Copyright © 2007, 2004, by Mosby, Inc., an affiliate of ...brainspew.com/advanced/emt/emt07/Chapter_007.pdf · 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier

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Slide 1Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

AirwayAirwayChapter 7Chapter 7


Case HistoryCase History

You respond to a motor vehicle You respond to a motor vehicle crash. On arrival, you find a crash. On arrival, you find a demolished vehicle with a 40demolished vehicle with a 40--yearyear--old unresponsive, cyanotic male old unresponsive, cyanotic male slumped over the wheel of his car. slumped over the wheel of his car. He is making gurgling noises as he He is making gurgling noises as he breathes shallowly at a rate of 8 breathes shallowly at a rate of 8 times per minute. Blood and loose times per minute. Blood and loose teeth are in the upper airway. teeth are in the upper airway.


Analysis of the CaseAnalysis of the Case

Rapid extrication with immobilization of cervical spineRapid extrication with immobilization of cervical spine

Airway: jaw thrust, suction, Airway: jaw thrust, suction, oropharyngealoropharyngeal airwayairway

MouthMouth--toto--mask or bagmask or bag--valvevalve--mask with supplemental oxygen, mask with supplemental oxygen, or flowor flow--restricted, oxygenrestricted, oxygen--powered ventilatorpowered ventilator

Continuously monitor signs of adequate ventilation and Continuously monitor signs of adequate ventilation and oxygenationoxygenation

Henry: EMT Prehospital Care, Revised 3rd Edition Lecture Notes

Chapter 7: Airway

Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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OverviewOverview

Management of the airway and ventilation Management of the airway and ventilation represent the first and most critical steps in represent the first and most critical steps in most serious emergencies.most serious emergencies.

Humans are oxygenHumans are oxygen--dependent organisms.dependent organisms.

Three critical prioritiesThree critical prioritiesAirwayAirwayBreathingBreathingOxygenationOxygenation


Assess the Airway, Breathing, Assess the Airway, Breathing, Circulation in Every PatientCirculation in Every Patient

Assess for adequate vs. Assess for adequate vs. inadequate breathing to inadequate breathing to determine if the patient determine if the patient needs treatment to:needs treatment to:

Maintain airwayMaintain airwaySupport ventilation Support ventilation Supplement oxygenationSupplement oxygenation


Airway InterventionsAirway Interventions

Manual techniquesManual techniquesHead tilt/chin liftHead tilt/chin liftJaw thrustJaw thrust

Mechanical techniquesMechanical techniquesOropharyngeal airwaysOropharyngeal airwaysNasopharyngeal airwaysNasopharyngeal airwaysSuctionSuction


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Ventilation InterventionsVentilation Interventions

MouthMouth--toto--mask mask

BagBag--valvevalve--maskmask

FlowFlow--restricted oxygenrestricted oxygen--powered ventilatorpowered ventilator


Oxygen InterventionsOxygen InterventionsSupplemental oxygen for patient with Supplemental oxygen for patient with adequate ventilationadequate ventilation

NonrebreatherNonrebreatherNasal cannula (when patient cannot tolerate Nasal cannula (when patient cannot tolerate mask)mask)BlowBlow--by oxygen for children (when patient by oxygen for children (when patient cannot tolerate mask)cannot tolerate mask)

Positive pressurePositive pressureMouthMouth--toto--mask with supplemental oxygenmask with supplemental oxygenBagBag--valvevalve--mask with supplemental oxygenmask with supplemental oxygenFlowFlow--restricted oxygenrestricted oxygen--powered ventilatorpowered ventilator


Review of Anatomy and Review of Anatomy and PhysiologyPhysiology

Three main functions of Three main functions of respiratory systemrespiratory system

Delivery of oxygen from Delivery of oxygen from atmosphere to bloodatmosphere to bloodRemoval of carbon dioxideRemoval of carbon dioxidefrom the blood to the from the blood to the atmosphereatmosphere

Creation of voiceCreation of voice


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Structures and FunctionStructures and Function

NoseNosePharynxPharynxEpiglottis and larynxEpiglottis and larynxTracheaTracheaBronchi and bronchiolesBronchi and bronchiolesAlveoliAlveoli


LungsLungsTwo coneTwo cone--shaped organs consisting of:shaped organs consisting of:

Bronchi, bronchioles, and alveoliBronchi, bronchioles, and alveoli

Suspended in thoracic cavity and Suspended in thoracic cavity and separated by separated by mediastinummediastinum

Surrounded and protected by ribs Surrounded and protected by ribs thoracic spine, sternum, clavicle, and thoracic spine, sternum, clavicle, and musclesmuscles

Outer surface of lungs and inner Outer surface of lungs and inner surface of thoracic cavity lined with surface of thoracic cavity lined with pleurapleura


Elasticity of the LungsElasticity of the LungsLungs have natural tendency to collapse Lungs have natural tendency to collapse –– ““elasticity.elasticity.””Lungs fill thoracic cavity because of relative Lungs fill thoracic cavity because of relative ““negativenegative”” pressure pressure between pleura.between pleura.Pneumothorax disturbs relationship; lung collapsesPneumothorax disturbs relationship; lung collapses


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Muscles of BreathingMuscles of Breathing

Cause chest movement that Cause chest movement that results in air exchangeresults in air exchange

Quiet breathing involves two Quiet breathing involves two muscles:muscles:

Diaphragm Diaphragm External intercostalsExternal intercostals


Inspiration (Active Process)Inspiration (Active Process)

Diaphragm increases inferiorDiaphragm increases inferior--superior superior diameter of chest cavitydiameter of chest cavity

External intercostals increase anteriorExternal intercostals increase anterior--posterior, lateral dimensionsposterior, lateral dimensions

Increase in size results in more volume, Increase in size results in more volume, less pressure relative to atmosphere, less pressure relative to atmosphere, and air rushes in.and air rushes in.

Inspiration continues until pressure Inspiration continues until pressure within lung and atmosphere equalizes.within lung and atmosphere equalizes.


Expiration (Passive Process)Expiration (Passive Process)

Respiratory muscles relax and Respiratory muscles relax and elastic recoil of lungs.elastic recoil of lungs.

Chest cavity decreases in size Chest cavity decreases in size --less volume, pressure increases less volume, pressure increases relative to atmosphere.relative to atmosphere.

Air exits airway until atmosphere Air exits airway until atmosphere and chest pressure are equal.and chest pressure are equal.


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Accessory Muscles of Accessory Muscles of BreathingBreathing

Needed for forceful breathingNeeded for forceful breathingKey sign of respiratory distressKey sign of respiratory distress

Accessory muscles of inspiration Accessory muscles of inspiration increase the size of chest cavity by increase the size of chest cavity by further lifting rib cage and increasing further lifting rib cage and increasing diameterdiameter

InspiratoryInspiratory muscles muscles –– scalene (neck), scalene (neck), sternocleidomastoidssternocleidomastoids, , parasternalparasternal (chest) (chest)


Accessory Muscles of Accessory Muscles of ExpirationExpiration

Assist in forcefully evacuating air Assist in forcefully evacuating air

Pull down on ribs and compress abdominal contents into Pull down on ribs and compress abdominal contents into diaphragm diaphragm

Expiratory muscles Expiratory muscles —— internal intercostals and abdominal internal intercostals and abdominal muscles muscles

Active accessories indicate respiratory distress, signs include Active accessories indicate respiratory distress, signs include bulging neck muscles, retraction between ribs, abdominalbulging neck muscles, retraction between ribs, abdominaldistention.distention.


Respiratory VolumesRespiratory Volumes

Minute volumeMinute volumeThe amount of air delivered to the lungs each minuteThe amount of air delivered to the lungs each minuteEquals tidal volume times the number of breaths per minute Equals tidal volume times the number of breaths per minute

Normal minute volume for an adultNormal minute volume for an adultTidal volume (approx 500 Tidal volume (approx 500 mLmL/breath) x respiratory rate (normal /breath) x respiratory rate (normal range is 12range is 12--20/minute)20/minute)Example: MV = 500 Example: MV = 500 mLmL/breath x 12 breaths/min or 6000 /breath x 12 breaths/min or 6000 mLmL/min/min


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Using Minute VentilationUsing Minute Ventilation

An unresponsive male has An unresponsive male has respirations of 6 per minute and no respirations of 6 per minute and no noticeable chest rise.noticeable chest rise.

Is his minute ventilation adequate Is his minute ventilation adequate to support life?to support life?


Using Minute VentilationUsing Minute Ventilation

Provide rescue breathing to the patient with Provide rescue breathing to the patient with hypoventilation. hypoventilation.

How do you gauge adequate volume per How do you gauge adequate volume per breath? What is the tidal volume?breath? What is the tidal volume?

How many breaths a minute should be How many breaths a minute should be administered?administered?

What is the minute ventilation?What is the minute ventilation?


VentilationVentilationAdequate ventilationAdequate ventilation

Respiratory rate of 12 Respiratory rate of 12 -- 20 with visible 20 with visible chest risechest riseAlert mental state, muscle tone, and Alert mental state, muscle tone, and moving airmoving airNormal skin colorNormal skin color

Inadequate ventilation (respiratory failure)Inadequate ventilation (respiratory failure)Very slow ventilationVery slow ventilationVery rapid ventilation with minimal or no Very rapid ventilation with minimal or no chest risechest riseAltered mental state, poor muscle tone, Altered mental state, poor muscle tone, poor air flow, cyanosispoor air flow, cyanosis


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AlveolarAlveolar--Capillary ExchangeCapillary Exchange

DiffusionDiffusionMovement of gases from an area of higher concentration to an areMovement of gases from an area of higher concentration to an area of a of lower concentrationlower concentration

Oxygen and carbon dioxide diffuse at the lungs and at the tissueOxygen and carbon dioxide diffuse at the lungs and at the tissues.s.Lungs: Lungs: oxygen moves from the alveoli (higher) to the blood (lower)oxygen moves from the alveoli (higher) to the blood (lower)Tissues:Tissues: oxygen moves from the blood (higher) to the tissues (lower)oxygen moves from the blood (higher) to the tissues (lower)

Fluid in the alveoli can impair diffusion and lead to hypoxia.Fluid in the alveoli can impair diffusion and lead to hypoxia.


Clinical ApplicationClinical Application

Nerve agents, such as Nerve agents, such as sarinsarin, cause muscle paralysis , cause muscle paralysis and excessive secretions, including in the lungs. and excessive secretions, including in the lungs. Victims die a respiratory death, from hypoventilation Victims die a respiratory death, from hypoventilation and/or and/or ““drowning in their own secretions.drowning in their own secretions.””


Neuroregulation of BreathingNeuroregulation of Breathing

CNS monitorsCNS monitorsCarbon dioxide, oxygen, and pHCarbon dioxide, oxygen, and pHDirects respiratory muscles to rate and depth of ventilation, Directs respiratory muscles to rate and depth of ventilation, as neededas neededCarbon dioxide primary drive for normal personCarbon dioxide primary drive for normal person

Patients with COPDPatients with COPDOxygen may be primary drive for COPDOxygen may be primary drive for COPDUse caution when administering oxygenUse caution when administering oxygenBe prepared to provide positiveBe prepared to provide positive--pressure ventilation if a pressure ventilation if a COPD patient begins to COPD patient begins to hypoventilatehypoventilate..


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Infant and Child Infant and Child ConsiderationsConsiderations

Mouth and nose Mouth and nose ——smallersmallerObstructed more easilyObstructed more easily

More space taken up by More space taken up by tonguetongue

Lower tidal volumesLower tidal volumes

More prone to gastric inflationMore prone to gastric inflation


Adequate Breathing Adequate Breathing RhythmRhythm

Regular Regular IrregularIrregular

QualityQualityBreath sounds Breath sounds ——present and equalpresent and equalChest expansion Chest expansion ——adequate and equaladequate and equalMinimum effort of breathing Minimum effort of breathing

Depth (tidal volume) Depth (tidal volume) –– visible chest risevisible chest rise


Adequate Breathing RateAdequate Breathing Rate

Adult Adult —— 1212--20/minute20/minute

Child Child —— 1515--30/minute30/minute

Infant Infant —— 2525--50/minute50/minute


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Important TermsImportant Terms

Respiratory distressRespiratory distress

Respiratory failureRespiratory failure

Respiratory arrestRespiratory arrest


Respiratory DistressRespiratory Distress

Shortness of breathShortness of breathAgitation or restlessnessAgitation or restlessnessActive accessory muscle useActive accessory muscle useRetractionsRetractionsCyanotic skinCyanotic skinIncreased pulse rateIncreased pulse rateIncreased respiratory rateIncreased respiratory rate


Noisy BreathingNoisy Breathing

CrowingCrowingAudible wheezingAudible wheezingGurglingGurglingSnoringSnoringStridorStridor

A harsh sound heard during breathingA harsh sound heard during breathingUpper airway obstructionUpper airway obstruction


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Respiratory FailureRespiratory FailureInadequate BreathingInadequate Breathing

Depressed mental state (e.g., responsive to voice, Depressed mental state (e.g., responsive to voice, responsive to pain, or unresponsive)responsive to pain, or unresponsive)Rate Rate –– very fast or very slowvery fast or very slowRhythm Rhythm —— irregularirregularQualityQuality

Breath sounds Breath sounds —— diminished or absentdiminished or absentChest expansion Chest expansion —— unequal or inadequateunequal or inadequate

Depth (tidal volume) Depth (tidal volume) —— inadequate/shallowinadequate/shallowCyanotic skin colorCyanotic skin color


Inadequate BreathingInadequate BreathingRate Rate —— outside of normal rangesoutside of normal ranges

Rhythm Rhythm —— irregularirregular

QualityQualityBreath sounds Breath sounds —— diminished or absentdiminished or absentChest expansion Chest expansion —— unequal or inadequateunequal or inadequateIncreased effort of breathing Increased effort of breathing —— use of accessory muscles use of accessory muscles —— predominantly predominantly in infants and childrenin infants and children

Depth (tidal volume) Depth (tidal volume) —— inadequate/shallowinadequate/shallow


Respiratory ArrestRespiratory Arrest

Definition:Definition:

Complete cessation of breathingComplete cessation of breathing


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Airway InterventionsAirway InterventionsManual techniquesManual techniques

Head tilt/chin liftHead tilt/chin liftJaw thrustJaw thrust

Mechanical techniquesMechanical techniquesOropharyngeal airwaysOropharyngeal airwaysNasopharyngeal airwaysNasopharyngeal airwaysSuctioningSuctioning


Opening the AirwayOpening the Airway

Head tilt/chin liftHead tilt/chin lift

Jaw thrust (if injury to Jaw thrust (if injury to the neck is suspected)the neck is suspected)


Techniques of SuctioningTechniques of Suctioning

Body substance isolationBody substance isolationPurpose Purpose

Remove blood, liquids, and food Remove blood, liquids, and food particles from the airwayparticles from the airwaySome units are inadequate for Some units are inadequate for removing solid objectsremoving solid objectsSuction immediately when a Suction immediately when a gurgling sound is heard gurgling sound is heard


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Soft (French)Soft (French)

Useful for suctioning the Useful for suctioning the nasopharynxnasopharynx

When rigid device is not When rigid device is not possiblepossible

Inserted only as far as Inserted only as far as the base of the tonguethe base of the tongue


Suctioning IssuesSuctioning IssuesSuction for no more than 15 seconds at a time (less in infants aSuction for no more than 15 seconds at a time (less in infants and nd children).children).

Secretions that cannot be removed quicklySecretions that cannot be removed quicklyLog roll, clear manuallyLog roll, clear manually

If patient produces frothy secretions as rapidly as suctioning cIf patient produces frothy secretions as rapidly as suctioning can an remove:remove:

Suction for 15 secondsSuction for 15 secondsArtificially ventilate for 2 minutesArtificially ventilate for 2 minutesSuction for 15 secondsSuction for 15 secondsContinue in that mannerContinue in that manner

Rinse catheter and tubing as needed.Rinse catheter and tubing as needed.


Airway Adjuncts and Airway Adjuncts and TechniquesTechniques


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Oropharyngeal AirwayOropharyngeal Airway

Measure the airway.Measure the airway.


Oropharyngeal AirwayOropharyngeal AirwayInsert airway upside down, with Insert airway upside down, with the tip facing the roof of the the tip facing the roof of the patientpatient’’s mouth.s mouth.

Rotate device into position.Rotate device into position.

Alternate method: Hold the Alternate method: Hold the tongue down and forward with a tongue down and forward with a tongue depressor and insert tongue depressor and insert airway directly.airway directly.


Nasopharyngeal AirwayNasopharyngeal Airway

Measure from tip of Measure from tip of nose to tip of ear. Look nose to tip of ear. Look at diameter of nostril.at diameter of nostril.


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Nasopharyngeal AirwayNasopharyngeal Airway

Insert airway with bevel toward base of Insert airway with bevel toward base of nose or septum.nose or septum.


PositivePositive--Pressure VentilationPressure Ventilation

Required for patients in respiratory failure and Required for patients in respiratory failure and respiratory arrestrespiratory arrest

Characteristics of effective positiveCharacteristics of effective positive--pressure pressure ventilationventilation

Rate appropriate for ageRate appropriate for age»» Adult Adult –– One breath every 5One breath every 5--6 seconds6 seconds»» Children and infants Children and infants –– One breath every 3One breath every 3--5 seconds5 seconds

Chest rise observed with each breathChest rise observed with each breath


PositivePositive--Pressure VentilationPressure VentilationCharacteristics of effective positiveCharacteristics of effective positive--pressure pressure ventilation (continued)ventilation (continued)

Each breath delivered slowlyEach breath delivered slowly•• Over 1 to 2 seconds for adultsOver 1 to 2 seconds for adults•• Over 1 to 1.5 second for children and infantsOver 1 to 1.5 second for children and infants

Oxygen saturation is greater than 93%, if pulse Oxygen saturation is greater than 93%, if pulse oximeteroximeter is is used.used.


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PositivePositive--Pressure VentilationPressure VentilationOrder of EffectivenessOrder of Effectiveness

MouthMouth--toto--maskmask

TwoTwo--person bagperson bag--valvevalve--maskmask

FlowFlow--restricted, oxygenrestricted, oxygen--powered ventilation devicepowered ventilation device

OneOne--person bagperson bag--valvevalve--maskmask


MouthMouth--toto--MaskMask

Allows for good seal Allows for good seal and for direct feedback and for direct feedback to the rescuerto the rescuer


Oxygen reservoirOxygen reservoir

SelfSelf--refilling bagrefilling bag

Valve to allow oxygen inlet flow Valve to allow oxygen inlet flow of 15 L/minof 15 L/min

Valve to make it Valve to make it nonrebreathernonrebreather

If popIf pop--off valve, ability to off valve, ability to disable if necessary when high disable if necessary when high resistance encounteredresistance encountered

BagBag--ValveValve--MaskMask


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Bag capacity Bag capacity ——approximately 1,600 approximately 1,600 mLmL

Single rescuer may have Single rescuer may have difficulty maintaining an difficulty maintaining an airtight seal.airtight seal.

Result Result —— May provide less May provide less volume than mouthvolume than mouth--toto--maskmask



Select correct mask size (adult, Select correct mask size (adult, infant or child).infant or child).Position thumbs over top half of Position thumbs over top half of mask.mask.Place index and middle fingers Place index and middle fingers over bottom half.over bottom half.Place apex of mask over bridge of Place apex of mask over bridge of nose.nose.Lower mask over mouth and upper Lower mask over mouth and upper chin.chin.If mask has large round cuff, If mask has large round cuff, position center port over mouth.position center port over mouth.


TwoTwo--Rescuer BVMRescuer BVMTechnique is more effective than oneTechnique is more effective than one--rescuer method.rescuer method.

Position person holding mask in place Position person holding mask in place at patientat patient’’s head.s head.

Adjunctive airways (oral or nasal) may Adjunctive airways (oral or nasal) may be necessary in conjunction with bagbe necessary in conjunction with bag--valvevalve--mask.mask.

For trauma, maintain inFor trauma, maintain in--line line immobilization.immobilization.


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If No Chest RiseIf No Chest RiseReposition head.Reposition head.

If air is escaping from under the mask, If air is escaping from under the mask, reposition fingers and mask.reposition fingers and mask.

Check for obstruction.Check for obstruction.

If chest still does not rise and fall, use If chest still does not rise and fall, use alternative method of artificial ventilation alternative method of artificial ventilation (e.g., pocket mask, manually triggered (e.g., pocket mask, manually triggered device).device).

Consider use of adjuncts.Consider use of adjuncts.OropharyngealOropharyngeal airwayairwayNasopharyngeal airwayNasopharyngeal airway


FlowFlow--Restricted, OxygenRestricted, Oxygen--Powered Ventilation DevicePowered Ventilation Device

Peak flow of 100% OPeak flow of 100% O22 at rate up at rate up to 40 L/minto 40 L/min

InspiratoryInspiratory pressure relief valve pressure relief valve at 60 cm of Hat 60 cm of H22OO

Alarm is activated when relief Alarm is activated when relief pressure is exceeded.pressure is exceeded.

Position trigger so both hands Position trigger so both hands can remain on mask to maintain can remain on mask to maintain good seal.good seal.


Use of FlowUse of Flow--Restricted, OxygenRestricted, Oxygen--Powered Ventilation DevicePowered Ventilation Device

Immobilize head and neck.Immobilize head and neck.

Position mask.Position mask.

Trigger device until chest rises.Trigger device until chest rises.


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CricoidCricoid PressurePressureDuring artificial ventilation, air can enter During artificial ventilation, air can enter the esophagus.the esophagus.

Gastric distentionGastric distentionRegurgitationRegurgitation

Compresses esophagus between the Compresses esophagus between the cricoidcricoid cartilage and spinecartilage and spine

Closes esophagus and reduces chances Closes esophagus and reduces chances of air entering during positiveof air entering during positive--pressure pressure ventilationventilation


Inadequate Inadequate PositivePositive--Pressure VentilationPressure Ventilation

The chest does not rise and fall with artificial ventilation.The chest does not rise and fall with artificial ventilation.

The rate is too slow or too fast.The rate is too slow or too fast.

Forceful ventilations promote gastric inflation, vomiting, and Forceful ventilations promote gastric inflation, vomiting, and aspiration.aspiration.

Heart rate does not return to normal with artificial ventilationHeart rate does not return to normal with artificial ventilation..


Oxygen TherapyOxygen Therapy


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Oxygen CylindersOxygen Cylinders

Size ranges from D and E (portable) Size ranges from D and E (portable) to H (in board).to H (in board).

Contents are under pressure.Contents are under pressure.

Position cylinder to avoid falls and Position cylinder to avoid falls and blows to valveblows to valve--gauge assembly.gauge assembly.


Pressure RegulatorsPressure RegulatorsReduce high pressure of gas Reduce high pressure of gas in cylinder to a level not in cylinder to a level not injurious to patientsinjurious to patients

SingleSingle--staged and doublestaged and double--stagedstaged

Reduce tank pressure, Reduce tank pressure, measure tank pressure, and measure tank pressure, and regulate flow ratesregulate flow rates


Setting Up an Oxygen SystemSetting Up an Oxygen System

Confirm that the cylinder contains Confirm that the cylinder contains oxygen by identifying the color and oxygen by identifying the color and pin index grouping.pin index grouping.

Check to see that a rubber washer Check to see that a rubber washer (O(O--ring) is in place at either the ring) is in place at either the cylinder opening or the regulator cylinder opening or the regulator opening.opening.


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Setting Up an Oxygen SystemSetting Up an Oxygen SystemTo clear dust from the To clear dust from the opening, open the main opening, open the main valve at the top of the valve at the top of the cylinder slowly until gas cylinder slowly until gas starts to come out, then starts to come out, then immediately close the valve.immediately close the valve.



Attach the regulator by Attach the regulator by carefully aligning the pin carefully aligning the pin index from the regulator into index from the regulator into the cylinder holes.the cylinder holes.

Tighten the clamp with firm Tighten the clamp with firm hand pressure to ensure an hand pressure to ensure an adequate seal.adequate seal.



Open the valve two full turns.Open the valve two full turns.

Check the pressure gauge Check the pressure gauge (approx. 2000 (approx. 2000 psipsi).).

If the cylinder leaks, turn off the If the cylinder leaks, turn off the main valve and check the main valve and check the connection and firmness of the connection and firmness of the attachment.attachment.


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Setting Up an Oxygen SystemSetting Up an Oxygen SystemAttach the tubing or delivery Attach the tubing or delivery device to the regulator and device to the regulator and adjust liter flow.adjust liter flow.

Attach the delivery device to Attach the delivery device to the patient.the patient.


Discontinuing the Oxygen Discontinuing the Oxygen SystemSystem

Remove the oxygen Remove the oxygen delivery device from the delivery device from the patient.patient.



Turn off the flow of Turn off the flow of oxygen.oxygen.

Turn off the main valve Turn off the main valve at the top of the at the top of the cylinder.cylinder.


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Open the Open the flowmeterflowmeter valve to valve to bleed oxygen out of the bleed oxygen out of the system.system.

Detach the regulator by Detach the regulator by loosening the clamp; mark loosening the clamp; mark the cylinder if empty and the cylinder if empty and store in the appropriate area.store in the appropriate area.


Calculating Oxygen SuppliesCalculating Oxygen Supplies

Time remaining (min) = Time remaining (min) =

(Tank pressure [(Tank pressure [psipsi] ] -- 200 200 psipsi) ) ×× ConstantConstantFlow rate (L/min)Flow rate (L/min)


Case in PointCase in Point

You are transporting a patient who is receiving 15 You are transporting a patient who is receiving 15 L/min of oxygen by a nonrebreather mask. The L/min of oxygen by a nonrebreather mask. The estimated transport time is 20 minutes. On your E estimated transport time is 20 minutes. On your E cylinder, the pressure gauge reads 1200 cylinder, the pressure gauge reads 1200 psipsi. Do you . Do you have enough oxygen for this patient, or should you have enough oxygen for this patient, or should you prepare to change tanks en route?prepare to change tanks en route?


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Case in PointCase in Point

Time (min) = Time (min) = (1200 (1200 psipsi -- 200 200 psipsi) ) ×× 0.280.2815 L/min15 L/min

1818⅔⅔ minutes of oxygen remaining, if delivered minutes of oxygen remaining, if delivered at 15 L/minat 15 L/min


Nasal Nasal CannulaCannulaA flow rate of 2A flow rate of 2--6 L/min 6 L/min provides 24%provides 24%--40% oxygen. 40% oxygen.

Use if patient cannot tolerate Use if patient cannot tolerate nonrebreather mask.nonrebreather mask.


Applying a Nasal CannulaApplying a Nasal Cannula

Use personal precautions.Use personal precautions.

Place the nasal cannula Place the nasal cannula prongs into the patientprongs into the patient’’s s nose.nose.

Guide the tubing around the Guide the tubing around the patientpatient’’s ears and under the s ears and under the chin.chin.

Adjust the fit of the device Adjust the fit of the device under the chin.under the chin.


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Nonrebreather MaskNonrebreather MaskPreferred supplemental Preferred supplemental oxygen mask for prehospital oxygen mask for prehospital carecare

Provides up to 90% oxygenProvides up to 90% oxygen


NonrebreatherNonrebreather MaskMask


Applying a Applying a NonrebreatherNonrebreatherMaskMask

Use appropriate PPE.Use appropriate PPE.

PrefillPrefill reservoir bag with oxygen by reservoir bag with oxygen by placing two fingers inside mask and placing two fingers inside mask and closing off valve.closing off valve.

Extend elastic strap and place Extend elastic strap and place mask over patientmask over patient’’s head.s head.

Cinch metal band on patientCinch metal band on patient’’s nose s nose and adjust elastic strap to fit patient.and adjust elastic strap to fit patient.


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StomasStomasA breathing tube may be present. If A breathing tube may be present. If so, attach BVM directly to tube.so, attach BVM directly to tube.

If air escapes, close the mouth and If air escapes, close the mouth and pinch the nostrils.pinch the nostrils.

If stoma is obstructed, suction.If stoma is obstructed, suction.


Infants and ChildrenInfants and Children

Place head in correct neutral Place head in correct neutral position.position.

Avoid excessive hyperextension Avoid excessive hyperextension of the head.of the head.

Avoid excessive bag pressure.Avoid excessive bag pressure.

Ventilate until adequate chest rise Ventilate until adequate chest rise observed.observed.


Infants and ChildrenInfants and Children

Disable popDisable pop--off valve, if present.off valve, if present.

Gastric distention is common in Gastric distention is common in children.children.


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Facial InjuriesFacial InjuriesBlunt injuries to the face Blunt injuries to the face frequently result in severe frequently result in severe swelling.swelling.

Bleeding into the airway can be Bleeding into the airway can be a challenge to manage.a challenge to manage.

Have suction availableHave suction available


Dental AppliancesDental Appliances

Full dentures Full dentures —— ordinarily should be left in placeordinarily should be left in place

Partial dentures may become dislodged.Partial dentures may become dislodged.

Be prepared to remove denture if it becomes dislodged.Be prepared to remove denture if it becomes dislodged.


Airway Airway —— SummarySummaryAAirway, irway, bbreathing and reathing and ccirculation are assessed in irculation are assessed in every case.every case.

Assess need for treatment of Assess need for treatment of airway, positiveairway, positive--pressure pressure ventilations, and ventilations, and supplemental oxygen on supplemental oxygen on every case.every case.

Master skills of oxygen Master skills of oxygen administration, airway administration, airway management, and positivemanagement, and positive--pressure ventilation via pressure ventilation via practical skills training. practical skills training.


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Copyright © 2007, 2004, by Mosby, Inc., an affiliate of ...brainspew.com/advanced/emt/emt07/Chapter_007.pdf · 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier