Maintaining Oxygenation Phase 2 Medical Students Respiratory System A. J. Shearer Consultant Anaesthetics & Intensive Care

TOPIC l inspired gas l airway l pulmonary ventilation

BASIC LIFE SUPPORT (BLS) ADULT BLS Resuscitation Guidelines 2005 Resuscitation Council (UK) (NB: New guidelines 28 Nov 2005)

CLEAR AIRWAY l loosen tight clothing l remove any obvious obstruction from mouth l tilt head l lift chin

CHECK FOR BREATHING l look for chest movement l listen at mouth for breath sounds l feel for air with your cheek

Which is the currently recommended recovery position? RECOVERY POSITION

chest movements + = AIRWAY OBSTRUCTION no air movement no chest movement + = APNOEA no air movement NO AIR MOVEMENT

UNCONSCIOUS PATIENT Soft tissue collapse in pharynx OBSTRUCTION Relieved by:- l head tilt l chin lift l jaw thrust l oropharyngeal airway

l inserted through mouth to lower pharynx l no instrument required l cuffed hood over laryngeal opening l skill required for insertion easy to learn LARYNGEAL MASK AIRWAY (LMA)

ENDOTRACHEAL TUBE Through mouth (or nose) TRACHEA Introduced using a LARYNGOSCOPE CUFF forms seal in trachea CHECK:- l not in oesophagus l not inserted too far l cuff inflation correct

CRICOTHYROTOMY Safer & easier to perform than tracheostomy Between cricoid & thyroid cartilages Large needle or tube

ARTIFICIAL RESPIRATION Mouth MOUTH Mask Chest should rise visibly (normal chest expansion 5 -6 ml/kg) Do not inflate the lungs too quickly Wait for chest to fall fully before next inflation Mask BAG Endotracheal tube SELF-INFLATING RESUSCITATION BAG eg Ambu or Laerdal

OXYGEN SUPPLY Piped oxygen wall outlet kPa (4 bar) Cylinder kPa (137 bar) Pressure reducing valve necessary Key may be required to open cylinder Pressure gauge indicates contents Rotameter - flow control & indicator

OXYGEN MASKS Hudson medium concentration mask = 60% 5 l/min minimum Hudson high concentration mask = % 10 l/min minimum

ASSESSING OXYGENATION l clinical examination l pulse oximetry l arterial blood gas analysis

HYPOXIA CLINICAL SIGNS & SYMPTOMS l cyanosis l respiratory effects l cerebral effects l cardiovascular effects l acidosis l organ damage

ARTERIAL BLOOD GASES Reference Ranges:- PaO kPa <30 yrs kPa yrs kPa yrs kPa >70 yrs PaCO kPa pH

OXYGEN THERAPY Reference for practical review article:- Emergency oxygen therapy for breathless patient. Guidelines prepared by North West Oxygen Group. Murphy R. et al Emerg. Med. J. 2001; 18:

SUCTION Piped vacuum wall outlet Electrically powered vacuum pump 53 kPa (400 mmHg) Oxygen powered venturi suction Hand/ foot operated