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Introduction. First Responders usually provide care for airway and breathing without specialized equipment or supplies Adjunctive devices can enhance effectiveness of resuscitation:Suction devices help keep patient's airway clearOral/nasal airways help ensure air reaches patient's lungsBag mask units for more effective ventilation Supplemental oxygen.
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1. Ventilation Devices and Oxygen Lesson 8
2. Introduction First Responders usually provide care for airway and breathing without specialized equipment or supplies
Adjunctive devices can enhance effectiveness of resuscitation:
Suction devices help keep patient’s airway clear
Oral/nasal airways help ensure air reaches patient’s lungs
Bag mask units for more effective ventilation
Supplemental oxygen
3. Introduction continued Resuscitation adjuncts used depend on training and job
Devices may not always be available
Be able to ventilate without special equipment
Never delay care while waiting for adjunctive equipment
4. Suction Devices Used to clear blood, vomit, other substances from victim’s airway
Be familiar with equipment you may use
5. Using Suction Devices Clear plastic tip is inserted into mouth or nostrils
Suction tips vary from small, soft plastic tips, to larger, more rigid tips
Some devices have suction control port at base of tip
Be familiar with specific equipment you may use
6. Uses of Suction Useful if airway is fully or partially obstructed
Most suction units inadequate for removing solid objects
7. General Principles of Suctioning If patient vomits during ventilation, or secretions/blood impede ventilation, stop and quickly suction before continuing resuscitation
Airway usually needs suctioning if you hear gurgling sounds during breathing or ventilation
Turn patient’s head to side to help drain vomit or fluids before suctioning
If patient may have spinal injury, turn head and body inline as a unit with help of other responders
8. Suction: Safety Precautions Prolonged contact with mucous membranes can cause bruising, swelling, bleeding
Never insert suction tip further than you can see
Vigorous suctioning may stimulate gag reflex
Do not suction infant too deeply and suction mouth before nose
Use standard precautions
9. Suction in an Infant Watch for a decreased heart rate
If pulse is slow, stop suctioning and provide ventilation
Don’t suction too deep in an infant
Always suction infant’s mouth before nostrils
Suctioning nose may stimulate infant to inhale fluid/secretions from mouth
10. Skill: Suctioning (Adult or Child)
11. Skill: Suctioning Confirm suction device working and produces suction
Turn victim’s head to one side and open mouth
12. Sweep out solids and larger amounts of fluid with finger.
13. Determine maximum depth of insertion.
14. Turn on or create suction.
15. Insert catheter tip into mouth, move tip as you withdraw it.
16. Suctioning After suctioning, reposition the victim’s head with airway open
Resume rescue breathing or CPR
17. Skill: Suctioning (Infant)
18. Hold infant in position for suctioning
Head lower than body
Turned to one side
19. Squeeze suction bulb and insert tip into infant’s mouth.
20. Gradually release bulb to create suction as you withdraw tip.
21. Move bulb aside, squeeze it with tip down to empty
Repeat if necessary
Repeat suctioning steps for each nostril
Resume rescue breathing or CPR
22. Airway Adjuncts Help keep victim’s airway open
Prevent obstruction by tongue more easily than head position alone
Supplemental oxygen can be given through mask or BVM with airway in place
23. Oral Airways Use only with unresponsive victim without gag reflex
Can be breathing or not
Available in variety of sizes
Victim can be suctioned with airway in place
24. Sizing and Placement of Oral Airways Proper placement is essential
Periodically reassess to confirm airway remains in proper position
25. Skill: Oral Airway
Insertion
26. Choose correct size.
27. Insert with tip pointing toward roof of mouth.
28. When tip reaches back of mouth and you feel resistance, rotate airway 180 degrees.
29. Continue to insert until flange rests on lips.
30. Oral Airway in Children Alternate technique for inserting an oral airway in infants/children:
Select proper size
Measure from corner of patient’s lips to bottom of earlobe or angle of jaw
Open patient’s mouth
Use a tongue blade to press tongue down and out of way
Insert airway in the upright (anatomic) position
31. Nasal Airways Use with responsive victim
Use with unresponsive victim with gag reflex
Use with unresponsive victim with mouth or jaw injuries or tightly clenched teeth
32. Nasal Airways Less likely to cause gagging and vomiting than oral airways
Difficult to suction
If needed, suction using small flexible suction catheter
33. Skill: Nasal Airway
Insertion
34. Choose correct size.
35. Lubricate airway.
36. Insert into right nostril with bevel toward septum.
37. Insert straight back, sliding along floor of nostril. Insert until flange rests against nose.
38. After Insertion of Nasal Airway Continue to keep patient’s airway open with head tilt–chin lift or jaw thrust
Suction through nasal airway with small flexible suction catheter if needed
39. Bag Mask Ventilation Bag mask units are more effective for providing ventilations
Victim receives air from atmosphere (21% oxygen) rather than exhaled air (16% oxygen)
40. Components of BVM Unit
41. Using BVM: Sealing Mask Open airway and position mask on victim’s face
If alone, hold mask in one hand and squeeze bag with other
Use C-clamp technique
If there is a second rescuer, hold mask with both hands
42. Using BVM: Giving Ventilations Rescue breaths delivered by squeezing bag
Squeeze 1 L bag about ½ to ? of volume
Squeeze 2 L bag about ? of volume
Squeeze bag over 1 second (watch victim’s chest rise)
43. Using BVM: Giving Ventilations continued Give ventilation every 5-6 seconds in adult
Give ventilation every 3-5 seconds in infant or child
If supplemental oxygen, give smaller ventilations
44. Monitor Bag Mask Ventilations Do not over-ventilate patient
Watch for rise and fall of patient’s chest
Feel for resistance when squeezing bag
If air escapes around mask, reposition mask and fingers
If problems occur, use alternate technique
45. Using BVM: Supplemental Oxygen Use supplemental oxygen with BVM if possible
Attach oxygen reservoir bag to valve on bag and oxygen tubing
Use device same way
46. Using BVM: Mask and Bag Size Choose correct size mask for victim
Use right size bag
500 mL for newborns
750 mL for infants/small children
1200 mL for large children/adolescents
1600 mL for adults
47. Skill: BVM: Rescue Breathing
48. Assemble BVM and position and seal mask over victim’s mouth
49. Squeeze bag to provide ventilations
Recheck pulse about every 2 minutes
If no signs of circulation, call for AED and start CPR
50. Supplemental Oxygen Can supply up to 100% oxygen
Should be used along with other BLS techniques
Victims with serious medical conditions will benefit
51. Supplemental Oxygen: Equipment Pressurized cylinder
Pressure regulator
Flowmeter
Oxygen tubing
Oxygen delivery device
52. Safety Around Oxygen No smoking or open flame near oxygen source
Never use grease, oil, or adhesive tape on equipment
Never expose oxygen cylinder to temperature over 120°F
Never drop cylinder or let fall against another object
Never use non-oxygen regulator on oxygen cylinder
53. Oxygen Delivery Devices
54. Oxygen Delivery Devices Nasal Cannula
Resuscitation mask
Nonrebreathing mask
Bag-mask
55. Nasal Cannula Use with breathing victims who do not require high concentration of oxygen
Oxygen concentration depends on flow rate
1 to 6 LPM delivers 24% to 50% O2
56. Resuscitation Mask Use for nonbreathing victims
Some have oxygen port
Provides 30% to 60% oxygen with flow rate of 10 LPM
57. Nonrebreathing Mask Use with breathing victim
80% to 95% oxygen with flow at minimum of 8 LPM
Adjust flow rate to keep reservoir from collapsing completely when victim inhales
58. Bag-Mask Units Delivers oxygen through tube or reservoir
Up to 100% oxygen
Can also use with breathing victim
59. Oxygen Administration If you are alone with patient do not stop providing BLS to set up oxygen equipment
Wait until patient is more stable or until another rescuer can help
Once oxygen set up, continue to monitor oxygen flow rate, tank pressure, and victim’s condition
60. Skill: Oxygen Administration
61. Check equipment.
62. Remove any protective seal. Point cylinder away. Open main valve for 1 second.
63. Remove any protective seals and attach regulator.
64. Open main cylinder valve.
65. Check pressure regulator gauge.
66. Attach oxygen tubing to flowmeter and oxygen delivery device.
67. Set flowmeter at correct rate:
1 – 6 LPM for nasal cannula
10 LPM for face mask
10 -15 LPM for BVM or nonrebreathing mask
68. Confirm oxygen is flowing.
Position delivery device on victim.
Monitor pressure gauge.