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 patients airway clear
• Oral/nasal airways help ensure air reaches
  patients 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

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Suction Devices

• Used to clear blood, vomit, other substances from
  victims airway
• Be familiar with equipment you may use

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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

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Uses of Suction

• Useful if airway is fully or partially obstructed
  
• Most suction units inadequate for removing solid
  objects

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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 patients 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

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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
• Dont suction too deep in an infant
• Always suction infants mouth before nostrils
• Suctioning nose may stimulate infant to inhale
  fluid/secretions from mouth

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Skill

• Suctioning (Adult or Child)

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Skill Suctioning

• Confirm suction device working and produces
  suction
• Turn victims head to one side and open mouth

12

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

13

• Determine maximum depth of insertion.

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• Turn on or create suction.

15

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

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Suctioning

• After suctioning, reposition the victims head
  with airway open
• Resume rescue breathing or CPR

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Skill

• Suctioning (Infant)

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

19

• Squeeze suction bulb and insert tip into
  infants 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 victims 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

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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

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Sizing and Placement of Oral Airways

• Proper placement is essential
• Periodically reassess to confirm airway remains
  in proper position

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Skill

• Oral Airway
• Insertion

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• Choose correct size.

Choose correct size.
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• Insert with tip pointing toward roof of mouth.

28

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

When tip reaches back of mouth and you feel
resistance, rotate the airway 180 degrees.
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• Continue to insert until flange rests on lips.

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Oral Airway in Children

• Alternate technique for inserting an oral airway
  in infants/children
• Select proper size
• Measure from corner of patients lips to bottom
  of earlobe or angle of jaw
• Open patients mouth
• Use a tongue blade to press tongue down and out
  of way
• Insert airway in the upright (anatomic) position

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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

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Nasal Airways

• Less likely to cause gagging and vomiting than
  oral airways
• Difficult to suction
• If needed, suction using small flexible suction
  catheter

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Skill

• Nasal Airway
• Insertion

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• Choose correct size.

35

• Lubricate airway.

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Insert straight down

• Insert into right nostril with bevel toward
  septum.

37

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

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After Insertion of Nasal Airway

• Continue to keep patients airway open with head
  tiltchin lift or jaw thrust
• Suction through nasal airway with small flexible
  suction catheter if needed

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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)

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Components of BVM Unit
oxygen reservoir bag
self-inflating bag
one-way valve
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Using BVM Sealing Mask

• Open airway and position mask on victims 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 victims chest
  rise)

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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

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Monitor Bag Mask Ventilations

• Do not over-ventilate patient
• Watch for rise and fall of patients chest
• Feel for resistance when squeezing bag
• If air escapes around mask, reposition mask and
  fingers
• If problems occur, use alternate technique

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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

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Skill

• BVM Rescue Breathing

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• Assemble BVM and position and seal mask over
  victims mouth

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

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Supplemental Oxygen

• Can supply up to 100 oxygen
• Should be used along with other BLS techniques
• Victims with serious medical conditions will
  benefit

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Supplemental Oxygen Equipment

• Pressurized cylinder
• Pressure regulator
• Flowmeter
• Oxygen tubing
• Oxygen delivery device

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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
  120F
• Never drop cylinder or let fall against another
  object
• Never use non-oxygen regulator on oxygen cylinder

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Oxygen Delivery Devices
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Oxygen Delivery Devices

• Nasal Cannula
• Resuscitation mask
• Nonrebreathing mask
• Bag-mask

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Nasal Cannula
Note The Nasal Cannula is placed entirely in
front of patient

• 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

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Resuscitation Mask

• Use for nonbreathing victims
• Some have oxygen port
• Provides 30 to 60 oxygen with flow rate of 10
  LPM

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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

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Bag-Mask Units

• Delivers oxygen through tube or reservoir
• Up to 100 oxygen
• Can also use with breathing victim

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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 victims condition

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Skill

• Oxygen Administration

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• Check equipment.

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

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Dont forget the washer

• Remove any protective seals and attach
  regulator.

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• Open main cylinder valve.

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• Check pressure regulator gauge.

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• Attach oxygen tubing to flowmeter and oxygen
  delivery device.

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• Set flowmeter at correct rate
• 1 6 LPM for nasal cannula
• 10 LPM for face mask
• 10 -15 LPM for BVM or nonrebreathing mask

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F i n g e r
Fill the bag before placing on the patient

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