYE
MOVEMENT
SPONTANEOU
S
TO VOICE
TO PAIN
NO RESPONSE
VERBAL

SCORE

MOTOR

4
3
2
1

ORIENTED
CONFUSED
INNAPROPRIATE
WORDS

SCOR
E
5
4
3

INCOMPREHENSIBLE
SOUNDS

NO RESPONSE

SCOR
E
OBEYS COMMAND
6
LOCALIZES TO PAIN
5
WITHDRAWS TO
4
PAIN
ABNORMAL
3
FLEXION
(DECORTICATE)
ABNORMAL
2
EXTENSION
(DECEREBRATE)
INTERPRETATION1
NO RESPONSE

15 Normal

neurological
function
8 Critical score

MODULE VII
Body Mechanics

BODY MECHANICS
Terms:
GRAVITY the force that pulls toward the
center of the earth and affects all objects
FRICTION the act of rubbing an object
together
**gravity and friction are
forces that add resistance to many objects
CENTER OF GRAVITY the point at which the
mass of a body or object is centered; when
weight on all sides are equal
BASE OF SUPPORT area on which an object
rests and that provides support for the object
LINE OF GRAVITY vertical line between the
center of gravity and the ground; must fall
within the BOS if the body is to stay upright

BODY MECHANICS - the use of ones body to

produce motion that is SAFE (for patient and
self), EFFICIENT (less stress and strain on body
causing less injury) and ENERGY
CONSERVING; all of which allows the person to
maintain balance and control
POWER LIFT a lifting technique in which the
responders back is held upright, with legs bent
and the patient is lifted when the responder
straightens the leg to raise the upper body and
arms
POWER GRIP technique where the
backboard is gripped by inserting each hand
under the handle with the palms facing up and
the thumb extended, fully supporting the
underside of the handle on the curved palm
with the fingers and thumb

PROPER LIFTING AND MOVING TECHNIQUE

LIFTING
1. Always keep your back in a straight,
upright position.
2. When lifting, the legs should be spread
about 15 apart (shoulder length).
3. Keep your body as close to what you are
lifting as possible (keep your arms
tucked close to your body).
4. Grasp objects such as railings so your
hands are positioned with the palms
facing up.
5. Bend at the knees instead of the waist.

6. Avoid turning or twisting when lifting.

7. Know your limitations and call upon
additional help when the weight to be
lifted exceeds your lifting ability.
8. Communicate clearly and move on
three counts to ensure weight is evenly
distributed among the crew doing the
lifting.
9. Work out a code, that when used by
any person performing the lift results in
immediate
cessation
of
the
lift,
placement of the patient directly on the
ground, floor, or other surface and

TYPES OF CARRY
DIAMOND CARRY
- A lifting technique that requires 4
rescuers; 1 at the head part, 1 at the foot
part and 1 at each side of the patients
torso.
Steps:
1. Position yourself facing the patient
2. Rescuers on the sides each turn the
head end palm down and release the
other hand
3. The rescuers at the side turn toward
the foot end. The rescuer at the foot

ONE HANDED CARRYING TECHNIQUE

- On this method 4 or more rescuers
each use one hand to support the
backboard so that they are able to face
forward as they are walking.
Steps:
1. Before lifting make sure that at least 2
rescuers are on each side of the
backboard facing each other and are
using both hands.
2. Lift the backboard to carrying height
using correct lifting techniques.
3. Turn in the direction that you will walk,
and switch to using one hand.

CARRYING A PATIENT ON STAIRS

1. Strap the patient securely. Make sure 1
strap is tight across the upper torso,
under the arms, and secured to the
handles to prevent patient from sliding.
2. Carry the patient down the stairs with
the foot end first, head elevated.
3. Carry the head end first going up the
stairs, always keeping the head
elevated.

MODULE VIII
BASIC LIFE SUPPORT
(CPR)
FBAO
AED OPERATION

BASIC LIFE SUPPORT

IT IS A MEDICAL CARE
GIVEN BEFORE AN EMS
ARRIVES.
COMMON CAUSE OF
SUDDEN CARDIAC
ARREST IS A FAILURE
OF THE HEART TO
PUMP BLOOD.

RISK FACTORS:
Non Modifiable;
Heredity
Gender
Age
Modifiable;
Cigarette smoking
Hypertension
Elevated
cholesterol
Lack of exercise
Obesity
Stress

Other causes of sudden

cardiopulmonary arrest
Drowning
Electrocution
Trauma
Poisoning
Epilepsy
Allergy
Suffocation
Smoke inhalation
Drug overdose

TIME FRAME (CRITICAL

DECISION MAKING)
0 1 minute no brain
damage
1 4 minutes brain damage
not likely
4 6 minutes possible brain
damage
6 10 minutes brain damage
very likely
10 minutes above
irreversible brain damage

Significance of CPR Training

Cardiovascular diseases are
now the leading causes of
death in the country.
Most people die of heart attack
before they ever reach a
hospital.
There are other situations aside
from heart attack that can lead
to cardiopulmonary arrest.
Since these events can occur
anytime, anywhere, it is the
person nearest the victim who
may witness the arrest, this
person must be able to

ADULT CHAIN OF SURVIVAL

EARLY ACCESS
EARLY CPR
RAPID DEFIBRILLATION
EFFECTIVE ADVANCE LIFE
SUPPORT
INTEGRATED POST CARDIAC
ARREST CARE
PEDIATRIC CHAIN OF SURVIVAL
EDUCATION IN PREVENTION OF
CARDIOPULMONARY ARREST
EARLY CPR
EARLY ACCESS
EFFECTIVE PEDIATRIC ADVANCE
LIFE SUPPORT
PEDIATRIC POST RESUSCITATION

CARDIOVASCULAR DISEASE
HEART ATTACK (MYOCARDIAL
INFARCTION)

HEART ATTACK (MYOCARDIAL

INFARCTION)
SIGNS AND SYMPTOMS;
CHEST DISCOMFORT

HEART ATTACK ( Myocardial

Infarction)
SIGNS
AND SYMPTOMS;

Prolonged compressing
chest pain
Pain radiate to shoulder,
arm, neck, jaw
May be accompanied by
sweating, nausea,
vomiting, and shortness of
breath.

Early Warning Signs of

Respiratory Failure;
1.Unable to speak, breath,
cough
2.Clutched neck
3.Bluish color of skin and
lips

How does CPR work?

All the living cells of our
body need a steady supply
of oxygen to keep us alive.
CPR works because you can
breathe air into the victim
lungs to provide oxygen into
the blood. Then, when you
press the chest, you move
oxygen-carrying blood
through the body.

When you will do CPR?

Not appreciated or weak
carotid pulse
Ineffective or shallow
breathing

THE CABs of CPR

After determining
unconsciousness, you should
evaluate the condition of the bodys
most vital systems: The circulatory
system and respiratory system.
This is done by checking the CAB;
C Circulation: Does the victim
have pulse? Is the victim bleeding
severely?
A Airway: Does the victim have an
open airway (air passage that
allows victim to breath)?
B Breathing: Is the victim

SCENARIO ALGORITHM
1.Ensure the scene is safe.
2.Gently tap victims
shoulder.
3.Rescuer shout; Hey are
you okay?
4.Check for any medical
alert, tag, bracelet,
necklace, or any other
indicators.
5.Activate the EMS system
available in the
community.

AGE
GROUP
ADULT

CHILD

INFANT

HEALTH
CARE
PROVIDER
12 years
old and up
1 year to
12 years
old
Less than
1 year old
to 29 days
old

LAY
RESCUER
Greater
than 8
years old
1 to 8
years old
Less than
1 year old

CIRCULATION FOR HEALTH

CARE PROVIDERS
Check for pulse (Adult)
Maintain head tilt with one
hand on forehead.
Locate Adams apple with the
middle and index fingers of
hand.
Side fingers down into the
groove of neck on the side
closest to you.
Feel the carotid pulse for no
more than 10 seconds.

Check for pulse (Child)

Same location as in adult.
Feel the carotid pulse for no
more than 10 seconds.
Check for pulse (Infant)
Feel for the brachial pulse on
the inside of the upper arm
between elbow and shoulder
Check for signs of circulation.

Circulation for Lay

Rescuers
Quickly scan if the
victim is moving,
breathing normally,
or coughing.

IF THE VICTIM HAS NO

PULSE OR NO SIGNS
OF ANY CIRCULATION
PROCEED TO;
CHEST
COMPRESSIONS; (30
compressions: 2
Ventilations ratio for 5
cycles in 2 minute)
Starts with a
compression ends
with ventilation.

P PUSH HARD,
PUSH FAST
A ALLOW FULL
CHEST RECOIL
M MINIMIZE
INTERRUPTION
A AVOID
HYPERVENTILATION

AGE GROUP

DEPTH OF
COMPRESSIONS

ADULT

2 inches or 5cm

CHILD

2 inches or 5cm

INFANT

1 inches or
4cm

ADULT;
Center of the chest, between the
nipple area, and lower half of the
sternum
Place the heel directly on top of the
heel of the other hand.
Elbows lock, arms straight
Count aloud; one two three
twenty. One two three
four five six seven eight
nine 1 (30)
Push Hard, Push Fast
Chest Compressions (CHILD);
Same as adult. You may use heel of
one hand or as in adult
Chest Compressions (INFANT);
2 3 fingers compression
1 inches depth

AIRWAY

BREATHING
ADULT HEAD TILT CHIN LIFT
CHILD HEAD TILT CHIN LIFT
INFANT HEAD IN NEUTRAL POSITION
If the victim is breathing;
Maintain an open airway and position
the victim; Recovery position;
Placing the patient by rolling to his/her
side to help protect the airway.
If the victim is not breathing, but
pulse is present or with signs of
circulation;
ADULT 1 BREATH EVERY 5
SECONDS INTERVAL (24 BREATHS)
CHILD AND INFANT 1 BREATH
EVERY 3 SECONDS INTERVAL (40
BREATHS)

AGE GROUP
ADULT

Mouth to mouth

CHILD

Mouth to mouth

INFANT

Mouth to nose
and mouth

EFFECTIVE CPR
Presence of pulse
Skin color improves
Chest rise and fall
CPR appreciate rate and depth
WHEN TO STOP CPR
Victim recovers
Another trained person takes over
Rescuer is too exhausted
Valid Do not resuscitate order
WHEN NOT TO CPR
Advanced stage of decomposition
Decapitation
Rigor mortis
Livor mortis
Algor mortis

FOREIGN BODY AIRWAY

OBSTRUCTION
Most common cause of
obstruction in an
unconscious victim is the
tongue.
Could be mild or severe.
Clutching the neck is the
universal distress sign.
Look for absence of
breathing, coughing, or
speaking.

Severeairwayobstruction(Conscious
adult)
Ask patient to cough
Abdominal Thrust (5 times)

Back slap
If pregnant perform chest thrust

Foreign Body Obstruction

(Conscious Infant)
Back Slap 5 times
Chest Thrust 5 times (2 fingers)

Foreign Body Airway

Obstruction (Conscious
Child)
Abdominal Thrusts

If the heart is
damaged by disease
or injury, its
electrical system
can be disrupted.
This can cause an
abnormal heart
rhythm that can
stop the blood from

Defibrillation
Is the treatment of irregular, sporadic or
absent heart rhythms by an electrical
current to the heart. It is the only
definitive treatment for sudden cardiac
arrest (SCA). Defibrillation administered
within 3-5 minutes after collapse is most
successful. Every minute a victim is
unconscious translates to approximately
a ten percent decrease in the likelihood
of resuscitation. After ten minutes, very
few resuscitation attempts are
successful. Thus, the most important
element in the treatment of SCA is
providing rapid defibrillation therapy.
CPR may help prolong the window of
survival, but it cannot reverse SCA.

TAKENOTE:
Theearlierdefibrillation
occurs,thehigherthe
survivalrate.
WhenVentricularFibrillation
ispresent,CPRcanprovidea
smallamountofbloodflowto
theheartandbrainbut
cannotdirectlyrestorean
organizedrhythm.

TAKE NOTE:
When operating an AED;
Make sure that no one is
injured, including you.
Be sure no one is touching the
patient.
Do not defibrillate someone who
is touching metal that others
are touching.
Carefully remove any medication
patches from a patients chest
with your gloved hands and
wipe the area with a dry towel
before defibrillation to prevent
ignition of the patch.
Defibrillation is contraindicated
to trauma.

P POWER ON
A ATTACH PADS
A ANALYZING
RHYTHM
S SHOCK ADVICE

Using an AED on a Child

For UNWITNESSED, out-ofhospital cardiac arrest in
children, perform 5 cycles or
2 minutes of CPR before
using and attaching the AED.
For any in-hospital cardiac
arrest of a child or for any
sudden collapse of a child
out-of-hospital, use an AED
as soon as it is available.

IntegratingCPRandAEDUse
When arriving at the scene of a
suspected cardiac arrest, rescuers
must rapidly integrate CPR with use of
the AED. Most of the time 2 or more
rescuers are at the scene. In this case
the rescuers can initiate these
functions simultaneously:
1. Activating the emergency
response system and getting the
AED
2. Performing CPR
3. Operating the AED

SPECIAL SITUATIONS
The victim is less than 1 year of
age.

Currently there is not enough evidence

to recommend for or against the use of
AEDs in infants less than 1 year of age.

The victim has a hairy chest.

If a teen or adult has a hairy chest, the
AED pads may stick to the hair and may
not stick to the skin on the chest. If this
occurs, the AED will not be able to
analyze the victims heart rhythm. The
AED will then give a check electrodes
or check electrode pads message.

SPECIAL SITUATIONS
The victim is immersed in water or
water is covering the victims
chest.

Water is a good conductor of electricity.

Do not use an AED in the water. If the
victim is in water, pull the victim out of
the water. If the victims chest is
covered with water, water may conduct
the shock electricity across the skin of
the victims chest. This prevents the
delivery of an adequate shock dose to
the heart. If the water covers the
victims chest, quickly wipe the chest
before attaching the electrodes. If the
victim is lying on snow or in a small

SPECIAL SITUATIONS
The victim has an implanted
defibrillator or pacemaker.

Victims who have a higher risk for

sudden cardiac arrest may have
implanted defibrillators/pacemakers that
deliver shocks directly to the
myocardium. You can immediately
identify these devices because they
create a lump beneath the skin of the
upper chest or abdomen. The lump is
half the size of a deck of cards, with a
small overlying scar. If you place an AED
electrode pad directly over an implanted
medical device, the device may block
delivery of the shock to the heart.

SPECIAL SITUATIONS
The victim has a transdermal
medication patch or other object on
the surface of the skin where the
AED electrode pads are placed.

Do not place AED electrodes directly on

top of medication patch (eg, a patch of
nitroglycerin, nicotine, pain medication,
hormone replacement therapy, or
antihypertensive medication).The
medication patch may block the
transfer of energy from the electrode
pad to the heart and may cause small
burns to the skin. To prevent the
medication patch from blocking delivery
of energy, remove the patch and wipe

MODULE IX
THE SCENE SIZE
UP

THE SCENE SIZE UP

The pre-hospital setting is an
extremely uncontrolled
environment.
Failure to close attention to
scene characteristics and basic
guidelines may lead to serious
injury.
The experienced ambulance
personnel or a Team Leader
must first check the scene for
any hazards.
Safety of you, crew, patient,
bystanders.
Dont engage if is not safe.

Components of Scene Size up:

Obtain exact dispatch information
Body substance isolation and
personal protective equipment
Scene survey
Determine the mechanism of
injury or nature of illness
Determine the number of patient
and its status for prioritization of
care
Determine the need for additional
resources
Consider manual in-line cervical
spine precaution

Vehicular Crash
scenes:
Is the vehicle stable?
Are power lines
involved?
Does jagged metal or
broken glass pose
threat?
Is there a fuel break?
Is there fire?

DONT
ENGAGE IF
ITS NOT
SAFE. DONT
GO BEYOND
YOUR
SCOPE!!!

Protect the patient:

Discomfort
Determination of condition
Curiosity of the public
Risk of
hypothermia/hyperthermia
Protect the bystanders:
Utilize them as crowd control
Human barrier
This use of bystanders
demonstrates efficient
utilization of resources and
involves people in a positive
way.

Control the scene:

Provide light
Consider moving object or other
obstacles
Consider moving the patient
Maintain an escape route
Pay attention to bystanders
Control the scene
Stay calm
Use tract and diplomacy
Be flexible
Be Open-minded
Be alert
Be compassionate towards others

At the patients side

Do not allow bystanders to touch or disturb the
patient or his surroundings.
Be alert of the possibility that the patient at a
crime scene may not be a victim but also a
perpetrator.
Observe the bystanders and the surrounding
areas.
Take extreme care not to disturb any evidence
that is not directly on the patients body.
NEVER touch or move suspected weapons
UNLESS it is necessary for treating the patients
injuries.
WEAR GLOVES throughout the treatment to avoid
leaving your own fingerprints at the crime scene.
Do not cut through a knife holes on clothing that
needs to be cut. Keep the clothing and submit it
as evidence to the police.
If the patient is strangled, do not untie, cut a
point away from the knot.
If the patient is responsive, do not burden him
with questions about the crime. Treat his injuries
and transport him.
Realize that the patient will probably show

Assessment of the
crowd:
Is the scene chaotic or
hysterical? Do not allow
yourself to be pulled into
chaos.
Does the crowd seem
hostile to your presence?
Retreat until appropriate
security back up arrives.

Approaching the scene:

Less obvious approach
Hold your flashlight beside, NOT in front of
your body so that you wont make it a
possible target.
Walk as single file.
Make a mental map of concealment.
Take a moment to look at windows and corners.
Stand to side of the door when you try to knock
on it.
Assess the situation before making decisions.

Bar room scenes:

Be patient when no one will answer to your
questions about the injured person.
Have your partner stand and survey the
patrons at all times.
Do not turn your back at the people in the bar.
Do not reply to verbal threats, but never ignore
them either.

MODULE X
PATIENT
ASSESSMENT

PATIENT ASSESSMENT
It is the systematic procedure done by a
health care provider for a quality patient care.
Pre-Hospital Care Providers WEAPON
Prioritization of care (ABC)
Determination of life threatening conditions such
as external and INTERNAL BLEEDING.
Internal Bleeding is FATAL.
Helps in the DECISION MAKING of every
health care provider.
NOTE: BE CALM AND FOLLOW THE
ALGORITHM. DO IT STEP BY STEP; ONE AT
A TIME.

PATIENT ASSESSMENT
ALGORITHM
1.Scene Size-Up
2.Primary Assessment
3.Rapid Trauma/Medical
Assessment or Focused
Assessment
4.History taking
5.Secondary
Assessment/Detailed
Physical Assessment
6.Re-assessment
7.Proper endorsement to

CRITICAL DECISION MAKING

M A B C Pneumonic
Mental Status (Assess &
Decide)
Airway (Assess-ManageDecide)
Breathing (AssessManage-Decide)
Circulation (AssessCheck-SHOCK
management-Decide)
LOAD and GO or STAY
and PLAY

THE SCENE SIZE UP

Safety starts from
the beginning of your
shift; from the time
you were preparing
your equipment,
designating tasks,
and cleaning the
ambulance.
With those written
above, you will
properly practice
SAFETY until your
team will be
dispatched; AT THE
SCENE BEFORE YOU
ENGAGE.

COMPONENTS OF SCENE SIZE

UP:
1. ENSURE SCENE SAFETY
BSI and PPE ON
2. DETERMINE THE
MECHANISM OF INJURY or
NATURE OF ILLNESS
3. DETERMINE THE NUMBER
OF PATIENTS
4. DETERMINE THE NEED FOR
ADDITIONAL RESOURCES
5. CONSIDER MANUAL IN-LINE
CERVICAL SPINE
STABILIZATION.

PRIMARY ASSESSMENT
A PHASE IN THE PATIENT
ASSESSMENT ALGORITHM
WHERE YOU WILL IDENTIFY,
PRIORITIZE, MANAGE
IMMEDIATE LIFE
THREATENING CONDITIONS
OF THE PATIENT.
OBSERVED THE GOLDEN
PRINCIPLE OF LESS THAN 10
MINUTES.
PLATINUM MINUTES IN
TRAUMA

OBTAINING THE GENERAL

IMPRESSION:
Your immediate assessment to the
patient.
This includes persons age, sex,
race, level of distress, and overall
appearance.
Lower yourself to the patient to
show respect for the patient. It will
help the patient feel comfortable
and less threatened as you begin
your assessment.
Hi! Good Day, IM <your name>
from Red Cross ERU, I am here to
help you

ASSESS LEVEL OF CONSCIOUSNESS:

A-V-P-U Assessment
Considered as a VITAL SIGN because it can tell
the patient neurologic and physiologic status
ALTERED LOC means theres inadequate
perfusion and oxygenation
ALTERED MENTAL STATUS? LOAD and GO!
Alert The patient opens eye spontaneously.
The patient is aware of his/her environment. The
patient able to follow commands and coordinated
body movements.
Responsive to Verbal Stimuli Do not open
eyes spontaneously. The patient is able to
respond in some meaningful way when spoken
to.
Responsive to Pain stimuli No response unless
inflict a pain stimuli by gently but firmly pinch the
earlobe, pinch the muscle of the neck, press
down on the bones above the eye.

IF THE PATIENT IS
RESPONSIVE, EVALUATE
HIS/HER ORIENTATION;
Is he/she remembers
his/her name?
The patient is able to
identify his/her location.
The patient is able to tell
the current year, month,
and date.
The patient is able to
describe what happened
(MOI/NOI).

ASSESSING THE PUPILS

The diameter and reactivity to light of
the patients pupils reflect the status of
the brains perfusion, oxygenation, and
condition.
Normally round equally reactive to light
Less light - pupils dilate, allowing more
light to enter the eye, making it possible
to see even in a dim light.
High Light When bright light
introduced, pupils constrict, allowing less
light to enter, protecting the sensitive
receptors in the inner eye from damage.
Absence of any light Fully relaxed and
dilated

ASSESSING THE PUPILS

DEPRESSED BRAIN FUNCTION;
Injury of the brain or brain stem
Trauma or stroke
Brain tumor
Inadequate oxygenation and
perfusion
Drugs or toxins (central nervous
system depressants)
OPIATES Causes pupils to
constrict regardless of the
light

ASSESSING THE AIRWAY

Maintain airway patency
Head tilt and chin lift maneuver
if NO HEAD AND SPINAL INJURY.
C-SPINE PRECAUTION JAW
THRUST MANEUVER
Check for presence of
obstructions
Consider the use of the basic
airway adjuncts
Manage immediately potential
life threatening conditions

ASSESSINGTHEBREATHING
Look, listen and Feel
RRQD Assessment of breathing
4-point Auscultation
Assess the chest rise and fall
Immediate life threat; Manage it!
Assess the SPO2 before
administering the appropriate
oxygenation or ventilation

BREATH SOUNDS
Normal Breath Sounds clear
and quiet during inspiration and
expiration.
Wheezing obstruction of the
lower airways.
Rales or Crackles may
indicate cardiac failure.
Rhonchi Congested breath
sounds may suggest the
presence of mucus in the lungs.
Expect to hear a low-pitched,
noisy sounds that are most
prominent on expiration;
Productive cough associated with

DEPTH OF BREATHING
End Tidal CO2 via
Capnometer
Tidal Volume is the
measurement of depth of
breathing and is the
amount of air in and out
the lungs during one
breath.
35-45 mmHg normal
range of ETCO2
Above 45 hypoventilation

OXYGEN SATURATION
(SPO2)
Measurement of the
level of oxygen of the
circulating blood
95 100 % - Normal
SPO2
94 90 % - Mild
Hypoxia
89 75% - Moderate
Hypoxia

CHARACTERISTICS OF
RESPIRATION
Normal Equal chest rise and
fall. No use of the accessory
muscles.
Shallow Decreased chest or
abdominal motion.
Labored Increased breathing
effort. Use of accessory muscles
(neck, chest, abdominal muscles),
possible gasping, nasal flaring in
infants.
Noisy - snoring, wheezing,
gurgling, crowing, grunting, stridor

ABNORMAL RESPIRATION DESCRIPTION

Bradypnea

Rate of breathing is
abnormally < 10 bpm

Tachypnea

Rate of breathing is
abnormally >24 bpm

Hyperpnea

Increased in depth and in

rate (occurs normally in
exercise)

Hypoventilation

Rate of ventilation entering

the lungs is insufficient for
metabolic needs

Hyperventilation

Rate of ventilation exceeds

normal metabolic
requirements for exchange
of respiratory gases.

Cheyne-Stokes

Irregular; alternating
periods of apnea and
hyperventilation

Orthopnea

Respiratory condition in
which a person must sit or
stand to breath comfortably.

Biots

Shallow breathing
interrupted by irregular
periods of Apnea

NORMAL
RESPIRATORY RATE
ADULT 12 TO 20
BREATHS/MIN
CHILD 15 TO 30
BREATHS/MIN
INFANTS 25 TO 50
BREATHS/MIN

ASSESSING THE CIRCULATION

Check Carotid pulse no more than 10
seconds
Check Brachial, radial, dorsalis pedis.
Check for skin color
Check for skin temperature
Check for capillary refill
Check for blood pressure and pulse rate
CHECK FOR THE PRESENCE OF
INTERNAL AND EXTERNAL BLEEDING
INTERNAL BLEEDING is more
DANGEROUS.
CRITICAL DECISION MAKING

TAKENOTE
SignificantMechanismof
Injury/Natureofillness
PerformtheRAPID
TRAUMA/MEDICAL
ASSESSMENT(RAPID
SCAN)forabout60-90
seconds
NonSignificant
Mechanismofinjury/Nature
ofillnessPerformthe
FOCUSEDASSESSMENT.

RAPID SCAN
Identify and treat
immediate threats to
ABC.
Is bleeding present?
Critical Decision
Making
60-90 seconds

RAPID SCAN
Assess the head, looking and feeling
for DCAP BTLS.
Assess the Eyes, ears, and nose for
bleeding, discharge.
Assess the neck, looking and feeling
for DCAP BTLS, jugular vein distention,
tracheal deviation. Assess the neck
before application of cervical collar.
Assess the shoulder for crepitus
(INWARD DOWNWARD)
Assess the chest, looking and feeling
for DCAP BTLS, paradoxical motion,
crepitus.

RAPID SCAN
Assess the abdomen (DCAP BTLS, Bowel
sounds, rigidity (firm and soft), distention.
Assess the pelvis, looking and feeling for
DCAP BTLS. INSPECT FIRST. IF NO PAIN,
gently compress the pelvis DOWNWARD and
INWARD to look for tenderness and instability.
Assess the lower extremities for DCAP
BTLS. Check the pulse motor sensory.
Assess the upper extremities for DCAP
BTLS. Check the pulse motor sensory.
Assess the back. DCAP BTLS before
transferring to a back board or scoop stretcher.
UPDATE: LOG ROLLING CAN CAUSE
FURTHER INJURY IN A PATIENT WITH
POSSIBLE SPINAL INJURY

THE GOLDEN
RULE
The PLATINUM MINUTES
Initial assessment,
intervention,
packaging
TREATMENT FOR
SHOCK
CRITICAL DECISION
MAKING

ASSESS RE-ASSESS
CYCLE
Re-assess vital signs
often, watching for
trends that may
indicate a patient is
unable to compensate
for his/her injury or
illness. You should
suspect shock in any
patient exhibiting

HISTORY TAKING
Patient Information
Chief Complaint
OPQRST
SAMPLE
Vital Signs

SECONDARY ASSESSMENT
DETAILED PHYSICAL ASSESSMENT:
1. Observe the face.
2. Inspect the area around the eyes
and eyelids.
3. Examine the eyes for redness.
Check for pupil function.
4. Look for the behind the ears for
Battles Signs.
5. Check the ears for drainage of
blood.
6. Observe and palpate the head.
7. Palpate the cheeks.
8. Palpate the maxillae.
9. Check the nose for blood and
drainage.
10.Palpate the mandible.
11.Assess the mouth and nose. Check

DETAILED PHYSICAL ASSESSMENT:

12. Inspect the neck for jugular vein
distention, tracheal deviation, and any
abnormalities.
13. Palpate the front and back of the
neck.
14. Inspect the chest and observe
breathing motion.
15. Gently palpate over the ribs.
16. Listen to anterior breath sounds.
17. Listen to posterior breath sounds.
18. Observe FIRST and palpate the
abdomen and pelvis.
19. Gently inspect and assess the
pelvis.
20. Inspect the LOWER extremities
first then UPPER extremities. Check

VITALSIGNS
PULSERATE;
Regular,irregular,rapid,weak
Adult:60100beatsperminute
Child:80100beatsperminute
Infant:100120beatsperminute
Neonate:120160beatsperminute

VITALSIGNS
BLOOD PRESSURE;
SYSTOLIC
ADULT

90 140 mmHg

CHILDREN

80 110 mmHg

INFANT

70 95 mmHg

NEONATE

60 mmHg

DIASTOLIC
60 90 mmHg

VITALSIGNS
RESPIRATIONS;
Normal,shallow,labored,noisy
Adult12to20breathsperminute
Child15to30breathsperminute
Infant25to50breathsperminute
Neonate30to60breathsperminute

VITALSIGNS
PULSEOXIMETER(SPO2);
RANGE
NORMAL
MILD HYPOXIA
MODERATE
HYPOXIA
SEVERE
HYPOXIA

VALUE
95 100 %
94 90 %
89 - 75%
BELOW 75 %

TREATMENT
None
Give Oxygen
Give 100 %
Oxygen
Give 100 %
Oxygen with
positive
pressure

GLAUSCOWCOMASCALE(GCS)
EYES

SCORE

SPONTANEOUS

TO VOICE

TO PAIN

NO RESPONSE

VERBAL

SCORE

ORIENTED

CONFUSED

INAPPROPRIATE WORDS

INCOMPREHENSIBLE
WORDS

NO RESPONSE

GLAUSCOWCOMASCALE(GCS)
MOTOR

SCORE

OBEYS COMMAND

LOCALIZES TO PAIN

WITHDRAWS TO PAIN

ABNORMAL FLEXION
(DECORTICATE)

ABNORMAL EXTENSION
(DECEREBRATE)

NO RESPONSE

NORMALTotalScoreof15
CRITICALSCORETotalScoreof8
COMATotalScoreof3

APGARScoring(NEONATES)
SIGN
2
Activity
Active
(muscle
tone)
Pulse
>100 bpm
Grimace
Sneezes,
(reflex
coughs, pulls
irritability)
away
Appearance Normal over
(Skin color)
entire body
Respirations Good, crying

1
Arms and
Legs flexed

0
Absent

<100bpm
Grimaces

Absent
No response

Normal
except
extremities
Slow,
irregular

Cyanotic or
pale all over
Absent

MODULE XI
BASIC AIRWAY
AND BREATHING
MANAGEMENT

POINTSTOCONSIDER
Whentheabilitytobreatheisdisrupted,oxygendeliveryto
thebodytissuesandcellsiscompromised.

Ourcellsrequireaconstantsupplyofoxygeninorderto
survive.

Insufficientsupplyofoxygentothebrainwithin46
minutesresultstobraindamage.

ASSISTEDVENTILATIONWhenthepatientbreathing
inadequately.

SUPPLEMENTALOXYGENATION-Whenthepatient
spontaneouslybreathingbutwithdiscomfort.

OXYGENATIONtheprocessofloadingoxygenmolecules
ontohemoglobinmoleculesinthebloodstream.

RESPIRATIONTheactualexchangeofOXYGENand
CARBONDIOXIDEinthealveoliaswellasthetissuesofthe
body.

VENTILATION-Thephysicalactofmovingairinandoutof
thelungs

 Airway is divided into upper and lower

respiratory tract.

Structures that help us breathe include

the diaphragm muscles of the chest wall,
accessory muscles of breathing, and the
nerves from the brain and spinal cord to
those muscles.

Breathing muscles: DIAPHRAGM AND

CHEST MUSCLES (INTERCOSTAL
MUSCLES)

Accessory muscles for inspiration:

Sternocleidomastoid and scalenus

Accessory Muscles for expiration:

MANUAL WAY OF MAINTAING AN

OPEN AND PATENT AIRWAY
HEAD-TILT CHIN LIFT MANEUVER
JAW THRUST MANEUVER
MECHANICAL WAY:
OROPHARYNGEAL AIRWAY
ADJUNCT
NASOPHARYNGEAL AIRWAY
ADJUNCT
I GEL / SUPRAGLOTTIC AIRWAY
LARYNGEAL TUBE (SALT)

SUCTIONING
Clearing of airway for secretions,
obstructions such as blood,
vomitus, etc.
Duration of Suctioning:
Adult 15 seconds
Child 10 seconds
Infant 5 seconds
Trauma 5 seconds
Type of suction tip:
Soft Tip French and whistle tip
Rigid Tip Tonsil and Yankauer Tip
NOTE: Before suctioning, please stop

Ventilatory Devices