Unit 2: Artificial Ventilation

Unit 2: Artificial Ventilation
Lesson 1: Ventilation

Standard 13) Demonstrate concepts and skills of the following in a clinical/lab setting: a. Patient Positioning b. Transfers and Ambulation (including injury prevention and body mechanics) c. O2 Assessment and Administration (including fire safety) d. BLS (Basic Life Support) 11) Outline the gross normal structure and function of all body systems and summarize appropriate medical text(s) in order to relate signs and symptoms of common diseases and disorders associated with each. c. cardiovascular and respiratory systems

Lesson 1 – Ventilation Ventilation - movement of air in and out of lungs Oxygenation – getting oxygen molecules into bloodstream No ventilation = no oxygenation Ventilation and Oxygenation Ventilation is the movement of air in and out of the lungs. Oxygenation is the process of loading oxygen molecules on the hemoglobin molecules in the bloodstream. Without ventilation, oxygenation cannot occur. This is why it is so important for EMS professionals to correctly assess a patient's ability to ventilate.

Lesson 1 – Ventilation Adequate Ventilation: two ways to determine
Respiratory rate Rate of breathing Count breaths Tidal volume Depth of breathing Deep/shallow/normal Adequate Ventilation In order to recognize signs of inadequate ventilation, EMS professionals must be familiar with adequate ventilation. Two ways to determine if ventilation is adequate is to assess the rate and depth of breathing. The rate of breathing is the number of times a patient breathes per minute. This is also known as respiratory rate. One breath is equal to one inhalation and one exhalation. Normal respiratory rate for an adult is 12 to 20 breaths per minute. The rate for pediatrics is higher. Children breathe between 15 and 30 times per minute, and infants breathe between 25 and 50 times per minute. Emergency medical providers can determine the rate of a patient's breathing by counting breaths for a full minute or by counting breaths for 30 seconds and then multiplying by 2. The depth of breathing is the amount of air a patient moves in and out with each breath. This is also called tidal volume. Typically, an adult will inhale and exhale between 400 and 600 milliliters (ml) per breath. Emergency medical providers usually do not measure exact depth, but they must classify depth of breathing as deep, shallow, or normal. For example, a patient who is taking short breaths with little chest movement would be said to have shallow depth or shallow tidal volume.

Lesson 1 – Ventilation Minute Volume
Amount of air breathed in and out in one minute Determined by respiratory rate and tidal volume Minute Volume Minute volume is the amount of air a person breathes in and out in one minute. This is also called minute ventilation. Minute volume is determined by multiplying respiratory rate by tidal volume, as seen in the following equation: Respiratory Rate × Tidal Volume = Minute Volume For example, an average adult patient breathes 12 breaths per minute with a tidal volume of 500 milliliters (ml) of air per breath. This means that an average adult's minute volume is 6,000 ml, because: 12 breaths per minute × 500 ml of air per breath = 6,000 ml per minute

Lesson 1 – Ventilation Dead Air Space Area of lungs outside alveoli
Respiration does not take place About 30 percent of air inhaled remains in dead air space Dead Air Space It is important to know that not all of the air that is inhaled is used by the respiratory system. When air enters the lungs, only the air that reaches the alveoli is used for respiration. This means that the oxygenated air that remains in the bronchi and the bronchioles never reach the body cells. This area of the respiratory system is known as dead air space. About 30 percent of the air that is inhaled remains in the dead air space. Respiratory Rate, tidal volume, and minute volume may change, but dead space remains the same.

Lesson 1 – Ventilation Alveolar Ventilation
Amount of air breathed in one minute used for respiration Calculated using tidal volume, dead air space and respiratory rate Alveolar Ventilation You know that minute volume is the amount of air that a person breathes in and out each minute. You also know that 30% of the air that is inhaled is dead air. Knowing this, you can now determine alveolar ventilation. Alveolar ventilation is the amount of air breathed in one minute that reaches the alveoli and is used for respiration. Alveolar ventilation is calculated by subtracting dead air space from the tidal volume and then multiplying by the respiratory rate: (Tidal Volume - Dead Air Space) × Respiratory Rate = Alveolar Ventilation For example, the tidal volume for an average adult is 500 ml and the respiratory rate is 12 breaths per minute. First, determine the dead air space by multiply by 30%: 500 ml × 30% = 150 ml Now, complete the equation to calculate alveolar ventilation for an average adult: (500 ml ml) × 12 breaths per minute = 4,200 ml per minute The alveolar ventilation for an average adult is about 4,200 ml (or 4.2 L) per minute.

Lesson 1 – Ventilation Artificial Ventilation
Process of forcing air into patient’s lungs Used if patient unable to ventilate Used if ventilations inadequate Artificial Ventilation EMS professionals are usually not responsible for calculating minute volume and alveolar ventilation. However, it is vital for them to understand the principles. Because of the dead air space in the lungs, shallow breathing will result in insufficient oxygen levels in the body. If a patient is unable to ventilate or if ventilations are inadequate, emergency workers must begin artificial ventilation. Artificial ventilation is the process of forcing air into a patient's lungs. You will learn techniques of artificial ventilation in the following lessons.

Lesson 2: Artificial Ventilation

Lesson 2 – Artificial Ventilation
Process of forcing air into patient’s lungs Also called positive pressure ventilation Used when: patient unable to ventilate ventilations inadequate Patient must have a pulse Artificial Ventilation Artificial ventilation is the process of forcing air into a patient's lungs. Artificial ventilation is also called positive pressure ventilation. Patients who require artificial ventilation are those who have an open airway but are either unable to breathe on their own or are breathing inadequately. In either case, the patient must have a pulse. If the patient does not have a pulse, chest compressions must be performed in addition to artificial ventilation. In other words, if the patient does not have a pulse, begin CPR immediately.

Inadequate Ventilation indications: Abnormal respiratory rate Inadequate tidal volume Labored breathing Abnormal breathing sounds Varied depths of breathing Inadequate Ventilation Two indications that a patient has inadequate ventilation are abnormal respiratory rate and inadequate tidal volume. For example, a patient who is breathing too fast or too slowly needs artificial ventilation. In addition, a patient whose tidal volume is too shallow or too deep may also need artificial ventilation. Note that only one of these items must be present in order for a patient to require artificial ventilation. For example, if an adult patient has a normal respiratory rate of 12 breaths per minute, but the tidal volume of each breath is shallow, the ventilation is considered inadequate. Or if a patient's tidal volume is normal, but the respiratory rate is only 6 breaths per minute, ventilation is also considered inadequate. In both cases, EMS professionals must begin artificial ventilation. In addition to assessing respiratory rate and tidal volume, EMS professionals may also notice the following symptoms of inadequate ventilation: Patient demonstrates labored breathing, nasal flaring, sweating, and excessive use of accessory muscles. Patient demonstrates abnormal breathing sounds, such as snoring, stridor, wheezing, crowing, and rales. Patient demonstrates varied depths of breathing, between shallow and deep inhalations.

Inadequate Oxygenation Without ventilation, no oxygenation Hypoxia Indications of inadequate oxygenation Inadequate Oxygenation Recall that without ventilation, oxygenation cannot occur. Therefore, inadequate ventilation will also result in a lack of oxygenation. EMS professionals must be able to recognize the signs and symptoms of hypoxia, which is a decreased oxygen level in a patient. Indications that a patient has inadequate oxygenation are listed below. Patient demonstrates an altered mental status, confusion, abnormal behavior, combativeness, or is unresponsive. Patient's skin color shows signs of cyanosis, pallor, or mottling. Patient has been exposed to a high altitude, poisonous gas, or enclosed space.

Methods Mouth-to-mask Bag-valve mask Demand-valve Automatic transport ventilators Follow state guidelines Methods of Artificial Ventilation There are several methods of artificial ventilation that you will learn about in the following lessons. They include: Mouth-to-mask ventilation Bag-valve mask ventilation Demand-valve ventilation Automatic transport ventilators Most states allow EMRs and EMTs to perform mouth-to-mask, bag-valve mask, and demand-valve ventilation. Automatic transport ventilators, however, require a higher level of skill and knowledge. Some states permit EMTs to use these devices, but many states allow only paramedics to perform this high-level skill. Emergency medical providers should follow the guidelines and scope of practice in their state.

Basic Considerations Infection control precautions Don’t use mouth-to- mouth unless no other means available Airway must be clear and open Mask must be sealed properly Basic Considerations for Artificial Ventilation Regardless of which method of artificial ventilation is used, EMS professionals should follow some basic considerations for safety and effectiveness. Infection control precautions should be observed since emergency workers may come into contact with a patient's body fluids. Gloves and eyewear must be worn. If there are large amounts of blood and body fluids, it is safest for the emergency provider to wear a mask and gown as well. Mouth-to-mouth ventilation should not be used unless there are no other means of artificial ventilation available. Every effort should be made to use the mouth-to-mask method instead of the mouth-to-mouth method. The mask will protect both the patient and the emergency provider. Before artificial ventilation is used, the patient's airway must be opened using either the head-tilt, chin-lift maneuver or the jaw-thrust maneuver. Then, the airway must be cleared of obstructions, which may involve a finger-sweep or suctioning. Finally, the airway must remain patent. If necessary, an airway adjunct may be inserted. In order for artificial ventilation to be effective, the mask must be sealed properly over the patient's mouth and nose. If there is excessive leakage, not enough air will be pushed into the patient's airway.

Effective Ventilations Rate and tidal volume must be sufficient and steady Rate Adults 10-12/min Pediatric 12-20/min Tidal volume Chest should rise and fall Effective Ventilations In order for artificial ventilation to be effective, the rate and tidal volume must be sufficient and steady. Rate: Adults should be ventilated 10 to 12 times per minute (once every 5 to 6 seconds). Infants and children should be ventilated 12 to 20 times per minute (once every 3 to 5 seconds). Tidal Volume: The tidal volume, or amount of air in each ventilation, must be enough to cause the patient's chest to rise and fall. Emergency workers must evaluate the patient's chest throughout artificial ventilation. If the chest does not rise and fall, the airway may be blocked or the ventilation may have been delivered incorrectly.

Over-Ventilation Rate too fast and/or tidal volume too high May cause: Hypotension Gastric distention Vomiting Pneumothorax Decreased blood flow during CPR Ways to avoid over- ventilation Over-Ventilation One risk with artificial ventilation is the potential for over-ventilating the patient. Over-ventilation occurs when too much air is forced into the patient's airway or when the rate of ventilation is too fast. This is harmful to the patient. Over-ventilation may cause: Hypotension Gastric distention Vomiting Pneumothorax Decreased blood flow during CPR To avoid over-ventilation, make sure that the tidal volume of each ventilation is enough to make the patient's chest rise normally, but not excessively. Also make sure that an appropriate respiration rate is maintained.

Cardiac Output during Artificial Ventilation Normal ventilation: negative pressure Artificial ventilation: positive pressure Cardiac output decreases Blood pressure decreases Cardiac Output during Artificial Ventilation EMS professionals should be aware of the differences between normal ventilation and artificial ventilation and the effects of these differences on the patient's body. When a person breathes normally, negative pressure is created within the thoracic cavity. This negative pressure is what causes air to be sucked into the lungs. However, during artificial ventilation, air is forced into the patient's lungs, which creates positive pressure. A side effect of positive pressure in the thoracic cavity is a decrease in size of the pulmonary arteries, which are the arteries that carry blood from the heart to the lungs. This causes less blood flow to the lungs for oxygenation and less blood for the heart to pump to the body. As a result, cardiac output and blood pressure are decreased.

Lesson 3: Mouth-to-Mask Ventilation

Lesson 3 – Mouth-to-Mask Ventilation
Quickest and easiest way to begin artificial ventilation Uses pocket mask Mouth-to-Mask Ventilation Mouth-to-mask ventilation is typically the quickest and easiest way to begin artificial ventilation on a patient who is not breathing or is breathing inadequately. The mouth-to-mask technique employs the use of a pocket mask, which is placed over the patient's mouth and nose. The emergency rescuer will then breathe into the mask to provide ventilation and oxygen for the patient. Most EMS professionals keep a pocket mask with them at all times for these types of emergency situations.

The Pocket Mask features: Effective infection control One-way valve Clear to see mouth and nose Strap to go around head Oxygen inlet Various sizes The Pocket Mask Pocket masks have several features which make them effective infection control and life-saving devices for patients needing artificial ventilation. The mask itself is an infection control precaution. It prevents the rescuer from having direct contact with the patient's mouth and oral secretions. Pocket masks contain a one-way valve. This allows the rescuer's air to pass into the patient's airway, but it prevents the patient's exhalations from contacting the rescuer. Most masks are clear so that rescuers can observe a patient's mouth and nose during artificial ventilation. If secretions or vomit appear, the airway should be suctioned immediately. If a suctioning device is not immediately available, turn the patient onto the side and sweep the mouth to clear the airway. Many masks also contain a strap that goes around the back of the head to secure the mask to the patient's face. Though two hands are still needed to create an airtight seal, the face strap will hold the mask in place if CPR is needed. Many masks are equipped with an oxygen inlet which allows supplemental oxygen to be provided during ventilation. Pocket masks are available in various sizes for adults, children, and infants. Be sure to use the proper size during ventilation.

Providing Oxygen Ambient air about 21% oxygen Exhaled air about 16% oxygen Supplemental oxygen: Oxygen tank may be used for up to 50% oxygen Bag-valve method Demand-valve method Providing Oxygen Recall that ambient air contains about 21% oxygen. Since the body only uses 5% of that oxygen, 16% is released during exhalation. This is why mouth-to-mask ventilation is effective. As an emergency provider exhales into a patient's airway, the oxygen that is contained in that air can be used by the patient. If additional oxygen is needed, an oxygen tank can be attached to the pocket mask to provide up to 50% oxygen. Another way to provide supplemental oxygen is to use alternate methods of artificial ventilation, such as the bag-valve or demand-valve technique.

The E-C Method Form airtight seal with mask Finger placement Also called C&E method or C-clamp method The E-C Method When placing the pocket mask on the patient's face, rescuers should use the E-C method to form a proper airtight seal. The E-C method involves placing the thumb and forefinger in a C-shape around the valve of the mask while grasping below the patient's jaw with the remaining three fingers in an E-shape. This method is also called the C & E method or the C-clamp method. The E-C method is also used in other types of artificial ventilation, including the bag-valve, the demand-valve, and the ATV.

Lesson 4: Bag-Valve Ventilation

Lesson 4 – Bag-Valve Mask Ventilation
Used for patients not breathing or breathing inadequately Made of face mask attached to ventilation bag When bag squeezed, air is forced into patient Bag-Valve Mask Ventilation Bag-valve mask ventilation is a type of artificial ventilation that is used for patients who are not breathing or are not breathing adequately. The bag-valve device is made of a face mask that is attached to a ventilation bag. When the bag is squeezed by the rescuer, air is forced through the mask and into the patient's airway. This procedure is often referred to as "bagging" the patient.

The Bag-Valve Mask features: Several sizes available Clear plastic Non-rebreather valve Ventilation bag is self- refilling and several sizes available Tubing, inlet and reservoir can be attached to an oxygen source The Bag-Valve Mask The bag-valve device contains several key features. The mask is available in several sizes so that an appropriate fit can be made for adults, children, infants, and newborns. The mask is made of clear plastic so that the emergency provider will be able to begin suctioning if vomit or secretions appear in the airway. The top of the mask contains a non-rebreather valve and an exhalation port. This feature provides a vent for a patient's exhalations so that the same air is not inhaled. The ventilation bag is self-refilling when it is squeezed and released. The bag is available in several sizes so that the correct tidal volume is administered to adults, children, infants, and newborns. Bags should be made of a disposable material or be easily cleaned and sterilized. The oxygen tubing, inlet, and reservoir can be attached to an oxygen source. This way, higher concentrations of oxygen can be supplied to the patient. When using oxygen, the rescuer must ensure that the oxygen reservoir bag remains inflated during use.

One and Two-Person Rescues One-person method tiring and difficult Two-person method is more efficient and preferred One-Person and Two-Person Rescues Bag-valve mask ventilation can be performed by one or two rescuers. The two-person method is much more effective because the first person can hold the mask firmly in place and maintain a patent airway while the second person squeezes the ventilation bag. In the one-person method, it is difficult and tiring for the rescuer to establish an airtight seal with the mask and keep the airway open while squeezing the bag. For this reason, the two-person method is preferred. However, if only one emergency provider is available, the one-person method may be used.

Bag-Valve Mask vs. Mouth-to-Mask Mouth-to-Mask More consistent tidal volumes Preferred when one- person rescue Bag-Valve Mask Better seal, higher levels of oxygen provided Preferred when two- person rescue Bag-Valve Mask vs. Mouth-to-Mask There are advantages and disadvantages to both mouth-to-mask ventilation and bag-valve mask ventilation. The mouth-to-mask method often provides more consistent tidal volumes than bagging, especially during a one-person rescue. In addition, mouth-to-mask procedures give the rescuer the added benefit of feeling how well the air enters the patient's airway. On the other hand, when two rescuers are available, the bag-valve mask is ideal because a better seal of the mask can be maintained while higher levels of oxygen are provided to the patient. In general, mouth-to-mask ventilation is recommended when only one rescuer is present. As soon as a bag-valve mask and a second rescuer become available, the procedure should be switched to two-person bag-valve mask ventilation.

Lesson 5: Cricoid Pressure

Lesson 5 – Cricoid Pressure
Pressure applied to cricoid cartilage Sellick Maneuver Guides air into trachea instead of esophagus Cricoid Pressure During artificial ventilation, there is no guarantee that the air being forced into the patient's airway will enter the trachea and the lungs. Sometimes, the air is pushed into the esophagus and the stomach. This can result in gastric distension and vomiting. Applying cricoid pressure can prevent this from happening. Cricoid pressure, also called the Sellick Maneuver, is a technique in which pressure is applied to the cricoid cartilage in order to guide air into the trachea instead of the esophagus.

The Cricoid Cartilage Located between larynx and trachea Blocks esophagus when pressed backward The Cricoid Cartilage The cricoid cartilage is located between the larynx and the trachea. It is the only completely circular ring of cartilage in the upper airway. When the cricoid cartilage is pressed backward, it blocks the esophagus, which is located behind it. This maneuver will prevent air from flowing down the esophagus and into the stomach. Instead, air will be forced through the trachea and into the lungs.

Considerations Should only be applied to unresponsive patients Requires use of an additional emergency provider Should prevent vomiting but be prepared Considerations Cricoid pressure is an effective technique, but EMS professionals must use it with great care. The following considerations must be taken into account. Cricoid pressure should only be applied to unresponsive patients. Using cricoid pressure properly requires the use of an additional emergency provider. For example, if two rescuers are performing bag-valve mask ventilation, a third rescuer is needed to apply cricoid pressure effectively. Cricoid pressure should prevent a patient from vomiting as a result of gastric distension. However, if secretions and vomit appear in the airway, cricoid pressure must be released immediately and suctioning should be performed. If a suctioning device is not immediately available, turn the patient onto the side and sweep the mouth.

Lesson 6: Demand-Valve Ventilation

Lesson 6 – Demand-Valve Ventilation
Only EMTs or higher level EMS providers can use 100% oxygen delivered to patient through oxygen-powered valve and mask Also called flow- restricted, oxygen- powered ventilation device (FROPVD) Demand-Valve Ventilation You have already learned about the mouth-to-mask and bag-valve mask methods of artificial ventilation. These techniques are within the scope of practice of both EMRs and EMTs. There are other methods of ventilation, though, that should be performed only by EMTs or higher levels of EMS professionals. One of these methods is called demand-valve ventilation. Demand-valve ventilation is a form of artificial ventilation in which 100 percent oxygen is delivered to patients through an oxygen-powered valve and mask. This device is also called a flow-restricted, oxygen-powered ventilation device (FROPVD).

Demand-Valve Concerns Uses pressurized oxygen Pressure might be too strong and cause: Gastric distension Barotrauma Use with great care Shouldn’t use on chest trauma or pediatric patients Demand-Valve Concerns The demand-valve device uses pressurized oxygen to deliver artificial ventilations to patients. Some medical professionals are concerned that the pressure is too strong and could actually cause harm, such as gastric distension or barotrauma, to patients. Because of these concerns, EMTs must use demand-valve ventilation with great care and in accordance with the guidelines established in their state. It is also generally agreed that demand-valve ventilation should not be used on chest trauma patients or pediatric patients, both of which may have weaker or more delicate airways. In addition, changes have been made to the demand-valve devices to provide additional safety to patients.

Advantages: Can be done by one rescuer Reduces fatigue to rescuer Delivers 100% oxygen Ideal for patients with pulmonary edema Disadvantages: Can’t “feel” air Improper use may injure Requires oxygen source Can only be used on adults Advantages and Disadvantages Demand-valve ventilation does present health risks when used improperly. EMS professionals must consider the advantages and disadvantages to using this device. Advantages: Allows one rescuer to use both hands to maintain an airtight seal of the mask while administering positive pressure ventilation. Reduces fatigue in the rescuer, which is often caused by other forms of artificial ventilation like mouth-to-mask and bag-valve mask. Delivers 100% oxygen. Ideal for patients with pulmonary edema. Disadvantages: The rescuer is unable to "feel" the ease of air entering the patient's lungs, as with mouth-to-mask and bag-valve mask ventilation. Improper use may result in injury, such as gastric distension or barotrauma, to the patient. Requires an oxygen source, which may not always be readily available. Can only be used on adult patients, unless a special pediatric device is available.

Demand-Valve Device features: Flow rate no greater than 100% at 40 LPM Pressure relief valve Alarm On/off trigger conveniently positioned Valve to release patient’s exhaled air The Demand-Valve Device Demand-valve devices should be equipped with the following features to provide optimal safety to patients: A flow rate no greater than 100% oxygen at 40 LPM A pressure relief valve that opens at about 60 centimeters of water pressure An alarm to indicate if the relief valve pressure is exceeded An on/off trigger that is positioned conveniently for the EMT to be able to maintain an air tight seal of the mask while using the device A valve to release the patient's exhaled air.

Alternate Methods Two-person method Can be used for rescue breaths during CPR Alternate Methods Demand-valve ventilation can also be performed with two rescuers. In the two-person method, the first rescuer will maintain the face mask and head position while the second rescuer operates the demand-valve. This method is particularly helpful when the patient has a suspected spinal injury and the neck must be kept immobile. Demand-valve ventilation can also be used for administering rescue breaths during CPR. CPR, however, should only be used if the patient does not have a pulse.

Lesson 7: Automatic Transport Ventilator

Lesson 7 – Automatic Transport Ventilator
Automatic Transport Ventilator (ATV) Automatically controls respiratory rate and tidal volume Only for EMTs and higher levels of EMS providers Follow state guidelines when using ATV Automatic Transport Ventilator Another device that is used to deliver artificial ventilation to patients is the automatic transport ventilator. The automatic transport ventilator, or ATV, is a device that automatically controls the respiratory rate and tidal volume that is administered to patients during artificial ventilation. Like demand-valve ventilation, automatic transport ventilators should only be used by EMTs and higher levels of EMS professionals. In some states, only paramedics are permitted to use these devices. Emergency medical providers should follow the guidelines in their state when using an ATV.

Features of ATVs Small, lightweight, portable and durable Able to deliver 100% oxygen Able to connect to masks and endotracheal tubes Adjustable respiratory rate and tidal volume Features of ATVs While there are a wide variety of brands and models to choose from, there are certain features that are common to all ATVs: Must be small, lightweight, portable, and durable Able to deliver up to 100% oxygen Able to connect to masks and endotracheal tubes Adjustable delivery of respiratory rate and tidal volume

Select Respiratory Rate 10 BPM for adults 20 BPM for children Select Tidal Volume Calculate using patient’s estimated body weight Start at low end of range Shouldn’t be raised above 800 ml Selecting Rate and Tidal Volume To use an ATV, EMTs must set the device to the respiratory rate and tidal volume that is appropriate for the patient. Typically, the respiratory rate is set to 10 breaths per minute (BPM) for adults and 20 BPM for children. Determining the tidal volume, however, requires some calculating. First, the EMT must estimate the patient's body weight in kilograms (kg). Then the weight is multiplied by 8 to 10 milliliters (ml). Patients are first ventilated with the lowest tidal volume limit and then it may be increased if needed. Typically, tidal volume should not be raised above 800 ml. For example, suppose Brian estimates that his patient Lucy, who is a petite female in her 40's, weighs 50 kilograms. Brian first multiplies 50 kg by 8 ml to determine the lowest tidal volume limit. Then, he multiplies 50 kg by 10 ml to determine the highest tidal volume limit. 50 kg × 8 ml = 400 ml 50 kg × 10 ml = 500 ml Brian will start ventilating Lucy with a tidal volume of 400 ml. However, if 400 ml is not a great enough volume to cause Lucy's chest to rise and fall, Brian can increase the tidal volume up to 500 ml. Click the following link to learn how to convert pounds to kilograms.

Advantages Steady, controlled ventilation Can be used by one rescuer One rescuer can apply cricoid pressure if needed Advantages and Disadvantages There are both advantages and disadvantages to using ATVs. EMS professionals should be aware of both sides when using these devices. Advantages: Provides steady, controlled ventilation with a set respiratory rate and tidal volume. Allows one rescuer to use both hands to maintain the airway and an airtight seal of the mask. If needed, allows one rescuer to hold the face mask in place while also applying cricoid pressure. Disadvantages: The rescuer is unable to "feel" the ease of air entering the patient's lungs, as with mouth-to-mask and bag-valve mask ventilation. Improper use may result in injury, such as barotrauma, to the patient. Requires an oxygen source, which may not always be readily available. A pocket mask or bag-valve mask must be available as a back-up in case the oxygen source is depleted. Should not be used on children under the age of 5 years.

Disadvantages Rescuer unable to “feel” ease of air entering lungs Improper use may cause injury Requires oxygen source Must have backup method available Can’t be used on children under 5 Advantages and Disadvantages There are both advantages and disadvantages to using ATVs. EMS professionals should be aware of both sides when using these devices. Advantages: Provides steady, controlled ventilation with a set respiratory rate and tidal volume. Allows one rescuer to use both hands to maintain the airway and an airtight seal of the mask. If needed, allows one rescuer to hold the face mask in place while also applying cricoid pressure. Disadvantages: The rescuer is unable to "feel" the ease of air entering the patient's lungs, as with mouth-to-mask and bag-valve mask ventilation. Improper use may result in injury, such as barotrauma, to the patient. Requires an oxygen source, which may not always be readily available. A pocket mask or bag-valve mask must be available as a back-up in case the oxygen source is depleted. Should not be used on children under the age of 5 years.

Unit 2: Artificial Ventilation

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