Chapter 7 Airway and Oxygen Management EMR 7-1 1-

Introduction Under normal circumstances, brain cells can survive approximately four to six minutes after the heart stops beating before irreversible brain damage or death In a cold environment, brain damage or brain death from lack of oxygen may be delayed beyond this typical timeline This chapter focuses on techniques used to open and secure an airway, suction, ventilate, and deliver oxygen to a patient EMR 7-2 1-

Determining if a Patient’s Airway Is Open Learning Objective 1 Determining if a Patient’s Airway Is Open AIRWAY Airway must be open for oxygen delivery Requires adequate opening From the mouth and nose down the trachea to the lungs PENMAN AVPU EMR 7-3

Determining if a Patient’s Airway Is Open Learning Objective 1 Determining if a Patient’s Airway Is Open POSITIONING CONSIDERATIONS Victim in a car If mechanism of injury indicates, suspect a spinal injury Trauma situation Jaw thrust maneuver If no breathing, turn victim as a unit and proceed to open the airway EMR 7-4

Determining if a Patient’s Airway Is Open Learning Objective 1 Determining if a Patient’s Airway Is Open AIRWAY OBSTRUCTION Determine if airway is obstructed Food, toys, dentures, or broken teeth Secretions Spasms Opening obstructed airway Current AHA guidelines EMR 7-5

Suction Devices for Obstructed Airways Learning Objective 2 Suction Devices for Obstructed Airways SUCTIONING THE AIRWAY Secretions causing the obstruction Perform maneuver to clear secretions Suctioning necessary if not clear Preventing aspiration Clearing secretions helps clear airway EMR 7-6

Suction Devices for Obstructed Airways Learning Objective 2 Suction Devices for Obstructed Airways MANUAL AND MECHANICAL SUCTIONS Manual suction Suctioning unit manually operated Mechanical suction unit Portable suction device Battery operated EMR 7-7

Suction Devices for Obstructed Airways Learning Objective 2 Suction Devices for Obstructed Airways MECHANICAL SUCTIONING Catheters Rigid and flexible longer catheters (basic types) Suctioning Vomiting Gag reflex EMR 7-8

Suction Devices for Obstructed Airways Learning Objective 2 Suction Devices for Obstructed Airways RECOVERY POSITION Used when patient breathes without assistance Allows secretions to drain Lateral recumbent position Do not use with suspected spinal injury EMR 7-9

Oropharyngeal and Nasopharyngeal Devices Learning Objective 3 Oropharyngeal and Nasopharyngeal Devices AIRWAY DEVICES Maintain open airway Keep tongue from obstructing back of mouth Help maintain open airway Head-tilt, chin-lift maneuver Jaw thrust maneuver EMR 7-10

Oropharyngeal and Nasopharyngeal Devices Learning Objective 3 Oropharyngeal and Nasopharyngeal Devices RIGID OROPHARYNGEAL AIRWAY (OPA) Used to maintain a patent airway Placed in unresponsive patients Comes in various sizes Most unconscious patients will need an airway placed Using the OPA EMR 7-11

Oropharyngeal and Nasopharyngeal Devices Learning Objective 3 Oropharyngeal and Nasopharyngeal Devices NASOPHARYNGEAL AIRWAY (NPA) Flexible tube inserted into nasal passageway Used when OPA cannot be used Not indicated for potential skull or facial fracture Risk of brain injury through sinus cavity Using the NPA EMR 7-12

Using a Pocket Mask or Bag Valve Mask Learning Objective 4 Using a Pocket Mask or Bag Valve Mask BREATHING After patient’s airway is open, assess for air exchange Determine if the patient needs ventilation Determine if the patient needs supplemental oxygen Add oxygen if available EMR 7-13

Using a Pocket Mask or Bag Valve Mask Learning Objective 4 Using a Pocket Mask or Bag Valve Mask VENTILATING A PATIENT Will need ventilation if: Unresponsive with apnea Unresponsive with agonal breathing Bradypnea or tachypnea EMR will also provide chest compressions in most situations EMR 7-14

Using a Pocket Mask or Bag Valve Mask Learning Objective 4 Using a Pocket Mask or Bag Valve Mask POCKET MASK Delivers ventilations during cardiac arrest, respiratory arrest, or severe respiratory compromise Choosing a size Using the pocket mask Possible issues EMR 7-15

Using a Pocket Mask or Bag Valve Mask Learning Objective 4 Using a Pocket Mask or Bag Valve Mask BAG VALVE MASK (BVM) Used to provide positive pressure ventilation Using a BVM Possible issues Using a BVM on a patient with a tracheostomy EMR 7-16

Indications for Supplemental Oxygen Learning Objective 5 Indications for Supplemental Oxygen SUPPLEMENTAL OXYGEN DELIVERY Applied to patients with respiratory compromise Delivered via: Nasal cannula Non-rebreather mask over the mouth, nose, or tracheostomy EMR 7-17

Indications for Supplemental Oxygen Learning Objective 5 Indications for Supplemental Oxygen INDICATIONS OF RESPIRATORY COMPROMISE Rate- tachypnea or bradypnea Quality-requires effort to speak/ breathe, tripod position or use accessory muscles Sounds- snoring, high pitched grunting, wheezing Skin color- pale, mild cyanosis Verbalizations- “short of breath” Altered mental status (AMS)- confusion or agitation EMR 7-18

Nasal Cannula and Non-Rebreather Mask Learning Objective 6 Nasal Cannula and Non-Rebreather Mask NASAL CANNULA (NC) Soft flexible tube Two nasal prongs Oxygen delivery into patient’s nostrils 25 to 45 percent oxygen concentration Using the nasal cannula EMR 7-19

Nasal Cannula and Non-Rebreather Mask Learning Objective 6 Nasal Cannula and Non-Rebreather Mask NON-REBREATHER (NRB) MASK Covers nose and mouth of patient Has a one-way valve and a reservoir bag 60 to 95 percent oxygen concentration Using the NRB mask EMR 7-20

Nasal Cannula and Non-Rebreather Mask Learning Objective 6 Nasal Cannula and Non-Rebreather Mask BLOW-BY OXYGENATION Used for children Used for adults who do not like NRB mask Provides oxygen for patients who cannot tolerate masks Using blow-by oxygen EMR 7-21

Explain Pulse Oximetry Learning Objective 7 Explain Pulse Oximetry OXYGEN DELIVERY Used for patient needing ventilation and supplemental oxygen Measured in liters per minute Flow adjusted by regulator on tank Level determined by signs and symptoms EMR 7-22

Explain Pulse Oximetry Learning Objective 7 Explain Pulse Oximetry PULSE OXIMETER Measures oxygen being carried by hemoglobin Should be above 95 percent Placement usually on finger Reading the pulse oximeter Oxygen delivering devices EMR 7-23

Appropriate Handling for Oxygen Tanks Learning Objective 8 Appropriate Handling for Oxygen Tanks OXYGEN TANKS Storage vessel for oxygen Identified by green color Come in various sizes Oxygen regulators Assembling the oxygen regulator tank EMR 7-24

Appropriate Handling for Oxygen Tanks Learning Objective 8 Appropriate Handling for Oxygen Tanks CHANGING AN OXYGEN TANK Monitor amount remaining Change when needle on gauge is in shaded red area Change O-ring Make sure additional O-rings and wrench available EMR 7-25

Appropriate Handling for Oxygen Tanks Learning Objective 8 Appropriate Handling for Oxygen Tanks OXYGEN TANK SAFETY Tanks are pressurized Could become projectiles Never carry by regulator or stem Never leave tank standing upright while unsupervised Spark or flame could easily cause fire EMR 7-26

Summary EMR needs to effectively manage the patient’s airway with positioning, suctioning, or airway devices After the patient’s airway is open, the EMR should focus on the patient’s breathing If the patient is not breathing or is getting inadequate oxygenation, the EMR needs to determine what oxygen delivery device to use, as well as the proper oxygen concentration Basic and necessary skills must be mastered by the EMR to provide adequate oxygenation to the patient EMR 7-27 1-