Ventilation Devices and Oxygen

1. Ventilation Devices and Oxygen Lesson 8

2. Introduction First Responders usually provide care for airway and breathing without specialized equipment or supplies Adjunctive devices can enhance effectiveness of resuscitation: Suction devices help keep patient’s airway clear Oral/nasal airways help ensure air reaches patient’s lungs Bag mask units for more effective ventilation Supplemental oxygen

3. Introduction continued Resuscitation adjuncts used depend on training and job Devices may not always be available Be able to ventilate without special equipment Never delay care while waiting for adjunctive equipment

4. Suction Devices Used to clear blood, vomit, other substances from victim’s airway Be familiar with equipment you may use

5. Using Suction Devices Clear plastic tip is inserted into mouth or nostrils Suction tips vary from small, soft plastic tips, to larger, more rigid tips Some devices have suction control port at base of tip Be familiar with specific equipment you may use 

6. Uses of Suction Useful if airway is fully or partially obstructed Most suction units inadequate for removing solid objects

7. General Principles of Suctioning If patient vomits during ventilation, or secretions/blood impede ventilation, stop and quickly suction before continuing resuscitation Airway usually needs suctioning if you hear gurgling sounds during breathing or ventilation Turn patient’s head to side to help drain vomit or fluids before suctioning If patient may have spinal injury, turn head and body inline as a unit with help of other responders 

8. Suction: Safety Precautions Prolonged contact with mucous membranes can cause bruising, swelling, bleeding Never insert suction tip further than you can see Vigorous suctioning may stimulate gag reflex Do not suction infant too deeply and suction mouth before nose Use standard precautions

9. Suction in an Infant Watch for a decreased heart rate If pulse is slow, stop suctioning and provide ventilation Don’t suction too deep in an infant Always suction infant’s mouth before nostrils Suctioning nose may stimulate infant to inhale fluid/secretions from mouth

10. Skill: Suctioning (Adult or Child)

11. Skill: Suctioning Confirm suction device working and produces suction Turn victim’s head to one side and open mouth

12. Sweep out solids and larger amounts of fluid with finger.

13. Determine maximum depth of insertion.

14. Turn on or create suction.

15. Insert catheter tip into mouth, move tip as you withdraw it.

16. Suctioning After suctioning, reposition the victim’s head with airway open Resume rescue breathing or CPR

17. Skill: Suctioning (Infant)

18. Hold infant in position for suctioning Head lower than body Turned to one side

19. Squeeze suction bulb and insert tip into infant’s mouth.

20. Gradually release bulb to create suction as you withdraw tip.

21. Move bulb aside, squeeze it with tip down to empty Repeat if necessary Repeat suctioning steps for each nostril Resume rescue breathing or CPR

22. Airway Adjuncts Help keep victim’s airway open Prevent obstruction by tongue more easily than head position alone Supplemental oxygen can be given through mask or BVM with airway in place

23. Oral Airways Use only with unresponsive victim without gag reflex Can be breathing or not Available in variety of sizes Victim can be suctioned with airway in place

24. Sizing and Placement of Oral Airways Proper placement is essential Periodically reassess to confirm airway remains in proper position

25. Skill: Oral Airway Insertion

26. Choose correct size.

27. Insert with tip pointing toward roof of mouth.

28. When tip reaches back of mouth and you feel resistance, rotate airway 180 degrees.

29. Continue to insert until flange rests on lips.

30. Oral Airway in Children Alternate technique for inserting an oral airway in infants/children: Select proper size Measure from corner of patient’s lips to bottom of earlobe or angle of jaw Open patient’s mouth Use a tongue blade to press tongue down and out of way Insert airway in the upright (anatomic) position 

31. Nasal Airways Use with responsive victim Use with unresponsive victim with gag reflex Use with unresponsive victim with mouth or jaw injuries or tightly clenched teeth

32. Nasal Airways Less likely to cause gagging and vomiting than oral airways Difficult to suction If needed, suction using small flexible suction catheter

33. Skill: Nasal Airway Insertion

34. Choose correct size.

35. Lubricate airway.

36. Insert into right nostril with bevel toward septum.

37. Insert straight back, sliding along floor of nostril. Insert until flange rests against nose.

38. After Insertion of Nasal Airway Continue to keep patient’s airway open with head tilt–chin lift or jaw thrust Suction through nasal airway with small flexible suction catheter if needed

39. Bag Mask Ventilation Bag mask units are more effective for providing ventilations Victim receives air from atmosphere (21% oxygen) rather than exhaled air (16% oxygen)

40. Components of BVM Unit

41. Using BVM: Sealing Mask Open airway and position mask on victim’s face If alone, hold mask in one hand and squeeze bag with other Use C-clamp technique If there is a second rescuer, hold mask with both hands

42. Using BVM: Giving Ventilations Rescue breaths delivered by squeezing bag Squeeze 1 L bag about ½ to ? of volume Squeeze 2 L bag about ? of volume Squeeze bag over 1 second (watch victim’s chest rise)

43. Using BVM: Giving Ventilations continued Give ventilation every 5-6 seconds in adult Give ventilation every 3-5 seconds in infant or child If supplemental oxygen, give smaller ventilations

44. Monitor Bag Mask Ventilations Do not over-ventilate patient Watch for rise and fall of patient’s chest Feel for resistance when squeezing bag If air escapes around mask, reposition mask and fingers If problems occur, use alternate technique

45. Using BVM: Supplemental Oxygen Use supplemental oxygen with BVM if possible Attach oxygen reservoir bag to valve on bag and oxygen tubing Use device same way

46. Using BVM: Mask and Bag Size Choose correct size mask for victim Use right size bag 500 mL for newborns 750 mL for infants/small children 1200 mL for large children/adolescents 1600 mL for adults

47. Skill: BVM: Rescue Breathing

48. Assemble BVM and position and seal mask over victim’s mouth

49. Squeeze bag to provide ventilations Recheck pulse about every 2 minutes If no signs of circulation, call for AED and start CPR

50. Supplemental Oxygen Can supply up to 100% oxygen Should be used along with other BLS techniques Victims with serious medical conditions will benefit

51. Supplemental Oxygen: Equipment Pressurized cylinder Pressure regulator Flowmeter Oxygen tubing Oxygen delivery device

52. Safety Around Oxygen No smoking or open flame near oxygen source Never use grease, oil, or adhesive tape on equipment Never expose oxygen cylinder to temperature over 120°F Never drop cylinder or let fall against another object Never use non-oxygen regulator on oxygen cylinder

53. Oxygen Delivery Devices

54. Oxygen Delivery Devices Nasal Cannula Resuscitation mask Nonrebreathing mask Bag-mask

55. Nasal Cannula Use with breathing victims who do not require high concentration of oxygen Oxygen concentration depends on flow rate 1 to 6 LPM delivers 24% to 50% O2

56. Resuscitation Mask Use for nonbreathing victims Some have oxygen port Provides 30% to 60% oxygen with flow rate of 10 LPM

57. Nonrebreathing Mask Use with breathing victim 80% to 95% oxygen with flow at minimum of 8 LPM Adjust flow rate to keep reservoir from collapsing completely when victim inhales

58. Bag-Mask Units Delivers oxygen through tube or reservoir Up to 100% oxygen Can also use with breathing victim

59. Oxygen Administration If you are alone with patient do not stop providing BLS to set up oxygen equipment Wait until patient is more stable or until another rescuer can help Once oxygen set up, continue to monitor oxygen flow rate, tank pressure, and victim’s condition

60. Skill: Oxygen Administration

61. Check equipment.

62. Remove any protective seal. Point cylinder away. Open main valve for 1 second.

63. Remove any protective seals and attach regulator.

64. Open main cylinder valve.

65. Check pressure regulator gauge.

66. Attach oxygen tubing to flowmeter and oxygen delivery device.

67. Set flowmeter at correct rate: 1 – 6 LPM for nasal cannula 10 LPM for face mask 10 -15 LPM for BVM or nonrebreathing mask

68. Confirm oxygen is flowing. Position delivery device on victim. Monitor pressure gauge.