Component 3: Airway Management Techniques and Tools for NREMT® EMT

Differentiate visceral pleura and parietal pleura.

Visceral pleura covers the surface of the lungs.
Parietal pleura lines the inner surface of the chest wall, diaphragm, and mediastinum.

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What is the fluid between the two pleura membranes called?

Pleural fluid

Pulmonary surfactant is inside the alveoli to reduce surface tension; pleural fluid is between pleural layers to reduce friction.

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What nerve stimulates the diaphragm muscle to contract?

phrenic nerve

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Where is the heart located in the thoracic cavity?

mediastinum

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Define:

ventilation

It is the physical action of moving air in and out of the lungs.

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Define:

oxygenation

It is the loading of oxygen molecules onboard the hemoglobin in the bloodstream.

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Define:

respiration

It is the exchange of oxygen and carbon dioxide in the capillaries on the alveoli and other tissues of the body.

(O₂), (CO₂)

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What are the two actions of ventilation?

inhalation and exhalation

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Why is it important to create or secure a patent airway for a patient without a gag reflex?

A patient with no gag reflex cannot maintain a patent airway. We must provide a patent airway for oxygenation and possible positive pressure ventilation if needed.

(PPV)

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True or False:

There is no difference between internal and external respiration.

False

External respiration is gas exchange between alveoli and pulmonary capillaries.

Internal respiration occurs between systemic capillaries and tissue cells.

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What is the term for all of the chemical processes used by cells to sustain life in the absence of oxygen?

anaerobic metabolism

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Fill in the blank.

The ________ is the most common airway obstruction.

tongue

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True or False:

If the patient has a suspected spinal injury, it is appropriate to use a jaw-thrust maneuver.

True

The head-tilt, chin-lift maneuver may complicate any underlying injuries to the cervical spine.

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Describe:

adequate breathing

a normal respiratory rate (12 to 20 breaths/min)
a regular pattern of inhalation and exhalation
lung sounds will be clear and equal bilateral
equal chest rise and volume

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A patient is unconscious, unresponsive, and has snoring respirations at 5 breaths/min. What are the steps for airway and ventilation management?

Suspect airway obstruction due to tongue and snoring respirations.
If spinal trauma is suspected, open the airway with a jaw-thrust maneuver while maintaining manual cervical spine precautions.
If no spinal injury is suspected, use a head-tilt/chin-lift maneuver.
Suction the airway as needed to clear secretions.
Measure and insert an oropharyngeal airway (OPA) if the patient has no gag reflex.
Attach a bag-valve-mask (BVM) with supplemental oxygen at 15 L/min.
Provide positive pressure ventilations at 1 breath every 5–6 seconds, watching for adequate chest rise.

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Describe:

agonal gasps and/or breathing

It is described as intermittent and inadequate gasps.

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List the muscles used when the patient is demonstrating labored or difficulty breathing.

Dyspnea

Sternocleidomastoid
Pectoralis major
Intercostals
Abdominal

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What is the breathing pattern called that has irregular pattern(s) with periods of apnea?

Cheyne-Stokes

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List the causes of inaccurate pulse oximetry readings.

nail polish
carbon monoxide poisoning
severe distal vasoconstriction (chronic hypoxia, smoking, hypothermia)
hypovolemia
dirty fingers/nail beds

Can you think of any more?

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Describe:

capnography

It measures end-tidal carbon dioxide and provides a numerical reading and graph of CO₂ in the patient’s respirations.

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What is the normal capnography mm Hg reading range?

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35 to 45 mm Hg

List the types of airway obstruction(s).

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relaxed tongue
foreign bodies (food, objects, dentures)
swelling of the airway tissues
trauma
emesis/vomiting

Can you think of any more?

What is the concern if we insert the suction catheter too far into the semi-conscious patient’s oropharynx?

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stimulation or triggering of the patient’s gag reflex
inducing vomiting

When is inserting an oropharyngeal indicated?

(OPA)

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In unresponsive patients (breathing or apneic) when their gag reflex is no longer intact.

# True or False: When measuring the appropriate size of an **oropharyngeal airway** for placement, we measure from the corner of the mouth to the tip of the earlobe.

True

# Describe: The measurement of a **nasopharyngeal airway**. | NPA

An NPA should be measured from the **tip of the patient's nose** to the **tip of their earlobe.**

When providing **positive pressure ventilation**, you notice the patient's dentures have come loose. Should you **continue to ventilate** or **remove the dentures** and then continue to ventilate? | PPV

**Remove the dentures** to prevent them from becoming an airway obstruction.

What type of **lubricant** is used when preparing a **nasopharyngeal airway** for insertion?

water-soluble lubricant

# True or False: The **BVM** should be hooked up to **15 LPMs** of oxygen (O₂).

True

Upon inhalation, does the **diaphragm** contract or relax?

When inhaling, the diaphragm will **contract** to pull downward, **drawing air inward.**

# True or False: When applying a **Non-Rebreather Mask**, the mask should be prefilled with no less than **10 L/min**.

True ## Footnote The non-rebreather mask should be set to 10–15 L/min to ensure the reservoir bag stays inflated.

What is the **benefit** of cracking the valve on the oxygen (O₂) tank prior to assembling the regulator/gauge?

To **blow out any lint or debris** that may obstruct the flow of oxygen (O₂) through the regulator. ## Footnote For safety, when clearing the valve, point the opening away from anyone, including yourself.

What is the **oxygen (O₂) flow rate** for a nasal cannula?

between **1 and 6 L/min**

List oxygen-delivery **devices**

* nasal cannula * non-rebreather mask * BVM with reservoir * mouth to mask * venturi mask

What does the presence of **cyanosis** indicate?

It indicates that the patient is suffering from **poor circulation and/or poor oxygenation.**

What does it mean if the patient is **apneic**?

It refers to the **absence of breathing**, meaning the patient is **not breathing**.

# Define: In reference to airway management, define **aspiration**.

It is vomitus, liquids, blood, or other foreign substances **entering the lungs**.

How much **supplemental oxygen (O₂)** is administered when using a **non-rebreather mask**?

Up to **90%** O₂ on inspiration.

How do we **prefill the reservoir bag** before we apply the mask to the patient?

**Place a gloved finger over the one-way valve** of the non-rebreather mask, and prefill the reservoir bag.

What is the **point** where the left and right mainstem bronchi **bifurcate**?

They bifurcate at the **carina**.

You are providing **positive pressure ventilation** (PPV) with a **bag-valve-mask** and are not getting any chest rise. What should you do? | BVM

We should **re-adjust and re-evaluate the airway** because there is non-compliance with PPV.

List **contraindications** for the application of Continuous Positive Airway Pressure. | CPAP

* The patient is apneic. * Signs and/or symptoms of chest trauma or a pneumothorax. * The patient is actively vomiting. * The patient cannot follow commands. * A patient with a tracheostomy.

If we are providing positive pressure ventilation (PPV) too aggressively with **too much oxygen** (O₂), what will most likely **develop**, and what is the **concern**?

Excessive volume or force during PPV can cause **gastric distention**, increasing the risk of **vomiting** and **aspiration**. ## Footnote Use proper rate (1 breath over 1 second) and volume to reduce the risk of stomach inflation and airway compromise.

# Describe: Describe how to perform a **jaw-thrust** maneuver.

With a supine patient: * Place the head in the **in-line position**. * Place your fingers **behind** the angle of the jaw and lift, or **pull up with your fingers**. ## Footnote This technique will pull a relaxed tongue off the back of the pharynx.

What is the **amount of air** (in mLs) that we move in and out in one breath called?

tidal volume

When inserting a **nasopharyngeal airway** (NPA), where should the **bevel** be?

It should be placed **against the nasal septum** whether **right or left** nare insertion.

# True or False: The nasopharyngeal airway (NPA) will **hold the tongue** of the posterior aspect of the throat.

False ## Footnote NPAs provide a nasal pathway but do not displace the tongue. Only OPAs are designed to move the tongue forward. NPA does not hold the tongue away from the airway; it only bypasses obstructions in nasal passages.

What **anatomy** separates the upper from the lower **airways**?

The **larynx** separates the upper and lower airways, and is protected by the **cricothyroid cartilage**.

# True or False: Oxygen (O₂) is a **prescribed** medication.

True

When providing **rescue breaths** for an adult, how often do we provide **ventilation**?

**One breath** (over one second) every **five to six** seconds.

# True or False: When placing a **nasal cannula** on a patient, it is best to have the **oxygen flow meter set**.

False ## Footnote Make certain the flow meter is off, apply the cannula, and then set the flow between 1 and 6 L/min.

What is the easiest way to quickly master your knowledge of airway management, respiration, and ventilation for **paramedic training**?

Brainscape's [EMT-P (1) Airway, Respiration, and Ventilation](https://www.brainscape.com/learn/nremt-paramedic?utm_source=crosslink&utm_medium=in-app&utm_campaign=in-app) Flashcards

Component 3: Airway Management Techniques and Tools Flashcards

This deck is a review of airway management tools and techniques. (52 cards)