ADVANCED CONCEPTS IN EMERGENCY CARE (EMS 483) RESPIRATORY ARREST ADVANCED CONCEPTS IN EMERGENCY CARE (EMS 483) Lalith Sivanathan 2015

Outline BLS Airway Breathing Circulation Basic airway skills Assessment and management Breathing Circulation Basic airway skills Airway adjuncts Suctioning Ventilation using advanced airway devices

BASIC LIFE SUPPORT Check responsiveness – Tap and shout , “Are you alright?” Check for absent or abnormal breathing (no breathing or only gasping) by looking at or scanning the chest for movement (about 5 to 10 secs) Activate emergency response system/ get AED

Circulation Check carotid pulse for 5 to 10 seconds If no pulse, start CPR (30:2) beginning with chest compressions Compress the centre of the chest (lower half of the sternum) hard and fast with at least 100 compressions per minute at a depth of at least 2 inches Allow complete recoil after each compressions per minute at the depth of 2 inches Allow complete chest recoil after each compression

Minimize interruptions in compressions (10 sec or less) Switch providers about every 2 minutes to avoid fatigue Avoid excessive ventilation If there is pulse, start rescue breathing at 1 breath every 5 to 6 seconds (10 to 12 breaths per minute). Check pulse about every 2 mins

Defibrillation If no pulse, check for a shockable rhythm with an AED/defibrillator as soon as indicated Follow each shock immediately with CPR, beginning with compressions

Ventilation rates AIRWAY DEVICE VENTILATIONS DURING CARDIAC ARREST VENTILATIONS DURING RESPIRATORY ARREST BAG MASK 2 Ventilations after every 30 compressions 1 ventilation every 5 to 6 seconds (10 to 12 breaths per minute) ANY ADVANCED AIRWAY 1 ventilation every 6 to 8 seconds (8 to 10 breaths per minute)

Airway management in Respiratory arrest Assess Is the airway patent Is an advanced airway indicated Is proper placement of airway device confirmed Is tube secured and placement reconfirmed frequently

Action as appropriate Maintain airway patency in unconscious patients by use of head tilt and chin lift, OPA and NPA Use advanced airway management if needed Confirm proper integration of CPR and ventilaton Confirm proper placement of advanced airway devices Secure the device to prevent dislodgement Monitor continuous quantitative waveform capnography

Breathing Assess Are ventilation and oxygenation adequate Are quantitative waveform capnography and oxyhemoglobin saturation monitored?

Action as appropriate Give supplementary oxygen when indicated Monitor the adequacy of ventilation and oxygenation Avoid excessive ventilation

Circulation What is the cardiac rhythm? Is the patient with a pulse unstable? Is defibrillation or cardioversion indicated? Are chest compressions effective? Is ROSC present? Has IV/IO access been established? Are medications needed for rhythm or BP? Does the patient need volume for resuscitation?

Action as appropriate Monitor CPR quality Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms Defibrillation / cardioversion Obtain IV/IO access Give appropriate drugs to manage rhythm and blood pressure Give IV/IO fluids if needed

Basic Airway Skills Head tilt – chin lift Jaw thrust without head extension (suspected cervical spine trauma) Mouth to mouth ventilation Mouth to nose ventilation Mouth to barrier device (using pocket mask) ventilation Bag mask ventilation

Basic airway adjuncts OPA NPA OPA is used in unconscious patients without gag reflex and should not be used in a conscious or semiconscious patient NPA May be used in conscious or semi conscious patients with an intact cough and gag reflex

Suctioning Catheter type Use for Soft Aspiration of thin secretions from the oropharynx and nasopharynx Performing intratracheal suctioning Suctioning through an in-place airway (i.e., NPA) to access the back of the pharynx in a patient with clenched teeth Rigid (yankauer) More effective suctioning of the oropharynx, particularly if there is think particulate matter

Oropharyngeal suctioning Measure the catheter before suctioning and do not insert it any further than the distance from the tip of the nose to the earlobe Gently insert the suction catheter or device into the oropharynx beyond the tongue Apply suction by occluding the side opening of the catheter while withdrawing with a rotating or twisting motion If using a rigid catheter place the tip gently into the oral cavity. Advance by pushing the tongue down to reach the oropharynx if necessary

Endotracheal tube suctioning Use sterile technique to reduce the likelihood of airway contamination Gently insert the catheter into the ET tube. Be sure the side opening is not occluded during insertion Insertion of the catheter beyond the tip of the ET tube is not recommended because it may injure the endotracheal mucosa or stimulate coughing or bronchospasm

Apply suction while withdrawing the catheter in rotating or twisting motion Suction attempts should not exceed 10 seconds To avoid hypoxemia, precede and follow suctioning attempts with a short period of administration of 100% oxygen

Ventilation using advanced airway Advanced airway includes Laryngeal mask airway Laryngeal tube Esophageal tracheal tube Endotracheal tube

Summary BLS Airway Breathing Circulation Basic airway skills Assessment and management Breathing Circulation Basic airway skills Airway adjuncts Suctioning Ventilation using advanced airway devices

Thank you….