Unit 3 Lesson 2 Airway Adjuncts & Oxygen Therapy

No cells, ear buds, or I-pads!

Paragraph 1 Once you gain access to the patient and begin your initial assessment, your first course of action is to establish an open airway. The most common impediment to an open airway is the tongue. When a patient becomes unconscious, the muscles relax. The tongue will slide back into the pharynx and obstruct the airway.

Paragraph 1 Airway adjuncts, devices that aid in maintaining an open airway, may be used early in the treatment of the unresponsive patient and continue throughout your care. The two most common airway adjuncts are oropharyngeal (OPA) and nasopharyngeal (NPA) airways.

Oropharyngeal airway (OPA)

Nasopharyngeal airway (NPA)

Nasopharyngeal airway (NPA)

Paragraph 2 Suctioning a patient involves the use of a vacuum device to remove blood, vomitus, and other secretions or foreign materials from the airway in order to prevent aspiration or obstruction of the airway. A Yankauer suction catheter is a rigid catheter used to clear the pharyngeal airway In the event of copious, thick secretions or vomiting.

Yankauer suction catheter

Paragraph 2 French catheters are flexible plastic tubes. They are identified by a “French” number. The larger the number, the larger the catheter. A 14 French catheter is larger than an 8 French catheter. French catheters are designed to be used in situations when a rigid tip cannot be used such as when a suctioning device must be passed through an NPA or, in the case of tracheobronchial suctioning, through an ET tube.

French catheters

Paragraph 3 Administration of oxygen is one of the most important and beneficial treatments a care provider can give. Conditions that may require oxygen include respiratory and cardiac arrest, shock, lung disease, and hypoxia. Hypoxia is an insufficient supply of oxygen to the brain.

Paragraph 3 Hypoxia may be indicated by cyanosis and a deterioration of the patient’s mental status. O2 is administered to assist in the delivery of artificial ventilations to nonbreathing patients and to breathing patients for a variety of conditions. A flow meter, on an O2 tank in the field or from a gas port in the hospital, allows control of the flow of oxygen in liters per minute (lpm).

Standard O2 tank and regulator

Regulator and flow meter

Paragraph 4 For the patient who is breathing adequately and requires supplemental oxygen, there are various O2 delivery devices available. In general, however, the non-rebreather mask and the nasal cannula are the two devices most commonly used.

non-rebreather mask

Paragraph 4 The non-rebreather mask is a face mask and reservoir bag device that delivers high concentrations of O2. The patient’s exhaled air escapes through a valve and is not rebreathed. A non-rebreather mask can deliver high flow O2 concentrations of 90 to 100% at 15 lpm.

nasal cannula

nasal cannula

Paragraph 5 A nasal cannula provides low concentrations of oxygen of 24 to 44% at 6 lpm through two prongs that rests in the patient’s nostrils. Patients who have chest pain or signs of shock need higher concentrations of O2 than what can be provided by a cannula. However, some patients will not tolerate a mask-type device because they feel “suffocated” by the mask. For the patient who refuses to wear an oxygen mask, the cannula is better than no O2 at all. The cannula should be used only when a patient will not tolerate a non-rebreather mask.

Paragraph 6 A bag-valve-mask (BVM) or “ambo-bag” is a hand held device with a face mask and self-refilling bag that can be squeezed by hand to provide artificial ventilations or positive pressure ventilations (PPV) to a patient and is it often referred to as “bagging” the patient. The bag-valve-mask unit can be used to ventilate a non-breathing patient and it is also helpful in assisting ventilations in the patient whose own respiratory attempts are not enough to support life, such as a patient in respiratory failure or a drug overdose.

bag-valve-mask (BVM) or “ambo-bag”

bag-valve-mask (BVM) or “ambo-bag”

Paragraph 6 Many different BVM units and systems are available; however, all of them have the same basic parts. The bag itself must be a self refilling shell that can be easily cleaned. It should also have a non-rebreathing, non-jam valve. Most BVMs have a standard 15/22 mm respiratory fitting to ensure a proper fit with other respiratory equipment, face masks, and endotracheal tubes. BVMs deliver PPV at high flow O2 concentrations of up to 90 to 100% at 15 lpm.

Paragraph 7 The most difficult part of delivering BVM ventilations is obtaining an adequate mask seal so that air does not leak in or out of the mask. Therefore, it is strongly recommended by the AHA that BVM ventilations be performed by two rescuers. One person is assigned to squeeze the bag, while the other rescuer uses two hands to maintain a mask seal.

Paragraph 7 The two person technique can be modified so that the jaw-thrust maneuver can be used to obtain an open airway on a patient suspected of having a neck or spinal injury. When no C- spine trauma is suspected, an open airway can be maintained by the head-tilt/chin-lift maneuver.

NOT head-tilt/chin-lift

head-tilt/chin-lift

We’re done!