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  2. Introduction • EMRsusually 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

  3. 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

  4. Suction Devices • Used to clear blood, vomit, other substances from patient’s airway • Suction equipment includes manual devices, powered devices, soft bulb syringes

  5. 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

  6. Uses of Suction • Useful if airway is fully or partially obstructed • Most suction units inadequate for removing solid objects

  7. 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

  8. 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

  9. Do Not Suction Longer Than • 15 seconds at a time for adults • 10 seconds at a time for children • 5 seconds at a time for infants

  10. 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

  11. Skill: Suctioning (Adult or Child)

  12. Confirm suction device working and produces suction • Turn patient’s head to one side and open mouth

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

  14. Determine maximum depth of insertion

  15. Turn on suction or pump handle to create suction

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

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

  18. Skill: Suctioning (Infant)

  19. Hold infant in position for suctioning • Head lower than body • Turned to one side

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

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

  22. Move bulb aside, squeeze it with tip down to empty • Repeat if necessary • Repeat suctioning steps for each nostril • Resume rescue breathing or CPR

  23. 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

  24. 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

  25. Sizing and Placement of Oral Airways • Proper placement is essential • Periodically reassess to confirm airway remains in proper position

  26. Skill: Oral Airway Insertion

  27. Choose correct size

  28. Open patient’s airway with head tilt–chin lift or jaw thrust and open the mouth • Insert with tip pointing toward roof of mouth

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

  30. Continue to insert until flange rests on lips

  31. Oral Airway in Children • Select proper size – measure from corner of patient’s lips to bottom of earlobe or angle of jaw • Open patient’s mouth • Use a tongue blade to press tongue down and out of way • Insert airway in the upright (anatomic) position Alternate technique for inserting an oral airway in infants/children:

  32. 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

  33. 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

  34. Skill: Nasal Airway insertion

  35. Choose correct size

  36. Lubricate airway

  37. Insert straight down • Insert into right nostril with bevel toward septum

  38. Insert straight back, sliding along floor of nostril • Insert until flange rests against nose

  39. After Insertion of Nasal Airway • Continue to keep patient’s airway open with head tiltchin lift or jaw thrust • Suction through nasal airway with small flexible suction catheter if needed

  40. 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

  41. Bag Mask Components oxygen reservoir bag self-inflating bag 1-way valve

  42. 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

  43. 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)

  44. 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

  45. 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

  46. 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

  47. 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

  48. 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

  49. Skill: Bag Mask for Ventilation – Two Rescuers

  50. Rescuer 1:Assembles bag mask and positions it over patient’s mouth and nose • Rescuer 2: Seals mask over patient’s mouth and nose