copyright © 2005 mosby, inc. all rights reserved. slide 0 oxygenation

Copyright © 2005 Mosby, Inc. All rights reserved. Slide 1

OxygenationOxygenation


OverviewOverview Artificial VentilationArtificial Ventilation

Mouth-to-Mask Mouth-to-Mask with Supplemental Oxygen Techniquewith Supplemental Oxygen Technique Two-Person Bag-Valve-Mask TechniqueTwo-Person Bag-Valve-Mask Technique Flow-Restricted, Oxygen-Powered Ventilation DeviceFlow-Restricted, Oxygen-Powered Ventilation Device One-Person Bag-Valve-Mask TechniqueOne-Person Bag-Valve-Mask Technique Considerations for Trauma PatientsConsiderations for Trauma Patients Assessing the Adequacy of Artificial VentilationAssessing the Adequacy of Artificial Ventilation


The Respiratory SystemThe Respiratory System

The respiratory system takes oxygen from the The respiratory system takes oxygen from the airair and makes it available for the and makes it available for the bloodblood to to transport to every transport to every cellcell and rids the body of and rids the body of excess carbon dioxide (CO2)excess carbon dioxide (CO2)


The Respiratory SystemThe Respiratory System The Airway The Airway

Upper airwayUpper airway• Extends from the mouth and nose to the tracheaExtends from the mouth and nose to the trachea

Lower airwayLower airway• Extends from the trachea to the alveoliExtends from the trachea to the alveoli


The Upper AirwayThe Upper Airway


The Upper AirwayThe Upper Airway

Nose and mouthNose and mouth PharynxPharynx

• OropharynxOropharynx

• NasopharynxNasopharynx

Epiglottis Epiglottis • Leaf-shaped structure that prevents food and liquid Leaf-shaped structure that prevents food and liquid

from entering the trachea during swallowingfrom entering the trachea during swallowing


The Lower AirwayThe Lower Airway


The Lower AirwayThe Lower Airway Trachea Trachea Cricoid cartilage Cricoid cartilage Larynx (voice box)Larynx (voice box)

Bronchi Bronchi • Two major branches of the trachea to the lungs; Two major branches of the trachea to the lungs;

bronchus subdivides into smaller air passages bronchus subdivides into smaller air passages ending at the alveoliending at the alveoli

Lungs Lungs DiaphragmDiaphragm


Respiratory TerminologyRespiratory Terminology VentilationVentilation

The movement of airThe movement of air

RespirationRespiration The exchange of gasesThe exchange of gases


VentilationVentilation

Air flows into the Air flows into the lungs because of lungs because of the negative the negative pressurepressure


VentilationVentilation ExhalationExhalation

Diaphragm and intercostal Diaphragm and intercostal muscles relax, decreasing muscles relax, decreasing the size of the thoracic the size of the thoracic cavitycavity• Diaphragm moves upwardDiaphragm moves upward

• Ribs move downward/inwardRibs move downward/inward

Air is expelled from the Air is expelled from the lungslungs


Normal BreathingNormal Breathing

Normal respiration should be effortlessNormal respiration should be effortless


Normal Respiratory RatesNormal Respiratory Rates

Adult—12-20/minuteAdult—12-20/minute

Child—15-30/minuteChild—15-30/minute

Infant—25-50/minuteInfant—25-50/minute


OxygenOxygen


Oxygen SourcesOxygen Sources

Common sizes of Common sizes of oxygen cylindersoxygen cylinders

Tanks must be handled carefully since their contents are under pressure.


Oxygen SourcesOxygen Sources

CylinderCylinder Capacity Capacity (in liters)(in liters)

DD 350350

EE 625625

MM 30003000

GG 53005300

HH 69006900


Equipment for Oxygen DeliveryEquipment for Oxygen Delivery

Oxygen regulatorsOxygen regulators To deliver the oxygen to To deliver the oxygen to

the patient at the correct the patient at the correct pressure and flow rate, a pressure and flow rate, a regulator is usedregulator is used

The regulator attaches to The regulator attaches to the valve of the tank to the valve of the tank to control the flow of control the flow of oxygenoxygen



Attaching the regulatorAttaching the regulator Remove protective sealRemove protective seal Quickly open, then shut, the valveQuickly open, then shut, the valve Attach regulator-flowmeter to tankAttach regulator-flowmeter to tank Attach oxygen device to flowmeterAttach oxygen device to flowmeter Open flowmeter to desired settingOpen flowmeter to desired setting Apply oxygen device to patientApply oxygen device to patient


Oxygen Masks Oxygen Masks



Equipment for Oxygen DeliveryEquipment for Oxygen DeliveryNonrebreather maskNonrebreather mask

Preferred method of giving Preferred method of giving oxygen to prehospital oxygen to prehospital patientspatients

Up to 90% oxygen can be Up to 90% oxygen can be delivereddelivered

Nonrebreather Nonrebreather bag must be bag must be full full before mask is placed before mask is placed on patienton patient

Flow rate should be Flow rate should be adjusted so that when adjusted so that when patient inhales, bag does patient inhales, bag does not collapse (not collapse (15 L/min)15 L/min)



IndicationsIndications for the nonrebreather mask for the nonrebreather mask Any adequately breathing patient with signs or Any adequately breathing patient with signs or

symptoms of symptoms of respiratory distressrespiratory distress

Any patient with potential or actual Any patient with potential or actual hypoperfusionhypoperfusion

Any other Any other patient who would benefit from high-flow patient who would benefit from high-flow oxygenoxygen



Nasal cannula Nasal cannula RarelyRarely the best method the best method

of delivering adequate of delivering adequate oxygen to the oxygen to the prehospital patientprehospital patient

Should be used only Should be used only when patients when patients will not will not toleratetolerate a nonrebreather a nonrebreather mask, despite coaching mask, despite coaching from the EMT-Basic from the EMT-Basic



Indications for the nasal cannulaIndications for the nasal cannula Patients who Patients who will not tolerate a maskwill not tolerate a mask

Medical patients Medical patients without respiratory compromisewithout respiratory compromise

Stable cardiac patients Stable cardiac patients without signs or symptoms of without signs or symptoms of cardiac compromisecardiac compromise

Patients with COPD who Patients with COPD who are not in respiratory are not in respiratory distressdistress


Manual Positioning Manual Positioning

Opening the AirwayOpening the Airway



Head-tilt chin-lift Head-tilt chin-lift when no neck injury when no neck injury suspected suspected



Jaw thrust when Jaw thrust when EMT-Basic suspects EMT-Basic suspects spinal injuryspinal injury


Assess the need for suctioning. Remember that a noisy airway is

a bad airway.


Oropharyngeal Airways Oropharyngeal Airways

Airway AdjunctsAirway Adjuncts



Oropharyngeal Oropharyngeal airwaysairways May be used to assist May be used to assist

in maintaining an open in maintaining an open airway on airway on unresponsive patients unresponsive patients without a gag reflexwithout a gag reflex

Patients with a gag Patients with a gag reflex will vomitreflex will vomit



The oral airway The oral airway displaces the tongue.displaces the tongue.



Oropharyngeal airwaysOropharyngeal airways Insertion techniqueInsertion technique


Nasopharyngeal Airways Nasopharyngeal Airways




Nasopharyngeal airwaysNasopharyngeal airways Less likely to stimulate Less likely to stimulate

vomitingvomiting May be used on patients May be used on patients

who are responsive but need who are responsive but need assistance keeping the assistance keeping the tongue from obstructing the tongue from obstructing the airwayairway



Nasopharyngeal Nasopharyngeal airwaysairways Even though the Even though the

tube is lubricated, tube is lubricated, this is a painful this is a painful stimulusstimulus



Nasopharyngeal Nasopharyngeal airwaysairways Insertion techniqueInsertion technique


SuctionSuction


SuctionSuction PurposePurpose

Remove blood, other liquids, and food particles from Remove blood, other liquids, and food particles from the airwaythe airway

Some suction units are inadequate for removing solid Some suction units are inadequate for removing solid objects like teeth, foreign bodies, and foodobjects like teeth, foreign bodies, and food

A patient needs to be suctioned immediately when a gurgling sound is heard with artificial

ventilation.


SuctionSuction

On-board suction devicesOn-board suction devices

Portable suction unitsPortable suction units


SuctionSuction

Suction cathetersSuction catheters Hard or rigidHard or rigid

• Used to suction the Used to suction the mouth and oropharynx mouth and oropharynx of an of an unresponsive patientunresponsive patient

• Should be inserted only as far as you can seeShould be inserted only as far as you can see

• Use rigid catheter for infants and children, but take Use rigid catheter for infants and children, but take caution caution not to touch back of airwaynot to touch back of airway


SuctionSuction

Suction cathetersSuction catheters Soft (French)Soft (French)

• Useful for suctioning the Useful for suctioning the nasopharynx nasopharynx and in other and in other situations when a situations when a rigid catheter cannot be usedrigid catheter cannot be used

• Should be measured so that it is inserted only as far as the Should be measured so that it is inserted only as far as the base of the tonguebase of the tongue


SuctionSuction

TechniquesTechniques


Artificial VentilationArtificial Ventilation

Techniques of VentilationTechniques of Ventilation



Preferred ventilation techniquesPreferred ventilation techniques Mouth-to-maskMouth-to-mask Two-person bag-valve-maskTwo-person bag-valve-mask Flow-restricted, oxygen-powered ventilation device Flow-restricted, oxygen-powered ventilation device

(video)(video) One-person bag-valve-maskOne-person bag-valve-mask



PrinciplesPrinciples Provide highest percentage of oxygen availableProvide highest percentage of oxygen available Maintain an open airwayMaintain an open airway Ensure an airtight sealEnsure an airtight seal Prevent gastric distentionPrevent gastric distention Ventilate patient with an adequate rate and volumeVentilate patient with an adequate rate and volume


Ventilation TechniquesVentilation Techniques

Mouth-to-mask with supplemental oxygen Mouth-to-mask with supplemental oxygen TechniqueTechnique



Indications for the BVMIndications for the BVM Respiratory arrestRespiratory arrest Cardiopulmonary arrestCardiopulmonary arrest To assist inadequate breathingTo assist inadequate breathing To hyperventilate patients in specific situationsTo hyperventilate patients in specific situations



Features of the BVM Self-refilling bag that is either disposable or easily

cleaned/sterilized Valve allowing maximum oxygen inlet flow rate of 15

L/min Standardized 15/22-mm fittings Inlet and reservoir to allow high-oxygen

concentration



Features of the bag-valve-mask One-way valve that prevents rebreathing of

exhaled air Constructed of materials that work in all

environments Available in infant, child, and adult sizes



Two-person bag-valve-maskTwo-person bag-valve-mask TechniqueTechnique



One-person bag-valve-maskOne-person bag-valve-mask TechniqueTechnique



Flow-restricted, oxygen-powered Flow-restricted, oxygen-powered ventilation devicesventilation devices TechniqueTechnique



Considerations for trauma patientsConsiderations for trauma patients Unresponsive trauma patients are an airway Unresponsive trauma patients are an airway

challengechallenge Spinal injuries require special careSpinal injuries require special care Ventilations must be modified to account for spinal Ventilations must be modified to account for spinal

injuriesinjuries



Assessing the Adequacy ofAssessing the Adequacy of

Artificial Ventilation Artificial Ventilation


Ventilation TechniquesVentilation Techniques Signs of adequate ventilationSigns of adequate ventilation

The chest rises and falls with each artificial The chest rises and falls with each artificial ventilationventilation

The rate is sufficient, approximately 12 per minute The rate is sufficient, approximately 12 per minute for adults and 20 times per minute for children and for adults and 20 times per minute for children and infantsinfants

Heart rate returns to normal with successful Heart rate returns to normal with successful artificial ventilationartificial ventilation



Signs of inadequate ventilationSigns of inadequate ventilation The chest does not rise and fall with artificial The chest does not rise and fall with artificial

ventilationventilation The rate is too slow or too fastThe rate is too slow or too fast Heart rate does not return to normal with artificial Heart rate does not return to normal with artificial

ventilationventilation


Special Situations inSpecial Situations inAirway ManagementAirway Management



Patients with laryngectomies (stomas)



Tracheostomy An artificial permanent opening in the trachea A breathing tube may be present. If it is

obstructed, suction it Some patients have partial laryngectomies



Ventilating Infants and Children



Ventilating infants and children Place head in correct neutral position for the infant

and extend slightly past neutral for a child Avoid excessive hyperextension of the head Avoid excessive bag pressure—use only enough

to make chest rise



Ventilating infants and children Ventilate with bag-valve-mask until adequate

chest rise occurs Do not use pop-off valve; must be disabled

(placed in closed position) to adequately ventilate child or infant

Gastric distention is more common in children An oral or nasal airway may be considered when

other procedures fail to provide a clear airway



Facial Injuries



Facial injuries The blood supply to the face is so rich, blunt

injuries to the face frequently result in severe swelling

Bleeding into the airway from facial injuries can be a challenge to manage



Obstructions



Dental Appliances



Dental appliances Dentures

• Ordinarily dentures should be left in place

• Partial dentures (plates) may become dislodged during an emergency

• Leave in place, but be prepared to remove it if it becomes dislodged


SummarySummary The Respiratory SystemThe Respiratory System

Respiratory AnatomyRespiratory Anatomy Respiratory PhysiologyRespiratory Physiology

OxygenOxygen Oxygen SourcesOxygen Sources Equipment for Oxygen DeliveryEquipment for Oxygen Delivery

Opening the AirwayOpening the Airway Manual PositioningManual Positioning Airway AdjunctsAirway Adjuncts SuctionSuction


SummarySummary Artificial VentilationArtificial Ventilation

Mouth-to-Mask with Supplemental Oxygen TechniqueMouth-to-Mask with Supplemental Oxygen Technique Two-Person Bag-Valve-Mask TechniqueTwo-Person Bag-Valve-Mask Technique Flow-Restricted, Oxygen-Powered Ventilation DeviceFlow-Restricted, Oxygen-Powered Ventilation Device One-Person Bag-Valve-Mask TechniqueOne-Person Bag-Valve-Mask Technique Considerations for Trauma PatientsConsiderations for Trauma Patients Assessing the Adequacy of Artificial VentilationAssessing the Adequacy of Artificial Ventilation

Special Situations in Airway ManagementSpecial Situations in Airway Management Patients with LaryngectomiesPatients with Laryngectomies Ventilating Infants and ChildrenVentilating Infants and Children Facial InjuriesFacial Injuries ObstructionsObstructions Dental AppliancesDental Appliances

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