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

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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

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

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

12. 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?

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

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

22. Thank you….