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© 2011 National Safety Council 7-1

VENTILATION DEVICES AND OXYGEN

LESSON 7


Introduction

• EMRs 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 and nasal airways help ensure air reaches patient’s lungs

- Bag mask units for more effective ventilation

- Supplemental oxygen


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


Suction Devices

• Used to clear blood, vomit, other substances from patient’s airway

• Suction equipment includes manual devices, powered devices, soft bulb syringes


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


Uses of Suction

• Useful if airway is fully or partially obstructed

• Most suction units inadequate for removing solid objects


General Principlesof Suctioning

• If patient vomits during ventilation, or secretions or 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


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


• 15 seconds at a time for adults

• 10 seconds at a time for children

• 5 seconds at a time for infants

Do Not Suction Longer Than


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 or secretions from mouth


Skill: Suctioning (Adult or Child)


1. Confirm suction device working and produces suction

2. Turn patient’s head to one side and open mouth


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


4. Determine maximum depth of insertion


5. Turn on suction or pump handle to create suction


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


7. Reposition patient’s head with airway open and begin or resume ventilation if needed


Skill: Suctioning (Infant)


1. Hold infant in position for suctioning

• Head lower than body

• Turned to one side


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


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


4. Move bulb aside, squeeze it with tip down to empty

5. Repeat if necessary

6. Repeat suctioning steps for each nostril

7. Resume rescue breathing or CPR


Airway Adjuncts

• Help keep patient’s airway open

• Prevent obstruction by tongue more easily than head position alone

• Supplemental oxygen can be given through mask or bag-valve-mask (BVM) with airway in place


Oral Airways

• Use only with unresponsive patient without gag reflex

• Can be breathing or not

• Available in variety of sizes

• Patient can be suctioned with airway in place


Sizing and Placement of Oral Airways

• Proper placement is essential

• Periodically reassess to confirm airway remains in proper position


Skill: Oral Airway Insertion


1. Choose correct size


2. Open patient’s airway with head tilt–chin lift or jaw thrust and open the mouth

3. Insert with tip pointing toward roof of mouth


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


5. Continue to insert until flange rests on lips


Oral Airway in Children

1. Select proper size – measure from corner of patient’s lips to bottom of earlobe or angle of jaw

2. Open patient’s mouth

3. Use a tongue blade to press tongue down and out of way

4. Insert airway in the upright (anatomic) position

Alternate technique for inserting an oral airway in infants/children:


Nasal Airways

• Use with responsive patient

• Use with unresponsive patient with gag reflex

• Use with unresponsive patient with mouth or jaw injuries or tightly clenched teeth


Nasal Airways (continued)

• Do not use with significant facial injuries and significant head trauma

• Less likely to cause gagging and vomiting than oral airways

• Difficult to suction

• Cause pain or significant bleeding in some patients


Skill: Nasal Airway insertion


1. Choose correct size


2. Lubricate airway


3. Insert into right nostril with bevel toward septum

Insert straight down


4. Insert straight back, sliding along floor of nostril

5. Insert until flange rests against nose


After Insertion of Nasal Airway

• Continue to keep patient’s airway open with head tiltchin lift or jaw thrust

• Suction through nasal airway with small flexible suction catheter if needed


Bag Mask Ventilation

• Bag mask units are more effective for providing ventilations

• Patient receives air from atmosphere (21% oxygen) rather than exhaled air (16% oxygen)

• Can be used for ventilation performed alone or during CPR by 2 rescuers


Bag Mask Components

self-inflating bag

oxygen reservoir bag

1-way valve


Using the Bag Mask: Sealing Mask

• Open airway and position mask on patient’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


Using the Bag Mask: Giving Ventilations

• Rescue breaths delivered by squeezing bag

- Squeeze one L bag about ½ to ⅔ of volume

- Squeeze two L bag about ⅓ of volume

• Squeeze bag over one second (watch patient’s chest rise)


Using the Bag Mask:Giving Ventilations (continued)

• Give ventilation every 5-6 seconds in adult

• Give ventilation every 3-5 seconds in child

• Give ventilation every 3 seconds in infant

• If supplemental oxygen, give smaller ventilations


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 problem occurs or you cannot get a good seal, use alternate technique


Bag Mask for Inadequate Breathing

• If patient is responsive, explain what you will be doing

• Initially assist patient’s breathing at the rate at which the patient has been breathing

• Squeeze the bag each time the patient begins to inhale

• Gradually adjust the rate and delivered volume of air as appropriate


Using the Bag Mask: Supplemental Oxygen

• Use supplemental oxygen if possible

• Attach oxygen reservoir bag to valve on bag and attach oxygen tubing to bag

• Use device same way


BVM with Children and Infants

• Use with a non-breathing infant or child the same as with an adult

• Choose a mask of the correct size

• Squeeze the bag only enough to make the chest rise


Skill: Bag Mask for Ventilation – Two Rescuers


• Rescuer 1: Assembles bag mask and positions it over patient’s mouth and nose

• Rescuer 2: Seals mask over patient’s mouth and nose


• Rescuer 1: Squeezes bag to provide ventilations

• Recheck pulse about every two minutes

• If no pulse, call for AED and start CPR


Supplemental Oxygen

• Can supply up to 100% oxygen

• Should be used along with other basic life support (BLS) techniques

• Patients with serious medical conditions will benefit


Supplemental Oxygen: Equipment

• Pressurized cylinder

• Pressure regulator

• Flowmeter

• Oxygen tubing

• Oxygen delivery device


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


Oxygen Delivery Devices

• Nasal cannula

• Resuscitation mask

• Non-rebreathing mask

• Bag mask


Nasal Cannula

• Use with breathing patients who do not require high concentration of oxygen

• Oxygen concentration depends on flow rate

• 1 to 6 liters per minute (LPM) delivers 24% to 50% O2

Note: The Nasal

Cannula is placed

entirely in front of patient


Resuscitation Mask (Pocket Mask)

• Use for non-breathing patients

• Some have oxygen port

• Can be used for breathing patients

• Provides 30% to 60% oxygen with flow rate of 10 LPM


Non-Rebreather Mask

• Use with breathing patient

• 80% to 95% oxygen with flow at minimum of 8 LPM

• Adjust flow rate to keep reservoir from collapsing completely when patient inhales


Bag Mask Units

• Delivers oxygen through tube or reservoir

• Up to 100% oxygen

• Can also use with breathing patient


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 patient’s condition


Skill: Oxygen Administration


1. Check equipment


2. Remove any protective seal

3. Point cylinder away

4. Open main valve for one second


5. Attach regulator and tighten it

Lining up the pins is a critical

step

Don’t forget

the washer


6. Open main cylinder valve and ensure there are no leaks


7. Check pressure regulator gauge


8. Attach oxygen tubing to flowmeter and oxygen delivery device


9. Set flowmeter at correct rate:

- 1-6 LPM for nasal cannula

- 10 LPM for face mask

- 10-15 LPM for bag mask or

non-rebreathing mask


10. Confirm oxygen is flowing

11. Position delivery device on patient

12. Monitor pressure gauge

Fi

ng

er

Fill the bagbefore placing on the patient