BLS Airway Managment

Identify types of oxygen cylinders and pressure regulators
D-400L, Jumbo D-640L, E-680L, M-3450L
High pressure regulators allow for tank-to-tank transfer.
Therapy regulators deliver gas to a patient.
List the steps for delivering oxygen from a cylinder and regulator
Place a therapy regulator on the tank, attach the correct delivery device, turn the regulator on, select the appropriate L-flow, apply O2 to the patient. Lay the tank on its side.
Explain safety considerations of oxygen storage and delivery.
Tank must be secured at all times. During transport it must be strapped down, while delivering O2 the tank must be on its side. O2 supports combustion so care must be taken to ensure no open flames are around.
Describe the indications, contraindications, advantages, disadvantages, complications, liter flow range, and concentration of delivered oxygen for supplemental oxygen delivery devices.
N/C – I: COPD, no F/M tolerance, SpO2 of 90-95%. CI: ∅. A: tolerated well. DA: mouth breathers don’t benefit. C: drying mucosa, sore/bleeding nares. LFR: 1-6L/M. Conc: 22-44%
NRB F/M: I: suspected hypoxemia, SpO2<90%. CI: ∅. A: Increased concentrations of FiO2. DA: may be restrictive. C: <6LPM≥ will accumulate CO2. LFR: 12-15 LPM. Conc: 90-95%
Describe the use of an oxygen humidifier.
Benificial for patients w/ croup, epiglottitis, bronchiolitis, or long term O2 therapy. Moistens respiratory mucosa and/or loosens thick secretions.
Define and explain the implications of partial airway obstruction with good and poor air exchange.
A partial airway obstruction w/ good air exchange allows for good but reduced oxygenation and ventilation, but may become fully obstructed, or cause possible aspiration. A partial airway obstruction w/ poor air exchange will reduce adequate oxygenation, possibly causing hypoxemia and hypoxia, may also become fully obstructed.
Define complete airway obstruction.
A complete airway obstruction, completely closes off the lower airway, ceasing any oxygenation and ventilation.
Describe causes of upper airway obstruction.
Trauma may close off the nasopharynx and larynx. The tongue is the most common airway obstruction in unresponsive patients. Foreign bodies may obstruct the airway. Laryngeal spasm/edema caused by epiglottitis, anaphylaxis, burns, toxic inhalation, trauma and extubation. Aspiration.
Describe complete airway obstruction maneuvers.
Oral or nasal airways in tongue obstruction. Heimlich maneuvers, chest thrusts, back blows, and finger sweep. Laryngoscopy. poss. intubation to force airway. poss. cricothyrotomy. Administration of bronchodilators.
Describe manual airway maneuvers.
Recovery position. Head-tilt Chin-lift, Jaw-thrust w/o cervical spine injury, and without patent airway. Just Jaw-thrust in poss. cervical spine injury.
Explain the purpose for suctioning the upper airway.
To remove fluid or objects from airway.
Improve gas exchange by allowing air to reach the lower airways.
Prevent Atelectasis.
Identify types of suctioning equipment.
Hand-powered
O2-powered
Battery-powered
Mounted Vacuum pump
Describe the indications for suctioning the upper airway.
Secretions, blood, or vomitus in the airway of an unresponsive patient prior to artificial ventilation.
Identify types of suction catheters, including hard or rigid catheters and soft catheters.
Rigid/Hard: Tonsiltip, Yankauer Catheters.
Soft: Whistle tip, Flexible, French Catheters
Identify techniques of suctioning the upper airway.
Preoxygenate before procedure 30sec-1min. Test suction, Measure from corner of mouth to earlobe. Place in mouth w/o suction. Apply suction 10-15 sec, remove w/suction. ventilate 30sec. flush with saline. repeat if necessary.
Identify special considerations of suctioning the upper airway.
Monitor for hypoxia and decreased myocardial oxygenation. May cause dysrhythmias, decreased HR and hypotension. May also increase ICP in TBIs.
Describe the use of an oral and nasal airway.
Maintain an open airway
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for inserting an oropharyngeal airway.
I: Unconscious pt. w/o gag reflex
A: Positions tongue forward, easily placed, improves airway patency, effective bite block.
DA: Head-tilt must be maintained
C: returned gag reflex may stimulate vomiting, complete airway obstruction if sized incorrectly.
C/I: Intact Gag reflex.
Tech: measure from corner of mouth to angle of jaw. Place w/ tip towards top of mouth, rotate 180, and complete insertion w/ flange on teeth/lips.
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for inserting a Nasopharyngeal airway.
I: obtunded or semi-conscious pt. w/ intact gag and potential airway compromise.
A: well tolerated in pt. w/ gag
DA: ∅
C: May kink and injury mucosa causing sever epistaxis. may cause laryngospasm or vomiting if gag intact.
C/I: Head or facial trauma, CSF in ears or nose.
Tech: Measure from tip of nose to angle of jaw or earlobe, lube, insert bevel towards septum until flush.
Define Gastric Distention.
Forcing air into the stomach, not lungs. may cause aspiration. Increased abdominal pressure creates less space for lungs decreasing expansion and exchange.
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for ventilating a patient with mouth to mouth.
I: no equip available
CI: pt. awake or w/known infections
A: good tidal volumes and O2 delivery
DA: Poss. direct contact w/ oral secretions.
C: rescuer hyperventilations, hyperinflation of pt.
Tech: use barrier device, pinch nostrils, give breath.
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for ventilating a patient with mouth to mask.
I: need for ventilation/oxygenation
CI: conscious pt.
A: Easy, reduces risk or exposure.
DA: Rescuer fatigue, Gastric Distention
C: Same as M2M
Tech: Same as M2M
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for ventilating a patient with One person BVM
I: Hypoventilation, ARF, apneic patient.
CI: ∅
A: High FiO2
DA: head/neck position, 2 rescuers required, F/M seal
C: Breath Stacking, Gastric Distention
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for ventilating a patient with two/three person BVM
Same as one person, but added by extra rescuers.
Allows for one person to maintain airway and perform sellick’s, a second to maintain a good seal, a third to squeeze bag.
Describe the Indications, Contraindications, Advantages, Disadvantages, Complications, and techniques for ventilating a patient with a Flow-resticted, oxygen-powered ventilation device.
I: Hypoventilation, ARF, apneic patient.
CI: pt. <16 y/o A: High FiO2, High Vt, easy to use DA: can't feel compliance C: Gastric Distention, pneumothorax
Compare the ventilation techniques used for an adult patient with those used for pediatric patients.
More difficult to maintain a seal, use appropriately sized mask.
Use a pediatric bag: 450-500mL
Use appropriate rates: 18-30 for 6-12y/o
higher for younger up to 30-60 for infants.
Explain the advantage of the two-person method when ventilating with a bag-mask.
Improves seal and improves adequate Tidal Volume.
Describe the Sellick (cricoid pressure) maneuver.
Helps prevent gastric distention. Apply gentle pressure to cricoid cartilage W/ thumb and index finger. released after intubation or during vomiting.
Describe the special considerations in airway management and ventilation for the pediatric patient.
More Flat nasal bridge makes seal difficult use an appropriately sized mask. The internal airway diameter is smaller and the C-rings are not fully developed making positioning of the airway more difficult. Hyperextension occludes the airway, so place padding under the shoulder to compensate. The lungs are smaller so a smaller Tidal Volume must be administered.
Explain the pathophysiology of breath-stacking, specifically the effects on venous return and blood pressure.
Progressive ventilation w/o adequate time for exhalation. Decreases Venous return w/ increased vena cava pressure, and decreases BP(Decreased Preload)
Define Indication
Intervention being considered has been shown to be beneficial
Define Advantage
Reason to give priority to one intervention as compared to another
Define Disadvantage
Comparative reason to give priority to another intervention
Define Complication
Possible outcome of a therapy which negatively impacts the patient’s health
Define Precaution
Action taken by the health care provider to mitigate/prevent complication
Define Contraindication
Predictable harmful outcome, so as to prevent intervention.