Patient Assessment: Airway Evaluation

Dr Aqeela BanoEMS 352

Patient Assessment: Airway Evaluation

• Quality of care depends on assessment• Adequate breathing– Patient is responsive, alert, able to speak– Rate between 12 and 20 breaths/min– Adequate depth – Regular pattern of inhalation and exhalation– Clear and equal breath sounds– Tendency toward stability in the body– Requires balance between acids and bases

• Acid in the body can be expelled as carbon dioxide from the lungs.

Acid-Base Balance

• Acidosis can develop if respiratory function is inhibited.

• Alkalosis can develop if the respiratory rate is too high.– Respiratory acidosis/alkalosis– Metabolic acidosis/alkalosis

Recognizing Inadequate Breathing

• Breathing rate of less than 12 breaths/min or more than 20 breaths/min

• Cyanosis: indicator of low blood oxygen• Note the following:

– Position– Chest rise/fall– Flared nostrils – Pursed lips– Retractions– Use of accessory muscles– Quick breaths, long exhalation– Labored breathing

Recognizing Inadequate Breathing

• Airway management steps:– Open the airway.– Clear the airway.– Assess breathing.– Provide appropriate intervention(s).

• Evaluation includes:– Observe– Palpate– Auscultate

Inadequate Breathing

• Feel for air movement.• Observe chest for symmetry.• Note any paradoxical motion.• Assess for pulsus paradoxus.– Systolic blood pressure drops more than

10 mm Hg during inhalation.

Inadequate Breathing

• Ask about history of present illness– Onset, trigger, duration?– Other symptoms? – Interventions, previous hospitalization?– Medications and overall compliance?– Risk factors?

Protective Airway Reflexes

• Evaluate protective reflexes.– Coughing, sneezing,

gagging

Assessment of Breath Sounds

• Auscultate breath sounds with stethoscope.– Should be clear and equal

Assessment of Breath Sounds

Assessment of Breath Sounds

• Duration: length of time for inspiratory and expiratory phases– Normal I/E ratio: 1:2– Expiration is prolonged with lower airway

obstruction.– Expiration is short with tachypneic patients.

Assessment of Breath Sounds

• Pitch: higher or lower than normal (stridor or wheezing). – Intensity of sound depends on:• Airflow rate• Constancy of flow throughout inspiration• Patient position• Site selected for auscultation

Pulse Oximetry

• Pulse oximeter: measures oxygen saturation of hemoglobin (Hb)– Normal: SpO2 of greater than 95%

Pulse Oximetry

• Erroneous readings may result from:– Patient motion– Poor perfusion– Nail polish – Venous pulsations– Abnormal hemoglobin

Arterial Blood Gas Analysis

• Blood is analyzed for pH, PaO2, HCO3

−, base excess, and SaO2.– pH, HCO3

−: acid-base status

– PaCO2: effectiveness of ventilation

– PaO2 and SaO2: oxygenation

End-tidal Carbon Dioxide (ETCO2) Assessment

• Detects carbon dioxide in exhaled air – Adjunct for determining ventilation adequacy– Confirms advanced airway placement– ETCO2 detector types:• Digital• Waveform• Digital/waveform• Colorimetric

End-tidal Carbon Dioxide (ETCO2) Assessment

• Capnometer– Numeric reading of

exhaled CO2

• Capnographer– Graphic

representation of exhaled CO2

– Three types:• Waveform• Digital/waveform• Colorimetric

End-tidal Carbon Dioxide (ETCO2) Assessment

• Waveform capnography– Exhaled carbon dioxide level displayed as a graphic

waveform – Includes contour, baseline level, rate, and rise of

carbon dioxide level

End-tidal Carbon Dioxide (ETCO2) Assessment

• Waveform capnography (cont’d)

– Phase A–B: initial stage of exhalation

– Phase B–C: expiratory upslope

– Phase C–D: expiratory or alveolar plateau

– Phase D–E: inspiratory down stroke

End-tidal Carbon Dioxide (ETCO2) Assessment

• Capnography can:– Indicate

effectiveness of chest compressions

– Detect return of spontaneous circulation

• Use is limited with cardiac arrest

SUMMARY OF PATIENT ASSESSMENT

• Clinical examination of patient– Assessment of respiration rate rythym– Clinical signs of adequate respiration– Assessment of breath sounds

• Pulse oximetre• Acid base balance• end tidal CO2 assessment