Airway and Ventilation Michael Clanton, M.Ed, ATC, CSCS, EMT-I Director of Athletic Training Brenau University UGA ATEC Course May 17th - 19th.
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Transcript Airway and Ventilation Michael Clanton, M.Ed, ATC, CSCS, EMT-I Director of Athletic Training Brenau University UGA ATEC Course May 17th - 19th.
Airway and Ventilation
Michael Clanton, M.Ed, ATC,
CSCS, EMT-I
Director of Athletic Training
Brenau University
UGA ATEC Course May 17th - 19th
Need to Breathe
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2
Need to Breathe
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Respiration
Respiration is defined as the
sum of the physical and
chemical processes in an
organism by which oxygen is
conveyed to the tissues and
cells and the oxidation products
, carbon dioxide and water are
given off
…
Four Stages
1)Air into Body
2) Oxygen onto
RBCs
3)RBCs to cells
4)Transfer o2/Co2
at cellular level
Reverse Procedure
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Airway Control
Ensuring airway is the first priority in
trauma management and
resuscitation
Remember to consider cervical spine
injuries in securing the airway
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Opening the Airway
Techniques
Head-tilt/Chin-lift
Jaw Thrust
Suctioning
Nasopharyngeal
airway
Oropharyngeal
airway
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6
Clearing the Airway
The first step in airway management
is a quick visual inspection
Foreign material (blood, teeth, food)
needs to either be swept away with
your finger or use suction (vomitus)
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Manuel Maneuvers
In unresponsive patients the tongue
becomes flaccid, falling back and
blocking the hypopharnyx.
The tongue is the most common
cause of airway obstruction
Any maneuver that moves the
mandible forward will pull the tongue
out the hypopharnyx
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Manuel Maneuvers
Trauma Jaw Thrust
Trauma Chin Lift
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Trauma Jaw Thrust
This is for patients with suspected cervical
spine injuries
It allows the cervical spine to stay in the
neutral position
The mandible is thrust forward by placing
the thumbs on each zygoma (cheekbone),
placing the index and long fingers on the
mandible and at the same angle pushing
the mandible forward
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Jaw Thrust
Used when spinal injury
suspected
Temporary procedure
Must be replaced with airway
adjunct unless patient begins
adequate spontaneous ventilation
11
Trauma Jaw Thrust
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Modified jaw-thrust in trauma
13
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Jaw Thrust
Technique
Place one hand on either side of
patient’s head, resting elbows on surface
on which victim is lying
Grasp angles of patient’s lower jaw, lift
with both hands
If patient’s lips close, retract lower lips
with thumbs
14
Jaw-thrust maneuver
15
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Jaw Thrust
Patients needing jaw thrust
Unresponsive trauma patient
Unresponsive patient with
undetermined mechanism of injury
16
Trauma Chin Lift
The chin and lower incisors are
grasped and then lifted to pull the
mandible forward.
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Trauma Chin lift
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Head-Tilt/Chin-Lift
Used when no neck injury is
suspected
Temporary procedure
Must be replaced with an airway
adjunct unless patient begins
adequate spontaneous ventilation
19
Head-tilt/chin-lift
20
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Head-Tilt/Chin-Lift
Technique
Place one hand on patient’s
forehead
Apply firm, backward pressure with
palm causing head to tilt backward
Place fingers of other hand under
bony part of patient’s lower jaw
near chin
Lift jaw upward to bring chin
forward
21
Head Tilt Chin Lift
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Head-Tilt/Chin-Lift
Patients needing head-tilt/chin-lift
Unresponsive patient without history
of trauma
Cardiac arrest patients without signs
of trauma
Apneic patients without signs of
trauma
23
Suctioning
Purpose
Remove blood, vomit, other liquids,
food particles from airway
May not be adequate for removing
large, solid objects (teeth, foreign
bodies, food)
Should be performed immediately
when gurgling is heard with
spontaneous or artificial ventilation
24
Suctioning
Suction devices
Mounted in ambulance
Portable
Electrical
Hand operated
Should generate 300mm Hg vacuum
Ensure batteries in units remain
properly charged
25
Suctioning
V-VAC
Hand powered
Disposable
Ease of use
Always suction on
the way out
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SUCTION CATHETERS
Hard/Rigid
Use with unresponsive athlete
Soft (French)
Use to suction nasopharynx
Suctioning
Rigid Suction Catheter
Used to suction mouth, oropharynx
of unresponsive patient
Inserted only as far as you can see
Take caution not to touch back of
airway, particularly in infants and
children (can cause heart rate to
drop)
29
Suctioning
Soft Suction
Catheter
Useful for
suctioning
nasopharynx or
tracheostomy
tubes
Should be
inserted only as
far as base of
tongue or end of
tracheostomy UGA ATEC Course
tube
30
SUCTION TECNIQUES
Insert catheter without suction
Insert only to tougue base
Apply suction 15 seconds max.
SPECIAL SUCTION
SITUATIONS
1. If suction does not work
quickly & easily - Log roll
and clear oropharynx
2. Frothy secretions form as
rapidly as suction can remove,
suction 15 seconds
- Ventilate 2 minutes\Repeat
Suctioning Videos
http://www.youtube.com/watch?v=7
LSRIOtmX_c&feature=related
http://www.youtube.com/watch?v=T
wNSNodYfEw&feature=related
33
Airway before
applying Sellick’s
34
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Sellick’s maneuver
(cricoid pressure)
35
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Oropharyngeal Airway
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Oropharyngeal Airway
The most frequently used airway
Inserted either direct or inverted
Indications
Patient who is unable to maintain
airway
To prevent intubated patient from
biting ET tube
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Oral Airways
Used on
unresponsive
patients without
gag reflex
Helps hold tongue
away from back of
throat
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38
Oral Airways
Patients needing oral airway
Unresponsive, apneic patients with or
without trauma
Any apneic patient being ventilated with
a BVM
39
Types of Oral Airways – Berman
(hollow edges) & Geudal (hollow
middle)
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40
Oropharyngeal Airway
Contraindications
Patient who is conscious or
semiconscious
Complications
Because it stimulates the gag reflex,
the use of OPA may lead to gagging ,
vomiting, and laryngospasms in
patients who are conscious
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Oropharyngeal Airway
Sizing
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Oropharyngeal Airway
Insertion
There are 2 ways
Insert and rotate 180 degrees
Use a tongue depressor to hold push
the tongue back and insert( for
children and infants)
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Rotate airway 180º into position.
45
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Improper placement of
oropharyngeal airway
Tongue
46
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UGA ATEC Course May 17th - 19th
Oropharyngeal Airway
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Oropharyngeal Airway
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Oropharyngeal Airway
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Oropharyngeal Airway
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Oral Airway videos
http://www.bing.com/videos/watch/vi
deo/oropharyngeal-airway-insertionanimationsample/4c75a32d7ab31818e53a4c75
a32d7ab31818e53a932854628358?q=video%2bof%2bna
sal%2bairway%2binsertion&FROM=L
KVR5>1=LKVR5&FORM=LKVR&adlt
=strict
http://www.youtube.com/watch?v=s
VlRylzLor0&feature=related
52
Nasopharyngeal airway, inserted
53
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Nasopharyngeal Airway
The NPA is a soft,
rubberlike device
that is inserted
through one of the
nares and then
along the curvature
of the posterior
wall of the
nasopharynx and
oropharynx
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Nasopharyngeal Airway
Indications
Patient who is unable to maintain
their airway
Contraindications
Avoid with patients who have a
suspected Fx to base of the skull or
mid face Fx
Complications
Bleeding caused by insertion
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Nasal Airways
Used on responsive
patients who need
help keeping tongue
out of airway
Insertion is
uncomfortable for
responsive patients
Not to be used in
patients with
suspected skull
fractures, oral
maxilfacial trauma
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56
Nasal Airways
Patients needing
nasal airway
Unresponsive
patients who are
snoring
Unresponsive
patients with gag
reflex
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57
Nasal Airways
Technique
Measure from tip of nose to earlobe
Ensure airway will fit through nostril
Lubricate with water-soluble lubricant
Insert with bevel toward base of nostril or
septum
If resistance is met, try other nostril
Do not use in patients with mid-face trauma
or possible basilar skull fractures
58
Nasopharyngeal Airway
Insertion
Lubricate the nasal
airway
Use the right nares
first
Beveled side in
Stop if you hit an
obstruction and go
to the other nares
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Nasopharyngeal Airway
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Nasal Airway Videos
http://www.youtube.com/watch?v=h
qwS6e8aLJs&feature=related
http://www.youtube.com/watch?v=9r
wXFIJPfEs&feature=related
61
Airway Limitations
Nasal/oral airways are not definitive
devices
Manual maneuvers must be used with
nasal/oral airways to ensure airway
stays open
Patients may require frequent
suctioning to remove blood, vomit,
other secretions from airway
Definitive devices such as endotracheal
tubes are required to completely
protect the airway
62
Special Considerations in
Airway Management
Anaphlaxis-Angioedema causing
engorgement of tissue occluding
ariway
Laryngeal Fractice-Trauma resulting
in bleeding or structural changes to
entrance to lower airway
2008 Finnish study found sports to be
the cause in 39% of all cases in the
study.
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Laryngeal Fractures
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Needle Cricothyroidectomy
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Athletes with Laryngeal
Fractures
Steve Yeager-LAD C
Stefon Johnson-USC
RB
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Needle Cricothyroidectomy
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Oxygen Delivery
“When in doubt err on benefiting the
patient and deliver oxygen.”
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BLS Airway/Ventilation Methods
Supplemental Oxygen
Increased FiO2
increases available
oxygen
Objective = Maximize
hemoglobin saturation
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69
Oxygen
Concerns about giving too much
oxygen to patients with COPD,
infants, and children are NOT
valid during short-term
emergency administration
Patients with COPD, infants, and
children who require oxygen
should be given high
concentration oxygen.
34
Oxygen Delivery
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Oxygen Delivery
Oxygen is an odorless, colorless gas
normally present in the atmosphere at 21%
Oxygen cylinders vary in size from D – 350
liters to H – 6900 liters.
The are colored green or have a green top
half.
Even though the volume may vary the
pressure is the same when the cylinders
are full at 2,000 psi
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Oxygen Delivery
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Oxygen Delivery
Indications for O2 Use
Any patient with an altered mental status or
who is unresponsive
Injuries to any body cavity or central nervous
system component
Multiple Fxs and multiple soft tissue injuries
Severe bleeding
Any evidence of shock
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Oxygen Delivery
Indications for O2 Use
Any patient in cardiac arrest or respiratory
arrest
Any signs of hypoxia in a patient with an
adequate respiratory rate and adequate tidal
volume
Medical conditions that may cause hypoxia to
cells or organ, such as stroke, heart attack,
drug overdose, asthma attack, allergic
reaction, seizures, airway obstruction and
environmental emergencies
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Oxygen Delivery
Safety Precautions
Never allow
combustible materials
such as oil or grease
to touch the cylinder,
regulator or fittings.
Never smoke or allow
someone to smoke in
the area where they
are in are located or in
use.
Store them below 125
degrees Fahrenheit
Never use without a
safe, properly fitting
regulator Keep all
valves closed
Store them laying
down or secured
strapped standing up.
They are under
pressure and could be
punctured and move
like an missile
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Pressure Regulators
Gas flow from the O2
cylinder is controlled
by a regulator that
reduces the high
pressure to a safe
range of 30 to 70 PSI
and controls the flow
of O2 from 1 to 15 lpm
These regulators
connect to the cylinder
at the yoke
The regulator
generally has 2 gauges
or a gauge and a dial
The gauge indicates
the pressure in the
tank and the dial
selects the flow of O2
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Delivery
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Oxygen Administration Videos
http://www.youtube.com/watch?v=fy
g5FnGk0zA&feature=related
http://www.youtube.com/watch?v=2
KaP18PjUmU&feature=related
http://www.youtube.com/watch?v=z
dIXQVVuLs4&feature=related
86
BLS Airway/Ventilation Methods
Mouth to Mouth
Mouth to Nose
Mouth to Mask
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87
Delivery Devices
Nasal cannula
Simple face mask
Partial rebreather mask
Non-rebreather mask
Venturi mask
Small volume nebulizer
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88
Oxygen Delivery Devices
Device
Oxygen Percentage
Nasal cannula
24% - 44%
Venturi mask
24, 28, 35, or 40%
Simple face mask
40 – 60%
Nonrebreather mask
80 – 95%
89
Oxygen Administration
Oxygen Delivery Systems
Device
Function
Common Flow Rate
Oxygen Concentration
Nasal cannulla
1-4 lpm
24-36
Mask
6+ lpm
35-55
Breathing and non
breathing
BVM
10+ lpm
90+ %
nonbreathing
Breathing victims only
Breathing and
Pocket Masks
The ideal mask has the following
characteristics
Is a good fit
Is equipped with a one way valve
Is made of a transparent material
Has a supplemental oxygen port
Is available in adult, pediatric and
infant sizes
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Oxygen Administration
Selecting a Resuscitation
Mask
Be transparent and made
out of a pliable material
Have a one-way valve
Have a standard coupling
assembly
Have an inlet for
supplemental oxygen
Work well in all
environmental conditions
Be easy to assemble and
use
Pocket Masks
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Nasal Cannula
Delivery 1-6 LPM
24 to 44%
Indication
Low FiO2
Long term
therapy
Contraindications
Apnea
Mouth breathing
Need for High
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FiO2
94
Oxygen Delivery
Nasal Cannula
Rarely the best method
Thus, DO NOT USE WITH
ATHLETES
Venturi Mask
Specific O2
Concentrations
24%
28%
35%
40%
Not a good choice
in Athletic
situations
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96
Oxygen Delivery Equipment
Non rebreather
mask
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Indications for Nonrebreather
Cyanotic (blue)
Cool
Clammy
Short of Breath
Oxygen Delivery
Nonrebreather Mask
Preferred method of delivery
Up to 90% oxygen can be delivered
Technique- reservior bag fill before
placement
15 LPM Flow rate
Non-Rebreather
The preferred method in the pre-hospital
setting
This device has an O2 reservoir bag
attached to a mask with a one way valve
With use of an nonrebreather mask the
patient is delivered 90%- 100% O2
The flow rate for a nonrebreather is 15 lpm
Inflate the reservoir bag completely before
applying it to the patient
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Bag-Valve -Mask
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Bag Valve Mask Device
Bag Valve device
Hand powered
Room air 21%
Oxygen @ 15 LPM
= 60%
Oxygen @ 15 LPM
with reservoir =
95%
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102
Oxygen Administration
Concentration of Oxygen
Delivered
Rescue breathing - 16%
Resuscitation mask - 16% w/ O2
it goes up to 50 %
BVM - 21% and w/ O2 it goes
up to 100%
Oxygen Administration
Advantages of BVM
Higher concentration of
oxygen than mask alone
Limits potential for
disease transmission
It is very effective when
used by two rescuers
Disadvantages
It is a tough skill for 1
rescuer to master
Without practice you
cannot stay proficient
It takes longer to
assemble
It is not readily available
to you
BLS Airway/Ventilation Methods
One-Person BVM
Difficult to master
Mask seal often inadequate
May result in inadequate tidal volume
Gastric distention risk
Ventilate only until see chest rise
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105
BLS Airway/Ventilation Methods
Two-person BVM
Most efficient method
Useful in C-spine injury
improved mask seal, tidal volume
Three-person BVM
Less utilized
Used when difficulty with mask seal
Crowded
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106
Bag-Valve -Mask
The BVM consists of a self inflating bag and
a nonrebreathing device
It can be used with basic or advance
airways
Most on the market today have a volume of
1600 ml and can deliver O2 concentration
of 90% to 100%
Children under 8 and infants use a BVM of
450 to 500 ml
Some models have a built in CO2 detector
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Bag-Valve -Mask
A BVM should have the following features
A self refilling bag
A non jamming valve system that lets in 30
lpm
Standard fittings to fit a variety of adjuncts
An O2 inlet and reservoir that can be
connected to an O2 source
A true nonrebreather valve
Adaptability to all environmental conditions
A variety of mask sizes
Transparent mask
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BVM Techniques
UGA ATEC Course May 17th - 19th
Oxygen Administration
To maintain a tight seal and
an open airway follow
these three steps
Tilt the persons head
back
Lift the jaw upward
Keep the mouth open
If you suspect a head or
neck injury use the jaw
thrust technique
BVM Techniques
Single Person Technique
Straddle the head
Thumb over the bridge of the nose
Index finger over the cleft above the chin
Seal the mask with your thumb and index finger while
pulling up on the mandible with your other fingers
The “E-C” technique will be performed with one hand
Squeeze the bag with the other hand
The bag may be compressed against your body if you
have small hands
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BVM Techniques
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Oxygen Administration
Using the BVM
Resuscitator
It is best that a BVM be
used by two rescuers
One rescuer positions the
mask and opens the
airway
The first rescuer
maintains a tight seal
while the second provides
ventilation's by squeezing
the bag
The two person technique
is preferred because of
the tight seal.
BVM Techniques
2 Person technique
Position yourself at the
top of the patients
head
Open the airway using
proper technique
Select the correct size
mask and insert an
airway if needed
Place the upper narrow
part of the mask over
the bridge of the nose
and lower it over the
mouth and chin
Place your thumbs on
the top half and your
index fingers over the
bottom
The other person
should squeeze the
bag with 2 hands
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BVM Techniques
With O2 connected the flow rate is 15 lpm
Deliver steadily over 1 second until chest rise
If no O2 you should ventilate over 1 to 2
second period until the chest obviously rises
Children should be 1 to 1.5 seconds
Connect O2 as soon as possible
Your patient may be awake and conscious
when you use a BVM. Check their O2
saturation. The BVM may be used to increase
respiration rate
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Bag Valve Mask Videos
http://www.youtube.com/watch?v=J
Wm4FG6k3TY&feature=related
http://www.youtube.com/watch?v=fh
MeMXXpZAc&feature=related
116
Thank You!
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Flail Chest
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Flail Chest
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Pneumothorax
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Pneumothorax
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Tension Pneumothorax
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Treatment for Tension
Pneumothorax
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Advanced Airway Adjuncts
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Combi-Tube
Combi-Tube
•Under medical direction only
•Two types available,
depending on size of the
athlete
•Need to lubricate with KY
jelly before use.
•Inflate balloons before
insertion to make sure they
are functioning properly
•Always inflate blue then
white -the same with
deflation.
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Combi-Tube
Insert with a thumb grasping tongue and forefinger
the jaw – insert until black line are at the teeth
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Combi-Tube
Combi-Tube Installed
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King LTD Airway
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King LTD Airway
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King LTD Airway
Test cuff and inflation
system for leaks by
injecting the maximum
recommended volume of
air into the cuffs (size 4 80 ml; size 5 - 90 ml).
Remove all air from both
cuffs prior to
insertion. The inflation
volume is printed on the
tube.
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King LTD Airway
Apply lubricant to the beveled distal tip and posterior aspect
of the tube, be careful that you don’t get lubricant into the
ventilation openings.
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King LTD Airway
The ideal head position for insertion of the
KING LT-D is the “sniffing position”.
However, the angle and shortness of the
tube also allows it to be inserted with the
head in a neutral position.
Hold the KING LT-D at the connector with
your dominant hand. hold mouth open and
apply chin lift with your other hand.
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King LTD Airway
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King LTD Airway
Rotate the King
Airway laterally 4590 degrees so that
the blue orientation
line is touching the
corner of the
mouth. Introduce
the tip into mouth
and advance the
airway behind the
base of the tongue.
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King LTD Airway
As tube tip passes
under the tongue,
rotate the tube
back to midline
(blue orientation
line facing chin).
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King LTD Airway
Without exerting
excessive force,
advance tube until
base of connector
is aligned with
teeth or gums.
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King LTD Airway
Using the syringe
provided, inflate
the cuffs of the
KING LT-D with the
appropriate
volume: Size 4 70
ml Size 5 80 ml
Inflation volume is
printed on the
tube.
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King LTD Airway
Attach BVM to the
KING LT-D. While
gently bagging the
patient to assess
ventilation,
simultaneously
withdraw the KING LTD until ventilation is
easy and free flowing
(large tidal volume
with minimal airway
pressure).
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King LTD Airway
Secure KING LT-D to patient using tape or other accepted means. A
bite block can also be used, if desired.
The KING LT-D is not an ET tube and can’t be used as a med route.
The end of the KING airway should be in the esophagus, not the
trachea;
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Thank You!
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