National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Chapter 9

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 9.1 List the major anatomical structures of the upper airway. 9.2 Describe and demonstrate how to manually open the airway or mouth using the following techniques: a.Head-tilt, chin-lift b.Jaw thrust c.Crossed finger

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 9.3 Describe how to clear a patient’s airway using the following methods: a.Gravity b.Finger sweep c.Suction 9.4 Describe how to place a patient into the recovery position. 9.5 Compare, contrast, and demonstrate the usage of a rigid suction catheter and a flexible suction catheter.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 9.6 List the indications of and uses for the following airway adjuncts, and demonstrate the proper methods for choosing the correct size and inserting them: a.Oropharyngeal airway b.Nasopharyngeal airway 9.7 Describe how to calculate the oxygen flow duration rate.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 9.8 Describe and demonstrate how to properly set up an oxygen tank for use. 9.9 List four tips for the safe use of oxygen Describe and demonstrate how to use the following oxygen delivery, ventilation, and barrier devices: a.Nasal cannula b.Nonrebreather mask c.Pocket mask d.Bag-valve mask e.Face shield

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Airway Anatomy and Physiology Airway Management Oxygen Therapy Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are called to the scene of an accident where you find a middle-aged ice climber; he is unresponsive to painful stimuli and has shallow respirations. He reportedly fell approximately 20 feet, striking his head and neck on a rocky outcrop. You note minor bleeding from his mouth as well as a deep cut on his chin. His pulse is rapid at 108/minute. His head and neck appear "crooked" and his left arm appears bent at an unnatural angle.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Upper Airway ◦ Mouth and nose to the larynx Lower Airway ◦ Trachea, bronchi, and alveoli continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Physically ensure that the airway is open and clear. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Head –Tilt, Chin Lift Maneuver continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Jaw-Thrust Maneuver continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Crossed-finger Method continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Clearing the Airway ◦ Gravity ◦ Finger Sweep ◦ Suction continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Principles of Suctioning ◦ Pre-oxygenate the patient ◦ Look in the nose/mouth to locate the fluid or object ◦ Insert the tip of the catheter (without suction) Do not insert the catheter farther than you can see Initially, leave the catheter hole on the handle uncovered continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Principles of Suctioning ◦ Turn on suction or cover the hole on the handle ◦ Suction for no more than seconds No more than 5-10 seconds in a child ◦ Repeat as indicated continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Recovery Position ◦ Also called High Arm In Endangered Spine (HAINES) or coma or left lateral recumbent position ◦ May be used for conscious or unresponsive patients. ◦ Especially helpful when there is only one rescuer. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Airway adjuncts ◦ Nasopharyngeal Airway (NPA) SSize LLubricate IInsert CCheck continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Airway adjuncts ◦ Oropharyngeal Airway (OPA) SSize IInsert CCheck continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management What commonly blocks the airway? Which airway maneuver would you use with the fallen ice climber? How long should you apply suction? How far should you insert the suction catheter?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You immediately perform a jaw-thrust maneuver to open the unresponsive patient’s airway. With an assistant protecting the spine, you carefully roll the patient onto his side to allow blood to flow out of his airway. You perform a finger sweep to remove several broken teeth. Upon arrival of a suction unit, you suction out the airway. Although the patient’s pulse is strong, his respirations are becoming increasingly shallow and erratic. His lips are cyanotic.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Barrier devices ◦ Face shields

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management Barrier devices ◦ Pocket masks

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Airway Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Possible Indications ◦ Short of breath ◦ Cardiac or respiratory arrest ◦ Cardiac chest pain ◦ Stroke ◦ Signs and symptoms of shock ◦ Decreased LOR ◦ Head injury ◦ Fractures long bone continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Oxygen Cylinders continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Set-Up ◦ Inspect the cylinder and regulator ◦ Momentarily “crack” the value ◦ Attach the regulator Align the two smaller pins. Finger-tighten the regulator. Set the flow rate to zero. ◦ Open the oxygen valve continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Safety ◦ Never use near a spark or open flame ◦ No smoking when oxygen is in use ◦ Keep petroleum materials away ◦ Turn off cylinder when not in use ◦ Protect the valve stem from damage ◦ Leave protective caps in place ◦ Clear stem before attaching regulator ◦ Do not over tighten regulator continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Delivery Adjuncts ◦ Nasal Cannula Low flow adjunct (1-6 LPM). Prongs concave downward. Delivers 24%-44% oxygen. Well tolerated by patients. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Delivery Adjuncts ◦ Non-Rebreather Mask High flow adjunct (10-15 LPM). Delivers 80%-90% oxygen. May cause patient anxiety. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Delivery Adjuncts ◦ Bag-Valve Mask (BVM) Patients who are not breathing or who need assisted breathing. Ambient air or supplemented with oxygen. High flow oxygen (12-15 LPM). Delivers 80%-100% oxygen. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Bag-Valve Mask (BVM) ◦ Two-Person Technique continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Bag-Valve Mask (BVM) ◦ One-Person Technique continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Pulse Oximetry ◦ Measures oxygen saturation in blood ◦ Typically 95% or higher continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Oxygen Therapy Gastric distention: ◦ Caused by stomach filling with air ◦ More common with children ◦ May result in vomiting or aspiration of gastric contents into the lungs ◦ Prevented by reducing ventilatory pressure (gentle breaths over two seconds)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You insert an OPA and begin providing artificial respirations using a pocket mask. As other providers arrive, you request that another OEC technician assist you in two-rescuer ventilation using a BVM and suction the patient as needed. You assist in immobilizing the patient and placing him onto a toboggan. He is then transported to a waiting ambulance.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Airway management is a skill that every OEC Technician must master. PRACTICE OFTEN! The head-tilt chin-lift method is the preferred technique for medical patients; the jaw thrust must be used for trauma patients with a head or neck injury and may be used on medical patients. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The recovery position can help keep a patient’s airway clear in a patient who does not have a gag reflex. NPA insertion is easy when you use “SLIC.” An OPA should be inserted only in a patient who does not have a gag reflex. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Use a barrier device to provide rescue breaths until the arrival of a bag-valve mask and oxygen. A nasal cannula can deliver 24–44 percent oxygen at 1–6 LPM. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary A nonrebreather mask can deliver 80–90 percent oxygen at 10–15 LPM. A BVM can deliver 80–100 percent oxygen at 12–15 LPM. Continually monitor the airway.