1. Maintaining Oxygenation Phase 2 Medical Students Respiratory System A. J. Shearer Consultant Anaesthetics & Intensive Care

2. TOPIC l inspired gas l airway l pulmonary ventilation

3. BASIC LIFE SUPPORT (BLS) ADULT BLS Resuscitation Guidelines 2005 Resuscitation Council (UK) (NB: New guidelines 28 Nov 2005)

5. CLEAR AIRWAY l loosen tight clothing l remove any obvious obstruction from mouth l tilt head l lift chin

6. CHECK FOR BREATHING l look for chest movement l listen at mouth for breath sounds l feel for air with your cheek

7. Which is the currently recommended recovery position? RECOVERY POSITION

8. chest movements + = AIRWAY OBSTRUCTION no air movement no chest movement + = APNOEA no air movement NO AIR MOVEMENT

9. UNCONSCIOUS PATIENT Soft tissue collapse in pharynx OBSTRUCTION Relieved by:- l head tilt l chin lift l jaw thrust l oropharyngeal airway

10. l inserted through mouth to lower pharynx l no instrument required l cuffed hood over laryngeal opening l skill required for insertion easy to learn LARYNGEAL MASK AIRWAY (LMA)

11. ENDOTRACHEAL TUBE Through mouth (or nose) TRACHEA Introduced using a LARYNGOSCOPE CUFF forms seal in trachea CHECK:- l not in oesophagus l not inserted too far l cuff inflation correct

12. CRICOTHYROTOMY Safer & easier to perform than tracheostomy Between cricoid & thyroid cartilages Large needle or tube

13. ARTIFICIAL RESPIRATION Mouth MOUTH Mask Chest should rise visibly (normal chest expansion 5 -6 ml/kg) Do not inflate the lungs too quickly Wait for chest to fall fully before next inflation Mask BAG Endotracheal tube SELF-INFLATING RESUSCITATION BAG eg Ambu or Laerdal

14. OXYGEN SUPPLY Piped oxygen wall outlet - 400 kPa (4 bar) Cylinder - 13700 kPa (137 bar) Pressure reducing valve necessary Key may be required to open cylinder Pressure gauge indicates contents Rotameter - flow control & indicator

15. OXYGEN MASKS Hudson medium concentration mask = 60% 5 l/min minimum Hudson high concentration mask = 90 - 100% 10 l/min minimum

16. ASSESSING OXYGENATION l clinical examination l pulse oximetry l arterial blood gas analysis

17. HYPOXIA CLINICAL SIGNS & SYMPTOMS l cyanosis l respiratory effects l cerebral effects l cardiovascular effects l acidosis l organ damage

18. ARTERIAL BLOOD GASES Reference Ranges:- PaO 2 11.5 - 14.8 kPa <30 yrs 9.1 - 14.5 kPa 30 - 50 yrs 8.3 - 13.3 kPa 51 - 70 yrs 8.2 - 12.2 kPa >70 yrs PaCO 2 4.7 - 6.1 kPa pH 7.36 - 7.44

19. OXYGEN THERAPY Reference for practical review article:- Emergency oxygen therapy for breathless patient. Guidelines prepared by North West Oxygen Group. Murphy R. et al Emerg. Med. J. 2001; 18: 421-423

20. SUCTION Piped vacuum wall outlet Electrically powered vacuum pump 53 kPa (400 mmHg) Oxygen powered venturi suction Hand/ foot operated