EMT-Intermediate Bridge Course
Airway Management and Disease
Terms and Key Points
Lower Airway Anatomy and Physiology
Bronchioles and alveoli
- Structure and anatomy
- Physiology of recoil
Pleural space
Physiology of the Respiratory System
Neurological and chemical control of ventilation
- General functions of the medulla
- Peripheral and CNS chemoceptor locations and functions
Ventilation versus Respiration
- Importance to cellular perfusion
- Medical and trauma causes of inadequate ventilation and respiration
Alveolar and arterial partial pressures of oxygen and carbon dioxide
Diffusion of oxygen and carbon dioxide at the alveolar-capillary membrane
Oxygen saturation – concepts
Factors impacting blood oxygen concentrations
Factors impacting carbon dioxide production and elimination
Regulation of respiration
- medulla
- stretch receptors
- chemoreceptors
- COPD and the hypoxic drive
Normal respiratory rates in adults, children, and infants
Respiratory measurement definitions:
- total lung capacity
- tidal volume
- dead space volume
- minute volume
o Medical and trauma conditions that change minute volume
Respiratory System Assessment and Terms
Signs of adequate v. poor air exchange in a respiratory distress patient
Pulsus paradoxus
Respiratory patterns
- Kussmaul, Cheyne-Stokes, Biot’s, Agonal
Description and causes of lung sounds
- Crackles (rales)
- Rhonchi
- Wheezes
Pulse oximetry measurements
- Normal percentages for pulse oximetry
- Percentages for mild and moderate hypoxia
- Causes for false pulse oximetry readings
End Tidal CO2 measurement– purpose and findings
Assessment of respiratory distress
- Scene assessment
- General impression
- Focused history and physical
Respiratory Disease and Trauma Profiles
Causes, pathophysiology and assessment findings related to the following:
- Simple pneumothorax
- Open pneumothorax
- Hemothorax
- Tension pneumothorax
- Pulmonary contusion
- Emphysema
- Chronic bronchitis
- Asthma
- Pulmonary edema/pleural effusion
- Adult respiratory distress syndrome
- Pneumonia
Respiratory medications
Albuterol
diphenhydramine
epineprhine
furosemide
Ipatroprium bromide
2005 EMT-Intermediate Curriculum Rollout
Airway Management and Airway Disease
In-Class Student Activities
Scenarios: for each scenario, perform the following:
1. Rate the severity of the person’s presenting condition using the “sick/not-sick” scale and circle the information from the scenario that justifies your decision.
2. Describe how you will manage the person’s airway and respiratory status in each situation (airway device, oxygen delivery, monitoring, further questions to ask). Write in specifics – i.e. “oxygen via NC at 4LPM” and specific drug doses.
3. Answer any follow-up questions that are listed.
4. Try to come up with at least 3-5 questions for focused history questions.
Scenario 1 – You respond to an asthma attack. You find a 15 year-old male on the baseball field at the high school.
List the signs and symptoms of a person in moderate respiratory distress.
List the signs and symptoms that would categorize a patient’s respiratory distress as critical.
Your patient is showing the following signs: RR of 34, leaning forward, awake but a little anxious. His skin is warm and clammy. His radial pulse is 118. You do not hear any audible sounds from the patient. You notice that he has purses his lips during exhalation and that his time for exhalation is extended.
Sick! (Critical) Moderate-Sick (Potential for Critical) Not-Sick
He is grasping onto an inhaler labeled, “Proventil.”
What is the generic name for Proventil?
What is the drug class for Proventil?
What does Proventil do?
What are the side effects for this drug?
His lung sounds reveal expiratory wheezing in the middle and lower lung fields.
Initial Treatments (first few minutes on scene):
What further questions/history should you ask before you leave the scene?
The new EMT-I scope of practice includes Atrovent as another choice for treating wheezes. How does this drug work differently from albuterol?
What is your “Plan B” if your treatments do not work and the patient’s condition remains the same? Be specific with your adjunct choices and delivery rates.
Scenario 2 – You respond to a seizure. Witnesses state that “Monica,” a 34 year-old female, had full-body convulsions for approximately 2-3 minutes.
Is a person able to breathe during a seizure?
What will happen to the patient’s oxygen and carbon dioxide levels when they seize for as long as Monica?
What should you expect with the rate and quality of her respirations when her seizure stops?
As you approach the patient, you find her on the floor, on her back, with her eyes closed. She has snoring, deep respirations at a rate of 12-14/minute. Her skin is pale and clammy. Her radial pulse is strong and rapid at 110.
How should you manage her airway and breathing at this point? How will these treatments change her oxygen and carbon dioxide levels?
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