SLSA Advanced Resuscitation PUAEME003B Administer Oxygen In An Emergency Situation Chapter 23 – Advanced Resuscitation and Oxygen Administration

UNIT 23 – ADVANCED RESUSCITATION AND OXYGEN ADMINISTRATION

Advanced Resuscitation Why Use Oxygen? (pg162) The Components Of Oxygen Resuscitation Equipment (pg162) Administering Oxygen Therapy (pg164) Setting Up Oxygen Resuscitation Equipment (pg165) Equipment Maintenance (pg166) Administering Suction* (pg167) Automatic Oxygen-Powered Resuscitator* (pg167) Oropharyngeal Airways (pg168) *These 2 sections are NOT part of the SLSA Advanced Resuscitation Certificate. They can be trained and utilised by qualified personnel ONLY Page numbers refer to the SLSA First Aid & Emergency Care Manual

Prerequisites A candidate must be a minimum age of 15 years old on the date of final assessment, AND Hold the PUAEME001A ‘Provide Emergency Care’ Competency, found in the SLSA 32nd Edition Training Manual: Unit 3 – Anatomy and Physiology Unit 4 – Basic First Aid Unit 5 – First Aid Unit 6 –Resuscitation Unit 7 – Basic Oxygen Also from SLSA FAEC Manual Chapter 8 – Respiratory Emergencies

Why use Oxygen? Patients likely to benefit from oxygen include those with the following conditions: Unconsciousness Shock Blood loss Chest pain Shortness of breath, including asthma Circulatory distress Severe pain Injuries After resuscitation Absent breathing

Oxygen Safety Safety precautions when using oxygen: Never use oxygen near an open flame Never use oxygen near cigarettes Never use grease or oil with oxygen equipment Oxygen promotes combustion Do not tamper with oxygen equipment Store in a cool place Store oxygen bottles lying flat, or securely fastened if upright Use only medical oxygen Do not use when delivering a shock via a defibrillator

Components of Oxygen Resuscitation Equipment Protective case Medical oxygen cylinder Cylinder cradle Cylinder yoke Sealing washer Locating pins Thumb screw Cylinder key wheel External cylinder connection Contents gauge

Components of Oxygen Resuscitation Equipment Regulator OP airways Airbag Oxygen reservoir bag Tubing Control valves Anaesthetic masks Therapy masks Chalk Gloves Pens, pencils & paper Other equipment (optional): Automatic oxygen-powered resuscitator Suction

Components of Oxygen Resuscitation Equipment Routine check of equipment: ‘Crack’ cylinder to clean (if not attached) Check sealing washer Insert cylinder and locate Ensure thumb screw is firmly done up Check contents of cylinder Check tubing Check therapy and anaesthetic masks Check oropharyngeal airways Check for chalk, pens/pencils and paper, gloves, spare sealing washer

Components of Oxygen Resuscitation Equipment Routine check of equipment (cont’d): Check flow of oxygen Check there is no odour from oxygen Check operation of oxygen nipples Check airbag (5 checks) Close cylinder valve and drain oxygen from system Check additional equipment (eg Suction, etc) The SLSA Oxygen Equipment Policy is located on SLSA website at www.slsa.com.au

Components of Oxygen Resuscitation Equipment Checking Suction (optional): Remove large suction tubing and hold near open end Turn suction lever fully on Test for suction Turn lever off Remove catheter and fit to large tubing Test for suction again Return to case in original position

Components of Oxygen Resuscitation Equipment Automatic oxygen-powered resuscitator (optional): As per oxygen equipment plus: Block off powerhead/ demand valve outlet with 1 hand and trigger the device Check for valve release Check for blockages

Administering Oxygen Therapy Check oxygen before each use Place unit in appropriate position to operate Connect therapy mask to tubing and turn on oxygen Place mask on patient’s face Adjust accordingly Reassure the patient If a conscious patient does not want to use the mask, they can hold the mask in front of their face, or remove the tubing from it and direct the oxygen flow around the mouth and nose

Administering Oxygen Therapy Mouth-to-mask resuscitation with oxygen: Increases oxygen received by patient from 16%-50% Therapy setting (8L per minute) Oxygen in patient’s lungs almost 45% Resuscitation setting (14-15L per minute) Oxygen in patient’s lungs slightly greater (i.e. >50%) Can be one-operator operation, preferred that two operators are used

Administering Oxygen Therapy Airbag checks: Check airbags by blocking patient valve Check function of disc membrane on patient valve Check overflow of membrane of reservoir valve (Laerdal bag only) Check air-intake membrane (rear valve of airbag)

Administering Oxygen Therapy Airbag oxygen resuscitator: Will supply the patient with up to 95% oxygen with flow rate of 14-15L per minute Possible for mouth-to-mask resuscitation with oxygen using therapy tubing whilst oxygen unit is being set up

Setting Up Oxygen Resuscitation Equipment Inform others of who you are and your qualifications Set up and place unit in appropriate position to operate Anaesthetic mask to Airway operator If not already being used Quickly check: Operation of patient valve Valve to oxygen reservoir bag Connection to oxygen supply Turn on oxygen to 14-15L per minute to allow inflation of airbag reservoir

Setting Up Oxygen Resuscitation Equipment Procedure: Inform other operators airbag is ready Attach patient valve with no change to Rescue Breathing rate Airbag oxygen resuscitator compressed with 2 hands (for adult) using gentle squeezing motion Squeeze airbag until chest rises Bag released and allowed to refill The rise and fall of the patient’s chest should be watched at all times during this procedure by both Airway and oxygen airbag operators

Setting Up Oxygen Resuscitation Equipment Procedure (cont’d): Remove oxygen equipment if not operating properly and continue with Rescue Breathing Recommended that 3 operators be present for operation during CPR Paediatric airbag (if available) should be used for children Compressed with 1 hand Airbag resuscitators are not designed for infants, and therefore should NOT be used on infants Can use airbag without oxygen bottle Remove reservoir bag

Setting Up Oxygen Resuscitation Equipment Operational time: Full ‘C’ cylinder (440-490 L) 50 minutes on Oxygen Therapy setting (8L per minute) 30 minutes on Resuscitation setting (14-15L per minute)

Equipment Maintenance General care: Machine kept clean and free of sand/foreign materials Checked: After every teaching session Before use each day Removed from service immediately if default found Serviced at least every 12 months

Equipment Maintenance Care after use: Used oxygen therapy masks sent to hospital or disposed of Tube Anaesthetic masks Patient valve Rear valve Airbag Reservoir valve Oxygen reservoir Washed in warm soapy water for 2 minutes, then rinsed in fresh running water

Equipment Maintenance Care after use (cont’d): Contaminated parts: Soaked in 70% alcoholic chlorhexidine or hypochlorite solution For at least 2 minutes Rinsed and dried Operate all parts before storage to ensure they are operational After every use, the resuscitator should be disassembled, cleaned, disinfected, reassembled and tested in an orderly sequence

Equipment Maintenance Storage: In a cool place Spare oxygen bottles kept near equipment Away from busy areas, sand, dust Away from oil and grease DO NOT: Store in enclosed space Allow smoking or near naked flame Leave pressure in system Empty cylinders should be filled without delay: Half-full or less can be used for training

Administering Suction (Optional) Types of devices: Electric Foot pump Vacuum bottle Hand pump Oxygen-driven suction consumes considerable oxygen (20-40L/min) It is essential that you close the valve immediately after use

Administering Suction (Optional) Procedures: Suction ONLY used in: unconscious patient, or Semiconscious patient Wearing gloves: Attach suction catheter to suction tubing Measure appropriate distance Lubricate the catheter Can repeat several times but no longer than 15 seconds Prevents hypoxia developing Check area between teeth and cheek, and under tongue Where they can’t cough or swallow

Automatic Oxygen-Powered Resuscitator (Optional) Can ventilate a non-breathing patient with 100% oxygen Warning Increased risk of distension Increased risk of over-inflation of lungs Increased risk of damage to middle ear Equipment only used by competent regular users

Automatic Oxygen-Powered Resuscitator (Optional) Procedure: Oxygen supply ON Control lever ON (if necessary) Adjust tidal flow and/or frequency (if necessary) Clear airway Open airway using head tilt/jaw support Insert oropharyngeal airway (if qualified)

Automatic Oxygen-Powered Resuscitator (Optional) Procedure (cont’d): Place mask on face and hold in position Ensure adequate tidal volume delivered For breathing patient Adjust control lever (equivalent)

Oropharyngeal Airways Help keep airway clear in unconscious patient Does not replace correct airway management practices Inserted using ‘rotation’ method: This method NOT recommended for infants, or children under 8 years old Comes in various sizes First Aiders must avoid direct contact with blood and other body substances Strongly recommended to wear gloves and use a resuscitation mask

Oropharyngeal Airways Care of OP airways: Stored in a sterile state Easily accessible in: First aid kit Oxygen unit First aid rooms Should be checked for deformities If used for training purposes: Mark with ‘Training Use Only’ Washed after use in warm soapy water for 2 minutes minimum OP airway appropriately disposed of after use on patient

Oropharyngeal Airways Choosing the appropriate-sized OP Airway Sizing: Flange just past centre of patient’s lips Curve run along patient’s jaw Correct size = reaches angle of patient’s jaw

Oropharyngeal Airways When to insert an OP airway: Use is optional <15 seconds to size and insert Inserted into: Unconscious patient in lateral position after airway cleared, or During Rescue Breathing/CPR while patient on their back after stopping Rescue Breathing/CPR briefly The OP airway should NOT be inserted during delivery of chest compressions

Oropharyngeal Airways Inserting of an OP airway into: Unconscious breathing patient = lateral position Non-breathing patient = lateral position or back OP airways must be inserted ONLY into deeply unconscious or non-breathing patients

Oropharyngeal Airways Inserting an OP airway: Open patient’s airway Ensure clear airway Choose appropriate sized airway Lubricate airway Insert OP airway using ‘rotation’ method Should slip easily into place Precautions when inserting an OP Airway Ensure lower lip is not pinched Ensure OP airway does not push tongue backwards and block airway Ensure adequate head tilt before inserting OP airway Don’t force the OP airway

Oropharyngeal Airways Removing the OP airway: Remove immediately if signs of rejection of OP airway Remove by: Sliding it out following its natural curve Do not attempt to rotate airway on removal IMPORTANT OP airways should not be used: If patient is conscious or semiconscious If correct size airway is not available If there is a large amount of vomit

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