Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Airway Management and Ventilation Team Work Chapter 6

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Positive Pressure Ventilation Oxygen Delivery Advanced Airway Assist Positive Pressure Ventilation Oxygen Delivery Advanced Airway Assist

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bag-Valve-Mask (BVM)

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bag-Valve-Mask (BVM) Available in infant, child, and adult sizes Provides less volume than mouth-to-mask Airtight seal is difficult to maintain with 1 rescuer Chest should rise and fall with ventilations Too much volume will cause gastric inflation Available in infant, child, and adult sizes Provides less volume than mouth-to-mask Airtight seal is difficult to maintain with 1 rescuer Chest should rise and fall with ventilations Too much volume will cause gastric inflation

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. BVM One FR opens airway and inserts OPA After an airtight seal is obtained, second FR squeezes bag to deliver ventilations One FR opens airway and inserts OPA After an airtight seal is obtained, second FR squeezes bag to deliver ventilations Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Cricoid Pressure Prevents gastric inflation and regurgitation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Cricoid Pressure Prevents gastric inflation and regurgitation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

O 2 Cylinders Tank is green Produced in several sizes Contents high in pressure Pressure changes with temperature Must be handled carefully and secured properly during transport Pressure of full cylinder is approximately 2000 psi Tank is green Produced in several sizes Contents high in pressure Pressure changes with temperature Must be handled carefully and secured properly during transport Pressure of full cylinder is approximately 2000 psi

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Regulator and Flowmeter

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Turning on Oxygen Tank Break the seal Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Be careful not to lose O-ring inside plastic tab Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Make sure the O-ring is placed between the regulator and tank properly Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Hand-tighten the regulator onto the tank Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank “Crack” tank - rotate stem quarter turn counter- clockwise Check for leaks - listen for “hiss” of air escaping “Crack” tank - rotate stem quarter turn counter- clockwise Check for leaks - listen for “hiss” of air escaping Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Check volume of tank by reading gauge on regulator Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Attach oxygen mask tubing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Turning on Oxygen Tank Use flow valve, turn regulator to desired flow rate Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nonrebreather Mask Best method of providing high- concentration O 2 to breathing patient Delivers 90–100% O 2 Best method of providing high- concentration O 2 to breathing patient Delivers 90–100% O 2 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nonrebreather Mask Bag should be inflated prior to placing on patient Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nonrebreather Mask Flow rate is 10 to 15 lpm Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nonrebreather Mask Application Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nasal Cannula Two prongs inserted into nares Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nasal Cannula Maximum flow rate 5–6 lpm Delivers 24– 40% O 2 Maximum flow rate 5–6 lpm Delivers 24– 40% O 2 Should NEVER be used on patient in respiratory distress Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nasal Cannula Application Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Advanced Airway Assist

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Role of First Responder Airway management is a team skill. First Responders have an integral role in airway and ventilation.

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Endotracheal Intubation Tube is inserted into the trachea through the mouth or nose Performed for complete airway control Cuff is inflated to prevent aspiration around the tube Minimizes aspiration and gastric inflation Improves oxygenation Allows for suctioning of the lower airway Tube is inserted into the trachea through the mouth or nose Performed for complete airway control Cuff is inflated to prevent aspiration around the tube Minimizes aspiration and gastric inflation Improves oxygenation Allows for suctioning of the lower airway

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. ET Intubation Equipment Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Endotracheal Intubation — Equipment Needed

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. ET Intubation Preparation Endotracheal Tube Stylet Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Preparation Syringe attaches to tube here Stylet is inserted here Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Preparation Two-person bag- valve-mask ventilation is an effective pre- oxygenation technique to increase the oxygen content in the lungs before intubation. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Assist You can assist with intubation by: Preparing suction You can assist with intubation by: Preparing suction Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Assist You can assist with intubation by: Performing cricoid pressure You can assist with intubation by: Performing cricoid pressure Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Assist You can assist with intubation by: Maintaining inline stabilization of head and neck You can assist with intubation by: Maintaining inline stabilization of head and neck Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

ET Intubation Assist You can assist with intubation by: Preparing to attach the BVM Preparing to secure the tube You can assist with intubation by: Preparing to attach the BVM Preparing to secure the tube Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Dual Lumen Airway

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A First Responder can perform or assist with: –Bag-valve-mask ventilation –Oxygen administration –Placement of advanced airways A First Responder can perform or assist with: –Bag-valve-mask ventilation –Oxygen administration –Placement of advanced airways Summary

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The management of airway and breathing are the foundation of patient care!