NREMT EMT 4: Patient Treatment and Transport - Breathing and Ventilation Support, Assisted Ventilations, Supraglottic Airways for EMTs Where Allowed, Continuous Positive Airway Pressure, CPAP

What This Is: Breathing and Ventilation Support

Breathing and ventilation support is a critical skill for EMTs and bystanders to help people who are struggling to breathe or have stopped breathing. Imagine a firehose with a blocked nozzle – water can't flow, and the fire won't be put out. Similarly, if someone's airway is blocked, they can't get enough oxygen, and their body will shut down.

Key Steps / Core Facts:

• Assisted Ventilation (Bag-Valve-Mask): Provides oxygen to a person who is not breathing or is having trouble breathing. Use a mask with a one-way valve to prevent oxygen from escaping. (AVPU, SAMPLE)
  • Ratio: 10-12 breaths per minute
  • Red flag: No chest rise or fall
• Supraglottic Airways (SGAs): A tube that goes into the mouth and above the vocal cords to help a person breathe. Used when a person is having trouble breathing and can't get a regular airway in. (OPQRSTI)
  • Size: Choose the right size based on the person's age and weight
  • Red flag: No air leak or resistance
• Continuous Positive Airway Pressure (CPAP): A machine that blows air into a person's airway to keep it open and help them breathe. Used for people with severe respiratory distress.
  • Pressure: 5-10 cm H2O
  • Red flag: No improvement in breathing or oxygen levels
• Oxygen Therapy: Provides extra oxygen to a person who is not getting enough. Use a mask or nasal cannula to deliver oxygen.
  • Flow rate: 2-6 liters per minute
  • Red flag: No improvement in oxygen levels or breathing
• Chest Compressions: Pushes down on the chest to help a person's heart pump blood. Used during CPR.
  • Depth: At least 2 inches (like pushing down a soda can)
  • Rate: 100-120 compressions per minute
  • Red flag: No chest rise or fall
• Rescue Breaths: Gives a person a breath to help them breathe. Used during CPR.
  • Volume: 1-2 liters
  • Rate: 1 breath every 5-6 compressions
  • Red flag: No chest rise or fall
• Airway Obstruction: A blockage in the airway that prevents a person from breathing. Can be caused by food, vomit, or other objects.
  • Red flag: No air leak or resistance
• Spinal Injury: A serious injury to the spine that can cause paralysis or death. Can be caused by a fall, car accident, or other trauma.
  • Red flag: No movement or sensation in the legs or arms
• CPR Ratio: The number of chest compressions to rescue breaths. 30:2 for adults and 15:2 for children.
• CPR Time: The amount of time a person should do CPR before stopping. 2 minutes for adults and 1 minute for children.
• BLS (Basic Life Support) Algorithm: A step-by-step guide for providing CPR and other life-saving interventions.
• OPQRSTI: A mnemonic to remember the steps for assessing a person's condition (Onset, Provocation, Quality, Region, Severity, Time, Investigation)

What Laypeople Can Do:

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to see if they respond.
• If a person is having trouble breathing, help them sit up and lean forward to open their airway.
• If a person is not breathing, start CPR by calling 911 and pushing down on their chest 100-120 times per minute.
• If a person is choking, help them cough up the object by standing behind them and giving them five quick blows between the shoulder blades.

Common Mistakes:

• Mistake: Not checking for a spinal injury before moving a person.
  • Fix: Use a backboard and straps to immobilize the person's spine before moving them.
• Mistake: Not using a mask with a one-way valve for assisted ventilation.
  • Fix: Use a mask with a one-way valve to prevent oxygen from escaping and to help the person breathe.
• Mistake: Not checking for airway obstruction before giving a person oxygen.
  • Fix: Check for airway obstruction by feeling for a blockage in the person's airway before giving them oxygen.

Quick Practice Scenarios:

1. A person is having trouble breathing and can't get enough oxygen. What should you do first? Answer: Check for airway obstruction and give assisted ventilation. Reason: To help the person breathe and get enough oxygen.
2. A person collapses and you can't find a pulse. What should you do first? Answer: Start CPR by calling 911 and pushing down on their chest 100-120 times per minute. Reason: To help the person's heart pump blood and get oxygen to their brain.
3. A person is choking and can't cough up the object. What should you do first? Answer: Stand behind them and give them five quick blows between the shoulder blades. Reason: To help the person cough up the object and clear their airway.

Last-Minute Exam Cram:

• Normal oxygen saturation: 95-100%
• Normal respiratory rate: 12-20 breaths per minute
• Normal blood pressure: 90-140/60-90 mmHg
• Agonal breathing is NOT normal breathing – start CPR.
• A person with a spinal injury should be immobilized with a backboard and straps before moving them.
• A person with a severe respiratory distress should be given CPAP.
• A person with a severe allergic reaction should be given epinephrine.
• A person with a cardiac arrest should be given CPR for 2 minutes before stopping.