OXYGEN THERAPY AND AIRWAY ADJUNCTS

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INTRODUCTION 

Optimal patient care requires that the EMT-I be able to maintain a patient’s airway using a variety of airway adjuncts and oxygen delivery devices. The following topics will be discussed during this lesson:

 

·          Airway maneuvers

 

·          Suctioning and suction equipment

 

·          Oxygen Delivery devices

 

·          Basic airway devices

 

·          Advanced airway adjuncts

 

·          Ventilation devices

 

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

 

1.         Execute the two airway maneuvers approved for EMT-Is.

 

2.         Identify and utilize the two oxygen delivery devices.

           

3.         Utilize the two basic airway adjuncts approved for the EMT-Is.

 

4.         Identify and manage the two advanced airway adjuncts used by EMT-Paramedics.

 

5.         Operate the three types of breathing devices utilized by the Long Beach Fire Department.

 

6.         Operate the two types of suction devices carried on all Long Beach Fire Department rescues.

 

SKILLS

 

Nasopharyngeal airway

Nasopharyngeal suctioning

Oropharyngeal airway

Oropharyngeal suctioning

Pocket mask

Tracheostomy tube suctioning

Ventilation of patient with ET/EOA/ETC via bag-valve device (BVD)

Ventilation with a bag-valve-mask (BVM) device

Oxygen Administration devices

 

 

 

KEY VOCABULARY 

The following terms will be used during this lesson:

 

·          ALOC - Altered level of consciousness

 

·          Adjunct - an assisting device

 

·          BVM - Bag-valve-mask device

 

·          ETC - Esophageal tracheal combitube

 

·          EOA - Esophageal obturator airway

 

·          ETT - endotracheal tube

 

·          NPA - Nasopharyngeal airway

 

·          OPA - Oropharyngeal airway

 

 

 

KEY CONCEPTS 

The following section provides information and space for taking notes on the key concepts

discussed by the instructor.

 

AIRWAY MANEUVERS

 

Head-Tilt/Chin-Lift

·          Simple technique

·          Place patient in a supine position

·          Place one hand on the forehead and the other under the chin

·          Gently extend the neck

·          Avoid compression on the soft tissue under the chin

·          Not used for trauma patients

 

 

Jaw Thrust Maneuver

·          Used for trauma patients to avoid neck extension

·          Place patient in supine position

·          Kneel behind the patient

·          Stabilize the head

·          Thrust the jaw forward using upward pressure on the mandible

 

 

 

Airway Management of the Unconscious Patient

·          The tongue is the most common cause of obstruction

·          Dental appliances may be left in place - they may help in mask seal maintenance

·          Trauma patients must be spinal immobilized

·          Non-trauma patients should be in left lateral position

·          Monitor the airway and breathing carefully - prepare to suction if necessary

 

 

GOLDEN RULE: Noisy breathing is obstructed breathing!

 

 

OXYGEN THERAPY AND DELIVERY DEVICES

 

Oxygen Administration Safety

·          Oxygen is extremely hazardous in contact with an open flame

·          Do not allow smoking in an area where oxygen is being administered

·          Educate all patients on O2

 

Nasal Cannula

·          Low concentration device

·          Only for patients NOT in respiratory distress

·          Maximum flow rate is 5-6 L/min.

·          Higher flow rates cause nasal drying and discomfort for the patient

·          Deliver approximately 30-40% O2 concentration

·          Adult and pediatric sizes

 

Simple Face Mask

·          Must fit over patient’s nose and mouth

·          Flow rates from 10-15 L./min.

·          Use for all patients in respiratory distress

·          Adult and pediatric sizes

 

Nonrebreather Mask

·          Provides high concentration of O2 (up to 90%)

·          Must fit over the patient’s nose and mouth

·          Flow rates from 10-15 L./min.

·          Fill the reservoir bag before placing on the patient

·          The reservoir bag before placing on the patient

·          The reservoir bag minimizes rebreathing exhaled air

·          Adult and pediatric sizes

 

    GOLDEN RULE:    Never withhold oxygen from anyone

                         in respiratory distress

 

 

BASIC AIRWAY ADJUNCTS

 

Oropharyngeal Airway

·          Unresponsive patients without a gag reflex

·          Remove if the patient begins to gag

·          Measure from the corner of the mouth to the angle of the jaw

·          Adult insertion:  insert upside down and rotate 180 degrees

·          Pediatric insertion:  use tongue blade to hold the tongue and insert forward

 

 

Nasopharyngeal Airway

·          May be used in more alert patients

·          Measure from the tip of the nose to the tip of the ear or tragus

·          Lubricate with water soluble lubricant

·          Insert gently with the bevel toward the septum

·          No not force the NPA

 

 

Suctioning

·          Used to clear the airway of blood, mucous, and vomitus

·          May be all the patient needs to open the airway

·          Rigid catheters (yankaur or tonsil tip) are used to suction the mouth and oropharynx

·          Soft catheters are used to suction the nose and nasopharynx

·          Insert the catheter to the base of the tongue and apply suction as the catheter is withdrawn

·          Suction no longer than 15 seconds

·          It may be necessary to log roll the patient and manually remove large amounts of emesis

 

 

Complications of Suctioning

·          Hypoxia

·          Bradycardia

·          Vomiting/aspiration

·          Trauma to the mucous membranes

·          Gagging

 

 

 

SUCTION DEVICES

·          Must be readily available and checked frequently.

·          Tubing and collection chambers are cleaned after each patient

·          Have soft and rigid catheters available

·          Rescue suction box

·          V-Vac hand held suction

 

 

ADVANCED AIRWAY ADJUNCTS

Assisting with Advanced Airway Tube Placement

·          Bag-Valve-Mask ventilation while tube is being prepared

·          Hyperventilate the patient 5-6 times immediately prior to tube placement attempts

·          Each attempt should be no longer than 30 seconds

·          EMT-Is may by asked to give a 20 second and 30 second warning

·          Be prepared to “bag” the patient between tube placement attempts

·          Have suction on and ready

·          Be prepared to turn the patient if they begin to vomit

·          Know the equipment

·          Be prepared to hand equipment to the EMT-Paramedic if requested

 

Endotracheal Tube (ETT)

·          EMT-Paramedic skill

·          First line advanced airway tube; preferred ALS method of maintaining an airway

·          Used in patients without a gag reflex to maintain and protect the airway

·          Provides for optimum ventilation and oxygenation

·          EMT-Is may be asked to ventilate the patient after the tube is in place

·          Confirm chest rise and breath sounds frequently

 

Esophageal Tracheal Combitube

·          EMT-Paramedic skill

·          Used if endotracheal tube attempts are unsuccessful

·          Used for cardiopulmonary arrest patients and deeply comatose patients without a gag reflex

·          EMT-Is may be asked to ventilate after the tube is in place

·          Ventilate the blue port first - if chest rise and breath sounds are absent the clear port will be ventilated

·          Confirm breath sounds and chest rise frequently

·          Fluid deflector should be directed away from the rescuers

·          Gastric suction may be applied to the clear port

 

 

 

VENTILATION DEVICES

Pocket Mask

·          A barrier device used in place of mouth to mouth ventilation

·          Many pocket masks are available

·          Some have a port for supplemental O2

·          Kneel at the patient’s head

·          Place the pocket mask over the mouth and nose

·          Ventilate and observe for chest rise

 

Bag-Valve-Mask device

·          Consists of a face mask, one way valve, self-inflating bag and O2 reservoir

·          Mask should be clear so that vomitus may be observed

·          Available in adult, infant, and child sizes

·          Should not have a “pop-off” valve.

·          If supplemental O2 is applied to the O2 port the delivered concentration is 80% to 100%.

·          An air tight seal and properly fitting mask is essential

·          Gastric distension results from too great volumes and poor head position

·          Insert an OPA to help maintain the airway

·          If trauma is present the head should not be tilted - use the jaw thrust maneuver to maintain an open airway

·          If there is no trauma the airway is maintained using the head-tilt position

·          Ventilate at a rate of one every 5 seconds for adults and one every 3 seconds for infants and children

·          Observe for chest rise with each ventilation

 

Bag-Valve Device

·          Used with an ETT or ETC

·          Observe for chest rise with each ventilation

·          Report immediately if chest rise is not observed

·          Assess breath sounds after moving the patient

·          Report immediately if compliance is decreasing (it becomes harder to bag)

·          Ensure that the bag is attached to supplemental O2

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