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LESSON 7. VENTILATION DEVICES AND OXYGEN. Introduction. EMRs 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
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LESSON 7 VENTILATION DEVICES AND OXYGEN
Introduction • EMRsusually 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 and nasal airways help ensure air reaches patient’s lungs • Bag mask units for more effective ventilation • Supplemental oxygen
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
Suction Devices • Used to clear blood, vomit, other substances from patient’s airway • Suction equipment includes manual devices, powered devices, soft bulb syringes
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
Uses of Suction • Useful if airway is fully or partially obstructed • Most suction units inadequate for removing solid objects
General Principlesof Suctioning • If patient vomits during ventilation, or secretions or 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
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
Do Not Suction Longer Than • 15 seconds at a time for adults • 10 seconds at a time for children • 5 seconds at a time for infants
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 or secretions from mouth
Confirm suction device working and produces suction • Turn patient’s head to one side and open mouth
Reposition patient’s head with airway open and begin or resume ventilation if needed
Hold infant in position for suctioning • Head lower than body • Turned to one side
Gradually release bulb to create suction as you withdraw tip
Move bulb aside, squeeze it with tip down to empty • Repeat if necessary • Repeat suctioning steps for each nostril • Resume rescue breathing or CPR
Airway Adjuncts • Help keep patient’s airway open • Prevent obstruction by tongue more easily than head position alone • Supplemental oxygen can be given through mask or bag-valve-mask (BVM) with airway in place
Oral Airways • Use only with unresponsive patient without gag reflex • Can be breathing or not • Available in variety of sizes • Patient can be suctioned with airway in place
Sizing and Placement of Oral Airways • Proper placement is essential • Periodically reassess to confirm airway remains in proper position
Open patient’s airway with head tilt–chin lift or jaw thrust and open the mouth • Insert with tip pointing toward roof of mouth
When tip reaches back of mouth and you feel resistance, rotate airway 180 degrees
Oral Airway in 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 Alternate technique for inserting an oral airway in infants/children:
Nasal Airways • Use with responsive patient • Use with unresponsive patient with gag reflex • Use with unresponsive patient with mouth or jaw injuries or tightly clenched teeth
Nasal Airways (continued) • Do not use with significant facial injuries and significant head trauma • Less likely to cause gagging and vomiting than oral airways • Difficult to suction • Cause pain or significant bleeding in some patients
Insert straight down • Insert into right nostril with bevel toward septum
Insert straight back, sliding along floor of nostril • Insert until flange rests against nose
After Insertion of Nasal Airway • Continue to keep patient’s airway open with head tiltchin lift or jaw thrust • Suction through nasal airway with small flexible suction catheter if needed
Bag Mask Ventilation • Bag mask units are more effective for providing ventilations • Patient receives air from atmosphere (21% oxygen) rather than exhaled air (16% oxygen) • Can be used for ventilation performed alone or during CPR by 2 rescuers
Bag Mask Components oxygen reservoir bag self-inflating bag 1-way valve
Using the Bag Mask: Sealing Mask • Open airway and position mask on patient’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
Using the Bag Mask: Giving Ventilations • Rescue breaths delivered by squeezing bag • Squeeze one L bag about ½ to ⅔ of volume • Squeeze two L bag about ⅓ of volume • Squeeze bag over one second (watch patient’s chest rise)
Using the Bag Mask:Giving Ventilations (continued) • Give ventilation every 5-6 seconds in adult • Give ventilation every 3-5 seconds in child • Give ventilation every 3 seconds in infant • If supplemental oxygen, give smaller ventilations
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 problem occurs or you cannot get a good seal, use alternate technique
Bag Mask for Inadequate Breathing • If patient is responsive, explain what you will be doing • Initially assist patient’s breathing at the rate at which the patient has been breathing • Squeeze the bag each time the patient begins to inhale • Gradually adjust the rate and delivered volume of air as appropriate
Using the Bag Mask: Supplemental Oxygen • Use supplemental oxygen if possible • Attach oxygen reservoir bag to valve on bag and attach oxygen tubing to bag • Use device same way
BVM with Children and Infants • Use with a non-breathing infant or child the same as with an adult • Choose a mask of the correct size • Squeeze the bag only enough to make the chest rise
Rescuer 1:Assembles bag mask and positions it over patient’s mouth and nose • Rescuer 2: Seals mask over patient’s mouth and nose