Lecture 1/30

• Ambient air is 21% oxygen.
• ABC’s in medical terms stand for airway, breathing, circulation.
• Patient assessment is patient driven.
• Noncritical patients should be reassessed at least every 15 minutes, and more often if necessary.
• Delayed capillary refill is bad for children.
• A patent airway allows oxygen in and out of the lungs.
• A patient must be breathing adequately for life support.
• The pharynx, nasopharynx, oropharynx, larynx, trachea, bronchi, bronchioles, and alveoli make up the respiratory system.
• Pediatric airway considerations include a smaller airway structure.
• For infants, the head should be moved to a neutral position, the mouth and nose should be directly up at the ceiling, and the trachea is more anterior and more flexible than in adults.
• In infants and children, the muscles of breathing are weaker and, if in distress, the breathing rate increases, causing the intercostal muscles to overwork and tire out quickly.
• The muscles of breathing include the external intercostal and diaphragm.
• Oxygenated blood is pulled from the skin quickly, turning cyanotic, and comes away from the periphery.
• Factors affecting ventilation include maintaining a patent airway and intrinsic factors such as infections, allergic reactions, and unresponsive patients.
• Extrinsic factors affecting ventilation include trauma and foreign body airway obstruction.
• Edema is a condition where fluid builds up causing swelling.
• Select and attach the appropriate suction catheter to the tubing.
• Recognizing adequate breathing involves checking for proper rate, regular rhythm, clear & equal bilateral lung sounds, and adequate depth.
• Sizing OPAs is done by measuring from the corner of the mouth to the earlobe.
• French suction catheter is a bigger gauge, smaller.
• Use water soluble lubricants when inserting suction catheters.
• Supplemental Oxygen is indicated for hypoxic patients who are breathing adequately and should not be withheld from any patient who might benefit from it.
• Oropharyngeal airways (OPAs) are indicated for unresponsive patients and apneic patients being ventilated.
• Nasal Cannulas are more common and are used for lower concentration of oxygen needed or patient cannot tolerate nonrebreathing masks.
• Supplemental Oxygen safety considerations include handling gas cylinders carefully, making sure the correct pressure regulator is attached, securing cylinders, and tailoring oxygen therapy to maintain oxygen saturation at or above 92%.
• Inspect and test suction unit regularly to ensure proper assembly of its parts and vacuum pressure of at least 300 mm Hg.
• Suction on the way out.
• If using an airway adjunct, insert oral or nasal airway.
• Yankauer suction catheter can cause airway obstruction or patient vomits and causes obstruction.
• Sizing NPAs is done by measuring from the corner of the nose to the earlobe and holding against the nose to check the width.
• Disengage suction after moving catheter/suction tip away from patient’s mouth.
• Nonrebreathing Masks work when patient exhales, patient isnt breathing what they exhale, up to 90% oxygen.
• Never suction for longer than 15 seconds for adults, 10 seconds for children, 5 seconds for infants.
• Nasopharyngeal airways (NPAs) are indicated for patients unable to maintain their own airway and patients who will not tolerate an oropharyngeal airway.
• Recognizing airway compromise can be done by audible sounds such as snoring and stridor, and by checking the patient's alertness, ability to speak, and hoarse voice.
• Recognizing inadequate breathing involves checking for a rate outside normal range, irregular rhythm, diminished, absent, or noisy auscultated breath sounds, inadequate chest expansion, chest trauma, increased effort of breathing, and retractions.
• Only put suction catheter as far as you can see.
• Airway management involves opening the airway via manual technique or suctioning the airway.
• Hypoxic drive is a condition where patients whose oxygen drops will start to breathe more when they have chronic lung disease and sense a drop in O2, while normal people sense an increase in CO2.
• Gathering patient history in patient assessment includes signs and symptoms, allergies, medication, past medical history, last oral intake/last took meds/last time took drugs/alcohol, and events leading up to current problem.