Transcript Fisioterapi Kardiovaskuler Pulmonal 2 Pertemuan 12

Oleh:
Slamet Sumarno
251207
Pengantar
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Suction adalah salah satu cara untuk
membersihkan jalan nafas yang
mengalami hambatan karena sputum,
mukus atau skret sehingga jalan nafas
menjadi bersih dan kebutuhan gas
dapat terpenuhi.
Suction harus dilakukan secara tepat,
benar dan aman sehingga dilakukan
dengan proses dan dianalisa tepat
TUJUAN:
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Mempertahankan jalan nafas yang
bebas (hegienis).
Untuk membersihkan sekret pada
pasien yang tidak mampu batuk.
Indikasi
1.
1.
2.
Pasien tidak mampu batuk :
neonatus, tracheatomi, indotracheal
tube
Pasien tidak mampu batuk efektif:
Retensi skret, neonatus, gagal nafas.
Membersihkan berfungsi tube.
Komplikasi
Parengeal suction akan merangsang
syaraf sympatis (N. vagus)
menimbulkan aktif sympatik dan
menyebabkan bradicardi dan henti
jantung dan henti nafas ( vagal
reflek).
Keterangan
umum/Perhatian
1.
2.
3.
Sekret yang menggangu jalan nafas
harus segera dikeluarkan krn dapat
menyebabkan gagal nafas.
Digunakan tehnik aseptik dan alat
steril.
Penghisapan sekret harus dilakukan
dengan prosedur yang tepat untuk
mencegah infeksi, luka, spasme,
udema serta perdarahan jalan nafas.
Keterangan
umum/Perhatian
4.
5.
6.
Lama penghisapan lendir tidak boleh lebih
dari: 5-10 dt untuk bayi dan anak.
10-15 dt untuk dewasa,
Vacum presure:
8-13,6 kPa (60-100 mmHg) untuk bayi.
13 – 20 (100-120 mmHg) untuk anak .
20- 27 kPa ( 120-200 mmHg untuk
dewasa.
Botol penampung sekret harus diisi
dengan cairan aseptik kira-kira ¼
bagian dicatat selama 24 jam dan
diganti.
Keterangan
umum/Perhatian
7.
8.
Untuk menjegah bradikardi selama suction
harus dilakukan pencegahan dengan pre
suction pemberian oksigen pada pasien,
Gunakan kateter suction seperti
indotrache cube.
Suction dapat menstimulasi batuk bila
tidak ada gangguann Vagus dengan
disertai batuk maka mobilisasi scret lebih
mudah.
Suction pada bayi dan
anak
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Sebelum memberikan suction
sebaiknya dibberikan Oksigenasi untuk
memperbaiki Hypoksia, Inspirasi
ooksigen pada gangguan nafas hanya
meningkat k/l 10% pada bayi,
hypoksia jangka pendek dapat
menyebabkan Retinopathy (bayi
prematur) (Robutan 1997)
Intervensi
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Vacum presure diberikan tidak terlalu tinggi
tetapi cukup kuat untuk menarik mukus ke
luar dengan intensitas antara 8-20 kPa (60150 mmHg).
Kateter yg digunakan antara 6-8(french
gange) FG. Ukuran 5 FG atau dibawahnya
tidak efektif, ukuran >10 untuk anak dan
dewasa >10Th
Diameter kateter tidak digunakan 50% dari
diameter jalan nafas.
Prosedur
1.
2.
3.
4.
5.
6.
Terangkan prosedur yang akan dilakukan
pada pasien.
Letakkan alat-alat disamping tempat tidur
pasien.
Jika mungkin buat posisi semi fowler.
Cuci tangan anda dengan aseptik.
Hidupkan sumber penghisap dengan
tekanan sesuai kebutuhan.
Ukur kateter sepanjang ujung hidung
sampai telinga.
Membersihkan melalui
mulut.
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Hubungkan sumber penghisap dinding
dengan penghisap logam.
Masukkan penghisap logam kedalam mulut
tanpa memberi tekanan penghisap,
kemudian lakukan penghisapan sekret
dengan hati-hati.
Hindarkan mata pasien dari percikan sekret
jalan nafas.
Bersihkan kateter logam dengan larutan
steril.
Berikan oksigen pada pasien dan lakukan
penghisapan lagi bila perlu.
Membersihkan memalui
hidung.
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Hubungkan sumber penghisap dengan
kateter penghisap.
Berikan pelicin pada ujung kateter penghisap.
Masukkan kateter penghisap melalui lubang
hidung atau dapat juga melalui mulut dengan
hati-hati tanpa memberikan tekanan pada
penghisap, kemudian lubang penghisap
ditutup dan sekret dihisap sambil kateter
ditarik perlahan-lahan.
Bersihkan kateter penghisap dengan larutan
steril.
Berikan oksigen pada pasien dan lakukan
pengisapan lagi bila perlu.
Untuk pasien dengan pipa
entratrakea terpasang
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Perlu 2 orang untuk penghisapan bila
mungkin, terutama pada anak yang aktif.
Satu memberikan oksigenasi.
Tekan tombal alrm ventilator jika perlu.
Lepaskan hubungan dengan sirkuit
ventilator atau pipa humidifer jika pasien
mempergunakan alat tersebut.
Gunakan ballon pemompa dan beri oksigen
3-5 kali inflasi dengan konsentrasi F1O2:
………
= 10% lebih besar dari konsentrasi O2
yang digunakan untuk neonatus dengan
berat badan kurang dari 3 kg.
=100% untuk pasien lain kecuali ada
ketentuan lain.
Selama prosedur, jaga agar gerakan dada
tetap adekuat dan jika diberikan
ventilator jaga agar tetap dalam
tekanan positif, Hindari tekanan yang
berlebihan.
Bila berat badan bayi kurang dari 2kg
harus dipasang pengukur tekanan pada
sirkuit.
Orang ke dua.
melakukan penghisapan
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Hidupkan penghisap dinding dengan tekanan
sesuai kebutuhan.
Pasang sarung tangan dan letakkan pengalas
diatas dada pasien.
Hubungkan penghisap dengan kateter
penghisap dengan tangan kanan.
Jaga agar kateter tetap steril.
Masukkan kateter kedalam lumen pipa trakea
dengan cepat sejauh mungkin tanpa dipaksa,
dengan lubang kateter terbuka dalam
keadaan tidak menghisap.
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Lakukan penghisapan sekret dengan
menutup lubang penghisap yang ada
disamping.
Kateter penghisap ditarik perlahan-lahan
untuk beberapa cm pertama, kemudian
ditarik secara cepat sambil diputar (rotasi).
Bila kateter sulit ditarik mungkin menempel
pada dinding bronkus, buka lubang
penghisap dan ulangi penghisapan dengan
tekanan lebih rendah.
Selama penghisapan pipa endotrakea
dipegang dengan tangan kiri untuk
mempertahankan posisi.
Hubungkan pipa endotrakea dengan balon
pemompa dan berikan oksigen.
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Pada neonatus dengan berat badan kurang dari 3 kg
konsentrasi O2 10% lebih tinggi dari yang sedang
digunakan. Pada pasien yang lain berikan oksigen
100% kecuali ada intruksi khusus.
Ulangi seluruh prosedur dengan tehnik yang sama
sampai jalan nafas relatif bersih dari sekret.
Selama penghisapan perhatikan warna kulit dan
denyut nadi pasien. Bila terjadi kelainan hentikan
penghisapan dan berikan ventilasi dengan segera.
Kateter penghisap dari endotrakea boleh digunakan
untuk dari mulutatau hidung sebaiknya tidak boleh.
Kembalikan pasien ke sirkuit ventilator atau pipa
humidifer bila sebelumnya tidak digunakan.
Matikan sumber penghisap, slang dalam keadaan
bersih
Peralatan dikembalikan dalam keadaan bersih dan
pasien dalam posisi semula.
Frekuensi penghisapan
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1.
2.
3.
4.
5.
Dilakukan tiap 2 jam bila perlu.
Atau setelah dilakukan chest fisioterapi.
Segera laporkan bila terdapat:
Kesulitan memasukkan kateter penghisap.
Bila skret sudah tidak bisa dihisap.
Sekret yang pekat dan banyak.
Sekret campur darah, berbusa dan atau
berbau.
Penderita sianotik, keadaan menurun,
apnnu dll
Hal-hal yg perlu dicatat
Waktu penghisapan.
2. Keadaan skret: jumlah, warna, bau
dan konsentrasi
3. Hal-hal yang terjadi selama
penghisapan:
Posisi, keadaan selama
penghisapan:
Hipoksia, bradikardi
1.
Respiratory Anatomy
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Nose and mouth :
Lungs
(Menghangatkan,
Visceral pleura (surface of
melembabkan dan menyaring
lungs)
udara).
Parietal pleura (internal
Pharynx
chest wall)
– Oropharynx
– Nasopharynx
Interpleural space
Epiglottis
(potential space)
Trachea (windpipe Cricoid
cartilage
Larynx (voice box).
Bronchi
Larynx
Upper Airway
Epiglottis
Tongue
Glottis
Lower Airway
Sistem
persarafan
pada jalan nafas
V - Trigeminal Nerve
Sensoriknya ke
daerah wajah
(touch, pain
and
temperature)
dan motoriknya
ke Temporal,
massester
Bila terganggu n.
V sensasi &
motorik
terganggu or
dapat
menimbulkan
nyeri =
trigeminal
Trigemin
al
neuralgi
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a
VII - Facial Nerve
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Ekpresi wajah, sensasi lidah anterior 2/3’s, salivary
glands and tear, nasal & palatine glands
Kerusakan otot-otot fasial & penyampaian sensasi(missing
sweet & salty) called Bell’s Palsy
IX - Glossopharyngeal Nerve
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Provides control
over swallowing,
salivation,
gagging,
sensations from
posterior 1/3 of
tongue, control of
BP and
respiration
Damage results in
loss of bitter &
sour taste &
impaired
swallowing.
X - Vagus Nerve
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The
wonderer
Provides
swallowing,
speech,
regulation of
2/3 of GI
tract
Damage
causes
impaired
voice,
Sensory supply of upper
airway
1) Mucouse membrane of nose : n. cranial. V
(trigeminal .)
 ophthalmic div. V1 (ant. Ethmoidal n. ) : ant.
part of nose
 maxillary div. V2 (sphenopaltine n.) : post.
part of nose
2) Soft and hard palate : palatine n.
3) Tongue
 br. of mandibular div V3 (lingual n.) : ant. 2/3
general sensation
 dan 1/3 oleh n. IX (glossopharyngeal n.)
 branch of VII ( facial n.) & IX : sensation of
taste
Sensory supply of upper
airway
4) Glossopharyngeal n (IX) : pharynx roof,
tonsil soft, palate under-surface innervation
5) Vagus n.(X) : epiglottis , airway , sensation
 Sup. Laryngeal br. : ext. br (motor) int. br
(sensory)
epiglottis, vocal cord , sensory supply
 Recurrent laryngeal n. : vocal cord ,
trachea , sensory supply
ANATOMY
Laryngeal n. injury
1) Sup. laryngeal n. (ext. laryngeal n. motor n. 로 cricothyroid m)
 unilat. : minimal effect
 bilat. : hoaresness, tiring of voice (but airway effect voice)
2) Recurrent laryngeal n.
 unilat. : ipsilat. Vocal cord paralysis (voice quality )
 bilat . : acute : stridor, respiratory distress
chronic : aphonia
3) Vagus n.
 unilat. :hoarseness
 bilat. : aphonia
Respiratory physiology
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Diaphragm
Inhalation (active process)
– Diaphragm and intercostal muscles
contract, increasing the size of the
thoracic cavity.
– Diaphragm moves slightly downward, ribs
move upward and outward.
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The negative pressure in the chest
cavity causes air flow into the lungs.
Respiratory physiology
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Exhalation (passive process)
Diaphragm and intercostal muscles
relax decreasing the size of the
thoracic cavity.
– Diaphragm moves upward, ribs move
downward and inward.
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The positive pressure inside the chest
cavity causes air flow out of the lungs.
Respiratory Physiology
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Oxygenation - blood and the cells become
saturated with oxygen
Hypoxia - inadequate oxygen levels in the
blood
Signs of Hypoxia
–
–
–
–
–
Increased or decreased heart rate
Altered mental status (early sign)
Agitation
Initial elevation of B.P. followed by a decrease
Cyanosis (often a late sign)
Alveolar Gas Exchange
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Oxygen-rich air enters the alveoli
during each inspiration.
Oxygen enters the blood in the
capillaries as carbon dioxide enters the
alveoli for exhalation.
Infant and Child
Considerations
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Mouth and nose - generally all structures
are smaller and more easily obstructed than
in adults.
Pharynx - infant’s and children’s tongues
take up proportionally more space in the
mouth than adults.
Trachea - (windpipe)
– Infants and children have narrower tracheas that
are obstructed more easily by swelling.
– Trachea is softer and more flexible in infants and
children.
Infant and Child
Considerations
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Cricoid cartilage - like other cartilage in the
infant and child, the cricoid cartilage is less
developed and less rigid. It is the narrowest
part of the infant’s or child’s airway.
Diaphragm - chest wall is softer, infants and
children tend to depend more heavily on the
diaphragm for breathing.
Opening the Mouth
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Crossed-finger technique
Inspect the mouth
– Vomit
– Blood
– Secretions
– Foreign bodies
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Be extremely cautious
– Fingers
– Gag or vomit
Opening the Airway
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Head-tilt, chin lift maneuver
– Adults vs.. Infants and Children
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Jaw thrust maneuver
Techniques of Suctioning
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Dasar intervensi suction: precautions
Maksud/ tujuan
– Mengalirkan benda asing dlm saluran
nafas spt: blood, liquids, and food
particles.
– Patient needs to be suctioned dengan
segera saat pasien ada suara meneguk
Types of Suction Units
1. Mounted Suction Devices
– Fixed on-board the ambulance
– 300mmHg pull on gauge when tubing is
clamped
– Should be adjustable (disesuaikan) for
infants and children
2. Portable Suction
Devices
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Electric - battery powered
Oxygen - powered
Hand - powered
Each device must have
– Wide-bore, thick walled, nonkink tubing
– Plastic collection bottle, supply of water
– Enough vacuum to clear the throat
3. Suction Catheters
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Catheter keras (yankaeur)
Penyulit pemakaian :
– Masuk lewat mulut.
– Terhambat Tonsil dan lidah.
– Used to suction mouth and oropharynx
– Inserted a limited depth
– Use caution on infants and children
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Soft tissue damage
Suction Catheters
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Soft catheter (French catheter)
– Used to suction mouth or nose and
nasopharynx
– Measured from tip of the nose to the tip
of the ear.
– Not inserted beyond the base of the
tongue
Techniques of Suctioning
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Posisikan pasienn yg baik terlentang atau miring
kan kepala dan badan bila bayi/anak. (Best
positioned at patient’s head)
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Perhatikan perubahan suction unit
Pilih catheter yg pas ukurannya, diameter catheter
50% Diameter jalan nafas.
Ukur/periksa dan berapa dalam chateter dapat
masuk
Suction from side to side
– Dewasa tidak lebih 15 seconds
– Infants & children Kurang dari 15 seconds (5-10)
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Bilas catheter dengan air desinfectance.
Special Considerations
(pertimbangan khusus).
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Bila Secret tidak dapat terhisap dianjurkan
dibantu dengan dibersihkan dengan jari.
Patient producing frothy secretions as
rapidly as suctioning can remove them
– Suction 15 seconds
– Positive pressure with supplemental
oxygen for 2 minutes then suction again
and repeat the process
Residual air removed from lungs, monitor
pulse and heart rate
Suction
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The importance of readiness can
not be overstated.
Study of suction equipment utilization.
Prehosp Emerg Care 1997 Apr-Jun;
1(2):91-5
Kozak RJ, Ginther BE, Bean Study of
suction equipment utilization.
The paramedics reported:
carrying suction equipment to the scene
of medical aid calls less than 25% of the time.
suction equipment is utilized during 50% of
advanced airway procedures.
WS.
Suction - Key Points
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Diingatkan agar memahami
dasar-dasar pemberian suction.
Suctions are limited in what they
remove
Immediate action is needed
Have a secondary device
Oropharyngeal Airway
(OPA)
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Used to maintain a patent airway only
on deeply unresponsive patients
No gag reflex
Designed to allow suctioning while in
place
Must have the proper size
If patient becomes responsive and
starts to fight the OPA remove it...
Inserting the OPA
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Select the proper size (corner of the mouth
to tip of the ear)
Open the patient’s mouth
Insert the OPA with the tip facing the roof
of the mouth
Advance while rotating 180°
Continue until flange rests on the teeth
Infants and children insertion
Nasopharyngeal Airway
(NPA)
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Nose hose, nasal trumpet
Used on patients who are unable to tolerate
an OPA or is not fully responsive
Do not use on suspected basilar skull
fracture
Still need to maintain head-tilt chin lift or
jaw thrust when inserted
Must select the proper size
Made to go into right nare or nostril
Inserting the NPA
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Select the proper size in length and
diameter
Lubricate
Insert into right nostril with bevel
always toward the septum
Continue inserting until flange rests
against the nostril
Insertion into left nostril
Assessment of Breathing
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After establishing an airway your next
step should be to assess breathing
Look
– Breathing pattern regular or irregular
– Nasal flaring
– Adequate expansion, retractions
Assessment of Breathing
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Listen
– Shortness of breath when speaking
– Unresponsive place ear next to patients
mouth
– Is there any movement of air?
Assessment of Breathing
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Feel
– Check the volume of breathing by placing
you ear and cheek next to the patient’s
mouth
Assessment of Breathing
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Auscultate
– Stethoscope
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Mid clavicular about the second intercostal
space and the fourth or fifth anterior
midaxillary line or next to sternum
– Check both sides
Present and equal bilaterally
 Diminished or absent
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Adequate Breathing
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Normal rate
– Adult 12 - 20/min
– Child 15 - 30/min
– Infant 25 - 50/min
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Rhythm
– Regular
– Irregular
Ventilation Volume
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Tidal volume-air inspired in each
breath
Minute volume-tidal volume multiplied
by the respiratory rate
Adequate Breathing
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Quality
– Breath sounds present and equal
– Chest expansion adequate and equal
– Effort of breathing
 use of accessory muscles
predominately in infants and children
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Depth (tidal volume)
– Adequate chest rise and fall
– Full breath sounds heard
Inadequate Breathing
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Rate
– Outside the normal limits
Tachypnea (rapid breathing) >20
 Badypnea (slow breathing) <12
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Rhythm
– Irregular breathing pattern
Inadequate Breathing
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Quality
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–
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–
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Breath sounds diminished, noisy or absent
Excessive use of accessory muscles, retractions
Reduced air flow at nose/mouth
Inadequate chest expansion
Nostril flaring (infants & children)
Depth
– Shallow (impaired depth) breathing
– Agonal respirations - occasional gasping
respirations
Inadequate Breathing
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Skin Color
Retractions
“Seesaw” breathing (abd & chest move
in opposite directions)
Any of these signs is by itself may be
reason to ventilate a patient without
delay
Positive Pressure
ventilation
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The practice of artificially ventilating,
or forcing air into a patient who is
breathing inadequately or not
breathing at all
Techniques of Artificial
Ventilation
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In order of preference
– Mouth to mask
– Two-person bag-valve-mask
– Flow-restricted oxygen-powered
ventilation device
– One-person bag-valve-mask
Considerations When Using
Artificial Ventilation
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Maintain a good mask seal
Device must deliver adequate volume
of air to sufficiently inflate the lungs
Supplemental oxygen must be used
Adequate Artificial
Ventilations
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Chest rises and falls with each
ventilation
Rate of ventilations are sufficient
Heart rate returns to normal
Color improves
Inadequate Artificial
Ventilations
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Chest does not rise and fall
Ventilation rate is too fast or slow
Heart rate does not return to normal
Color is not improved
Mouth-to-Mouth
Ventilation
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Air we breath contains 21% oxygen
5% used by the body
16% is exhaled
Danger of infectious disease
Mouth-to-Mask
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Eliminates direct contact with patient
One-way valve system
Can provide adequate or greater
volume than a BVM
Oxygen port (should be connected to
15 lpm)
Bag-Valve-Mask (BVM)
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EMT-B can feel the lung compliance
Consists of self-inflating bag, one-way valve,
face mask, intake/oxygen reservoir valve,
and an oxygen reservoir.
By adding oxygen and a reservoir close to
100% oxygen can be delivered to the
patient
When using a BVM an OPA/NPA should be
used if possible
Bag-Valve-Mask Cont...
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Volume of approximately 1,600 milliliters
Provides less volume than mouth-to-mask
Single EMT may have trouble maintaining
seal
Two EMT’s more effective
Pop-off valve must be disabled
Available in infant, child, and adult sizes
Bag-Valve-Mask Cont...
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Breaths should be 1.5 to 2 seconds
Guard against overinflation
Monitor the seal
Bring the jaw to the mask
Bag-Valve-Mask Cont...
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Assisted ventilations for hyper or
hypoventilating patients
– Explain procedure
– Place the mask
– Squeeze bag on inhalation
– Over next 5 to 10 breaths slowly adjust
rate and tidal volume to desired rate and
volume
Sellick Maneuver
Sellick Maneuver
Mask ventilation will be
made difficult by:
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poor mask seal -- beards
facial burns
facial scarring/cuts
facial dressings
edentulous patients
any evidence of airway obstruction
neck instability
penetrating neck trauma
repeated failed direct laryngoscopy
obesity/bull neck
Other ventilation techniques
will be made difficult by:
• lack of knowledge and
experience
• lower airway obstruction
• neck instability
• penetrating neck injury
Flow-Restricted, OxygenPowered Ventilation Device
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Known as a demand-valve device
Can be operated by patient or EMT
Unable to feel lung compliance
With proper seal will deliver 100% oxygen
Designed for use on adult patients
Gastric distension
Rupture of the lungs
A trigger positioned to allow EMT to keep
both hands on the mask
Automatic Transport
Ventilators
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Deliver 100% oxygen
Provide and maintain a constant rate and tidal
volume during ventilation
Advantages
– Frees both hands
– Rate, & tidal volume can be set
– Alarm for low oxygen tank
Disadvantages
– Oxygen powered
– not used in children under 5
– Cannot feel increase in airway resistance
Oxygen Therapy


Oxygen is a drug that can be given by
the EMT-B
“Generally speaking”, a patient who is
breathing less than 12 and more than
24 times a minute needs oxygen
Oxygen Dangers




Oxygen supports combustion, (it is not
flammable)
Avoid contact with petroleum products
Smoking
Handle carefully since contents are
under pressure
Oxygen Cylinders







All of the cylinders when full are the
same pressure of 2,000 psi.
Usually green or aluminum grey
D cylinder - 350 liters
E cylinders - 625 liters
M cylinders - 3,000 liters
G cylinders - 5,300 liters
H cylinders - 6,900 liters
High-Pressure Regulator


Provides 50 psi to an oxygen-powered,
ventilation device.
Flow rate cannot be controlled
Low Pressure/Therapy
Regulator


Permit oxygen delivery to the patient
at a desired rate in liters per minute
Flow rate can go from 1 to 25
liters/min.
Oxygen Humidifiers



Dry oxygen is not harmful in the short
term
Generally not needed in prehospital
care
Transport time of an hour or more
humidifier should be considered
Changing Oxygen Bottle






Check cylinder for oxygen remove protective
seal
Quickly open and shut tank to remove
debris
Place regulator over yoke and and align
pins.
Make sure new O ring is in place
Hand tighten the T screw
Open to check for leaks
Nonrebreather Mask






Preferred method of giving oxygen to
prehospital patients
Up to 90% oxygen can be delivered
Bag should be filled before placing on
patient
Flow rate should be adjusted to 15
liters/min.
Patients who are cyanotic, cool, clammy or
short of breath need oxygen
Concerns of too much oxygen
Nasal Cannula






Provides limited oxygen concentration
Used when patients cannot tolerate mask
Prongs and other uses
Concentration of 24 to 44%
Flow rate set between 1 to 6 liters
For every liter per minute of flow delivered,
the oxygen concentration the patient inhales
increases by 4%
Nasal Cannula Flow Rates






1
2
3
4
5
6
liters/min.
liters/min.
liters/min.
liters/min.
liters/min.
liters/min.
=24%
= 28%
= 32%
= 36%
= 40%
= 44%
Simple Face Mask




No reservoir
Can deliver up to 60% concentration
Rate 6 to 10 liters/min.
Not recommended for prehospital use
Partial Rebreather Mask



Similar to nonrebreather except it has
a two-way valve allowing patient to
rebreath his exhaled air.
Flow rate 6 to 10 liters/min.
Oxygen concentration between 35 to
60%
Venturi Mask



Provides precise concentrations of
oxygen
Entrainment valve to adjust oxygen
delivery
Mostly used in the hospital setting for
COPD patients
Special Situations
Inhaler Therapy



History
Medical Direction
Review of specific bronchodilator
medication
Laryngectomies (Stomas)




A breathing tube may be present
If obstructed, suction it
Some patients may have partial
laryngectomies
Be sure to close the mouth and nose
to prevent air escaping
Infants and Child Patients






Neutral position infant
Just a little past neutral for child
Avoid hyperextension of head
Avoid excessive BVM pressure
Gastric distension more common in children
Oral or nasal airway may be considered
when other procedures fail to clear the
airway
Obstruction
Anything (food, blood, swollen
tissue, vomit) that blocks the
airway will cause some level of
decrease of available oxygen to the
body.
Obstruction
The size of obstruction affects the
available air exchange.
For example, snoring will reduce air
Exchange while a food bolus can
actually stop air exchange.
Obstruction

When obstruction persists, repeat
FBAO procedures three times and
transport as soon as possible.
Facial Injuries



Rich blood supply to the face
Blunt injuries and burns to the face
result in severe swelling
Bleeding into the airway can be a
challenge to manage
Jaw Thrust
Technique Suction.







Gunakan cateter steril untuk mencegah nasocomial (infeksi
dirumah sakit).
Sebelum suction informasikan ke keluarga/pasien apa maksud
anda melakukan suction.
Siapkan alat siap pakai.
Sebelum dan sesudah suction dapat diberikan terapi oksigen
untuk mencegah vagal reflek.
Lakukan dengan waktu suction 3-5 detik untuk anak dan 5-10
atau 10-15 detik untuk dewasa.
Vacum presure =60-150 mmHg untuk dewasa dan 40-80
mmHg untuk anak ( 8- 20 kPa dewasa) 6-12 kPa anak
(Tergantung kepekatan mukus).
Dengan nafas dalam akan merangsang batuk pada sebagian
pasien.