The Ins and Outs of Respiration: Five Things EMTs Should Always Remember

EMTs may not be able to perform the full range of advanced airway options that paramedics typically employ, but that doesn’t mean they aren’t responsible for recognizing a tenuous airway, performing a thorough assessment, and choosing the appropriate treatment strategy. All emergency responders must be capable of airway interventions, so today we’ll discuss the ins and outs of respiration and five things EMTs should always remember when dealing with respiratory emergencies.

The Basics of Respiration: A Quick Review

If it’s been a while since you’ve reviewed the fundamentals of respiration, here’s a brief overview of how the body takes in air, disperses it within the lungs, and circulates it throughout the body. The five main factors of respiration are:

• Ventilation: the process of moving air into and out of the lungs
• Distribution: delivering air into the lungs, so that gas exchange can take place
• Diffusion: the exchange of gases at the lung tissue
• Perfusion: diffusion of oxygen via the pulmonary vasculature
• Circulation: transportation of oxygen throughout the body

Airway interventions are called for when one or more of these processes are interrupted. For example, an airway obstruction prevents the patient from being ventilated, which prevents the rest of the respiratory process from taking place.

Recognize the Signs of Hypoxia!

You must always remain vigilant when it comes to recognizing a tenuous airway. Your primary goal is to maintain a patent airway, thus preventing your patient from becoming hypoxic. Signs of hypoxia include:

• Increased work of breathing—use of accessory muscles, nasal flaring, and retractions; belly-breathing in pediatric patients
• Restlessness/agitation—the patient is unable to sit still
• Mental confusion
• Bradycardia (especially prevalent in children)
• Abnormal breath sounds (gurgling, wheezing, stridor)
• Inadequate breath sounds—inability to move adequate air
• Coma
• Seizures

Perform a thorough assessment, recognize the signs, and be prepared to intervene. You don’t want to wait until the patient is in dire straits before assisting ventilations or securing an airway adjunct.

Look at your patient. You will be able to recognize a patient in distress. It may be harder with pediatric or geriatric patients, since children will appear guarded under normal conditions and the elderly may have altered mentation due to previous stroke or dementia. Talk to the family or caregiver to obtain a detailed history so you can recognize when a patient is acting abnormally.

Airway Interventions

So you’ve recognized the signs of an airway emergency, you’ve realized your patient needs immediate intervention, and now you must act to avoid respiratory arrest. Here are your basic airway options:

• Positioning—Place the patient in a position of comfort, being sure to secure the C-spine and immobilize in suspected trauma. Elevating or shoring up the backboard on its side will allow for the drainage of oral fluids, thereby protecting the airway in trauma patients. If the patient is unresponsive, position the airway using:
• Head tilt–chin lift
• Tongue-jaw lift
• Jaw thrust
• Airway Adjuncts
• OPA (oropharyngeal airway) if the patient does not have a gag reflex
• Combitube or LMA (laryngeal mask airway)
• Supplemental Oxygen—with a non-rebreather mask at 15 liters per minute
• Suction—one of your most effective tools for maintaining airway patency

Suction: A Critical Airway Tool

Out of all your airway intervention tools, your portable suction unit is one of the most vital. There is no replacement for suction, so be sure you bring it with you in any potential airway emergency. Or, better yet, stow it in your trauma bag so it’s always on hand.

Here are a few maintenance reminders for keeping your portable suction unit functional:

• Ensure batteries are charged
• Test your unit at the start of each shift
• Disinfect the unit after each use
• Discard ALL disposable parts—canister, tubing, and catheters
• Dispose of biohazards properly
• Use a mild detergent or a mixture of bleach and water (1 part bleach/10 parts water) to sanitize the unit
• Follow the instruction manual when it comes to disinfecting the mechanics of the unit
• Do not submerge your suction unit
• Always wear personal protective gear when handling contaminated equipment:
• Gloves
• Face and eye protection
• Gown, when appropriate

Knowing the ins and outs of respiration is your first step in recognizing a respiratory emergency. By understanding the fundamentals of oxygenation, you can better recognize the signs and symptoms of inadequacy. Stay alert, be ready to intervene, and always keep your portable suction unit at the ready to stave off your next respiratory emergency.