Recognize the need to ventilate a patient, and do so immediately. Hypoventilation occurs when the rate of spontaneous ventilations falls below 8 per minute or when the tidal volume falls below approximately cc per breath.
In either case, assisted ventilations become necessary. Although apnea or hypoventilation may be corrected when the cause is reversed e. Position the patient, position the airway and maintain the proper airway position.
Lay the patient supine. In any circumstance, adequate space must be available for rescuers to move freely and comfortably around the patient, including enough area at the head for a rescuer to kneel or stand. Three or four fingers from each of the rescuers hands should be placed behind or on the angle of the jaw, and the jaw should be firmly thrust straight forward, pushing the chin toward the ceiling or sky. This will lift the posterior aspect of the tongue off the back of the oropharynx, thereby creating an open airway.
Maintain this position throughout the duration of the resuscitation effort. Assist positioning with an adjunct. A properly-sized nasopharyngeal airway NPA adjunct should be placed in a patient with a gag reflex, or an oropharnygeal OPA in patients without a gag reflex.
This will assist in keeping the tongue from falling onto the back of the throat and obstructing the airway. Select a properly sized mask. Seal the mask to the face. Bag-valve-mask ventilation can be done with one person or two, but two-person BVM ventilation is easier and more effective because a tight seal must be achieved and this usually requires two hands on the mask. Unless contraindicated, a pharyngeal airway adjunct is used when performing BVM ventilation. An oropharyngeal airway is used unless the patient has an intact gag reflex; in such cases, a nasopharyngeal airway nasal trumpet is used.
Bilateral nasopharyngeal airways and an oropharyngeal airway are used if necessary for ventilation. Among the many factors that can make achieving an air-tight seal difficult are facial deformity traumatic or natural , a thick beard, obesity, poor dentition, trismus, and cervical pathology. In such situations, BVM is attempted, but if it is unsuccessful, a supraglottic airway is placed unless contraindicated.
PEEP has also been shown to prevent lung injury. However, PEEP should be used cautiously in patients who are hypotensive or pre-load dependent because it reduces venous return.
Align the upper airway for optimal air passage by placing the patient into a proper sniffing position. Proper sniffing position aligns the external auditory canal with the sternal notch. To achieve the sniffing position, folded towels or other materials may need to be placed under the head, neck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck. In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck.
In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput. A: The head is flat on the stretcher; the airway is constricted. B: The ear and sternal notch are aligned, with the face parallel to the ceiling in the sniffing position , opening the airway. Avoid moving the neck and, if possible, use only the jaw-thrust maneuver or chin lift without head tilt to manually facilitate opening of the upper airway.
Aligning the external auditory canal with the sternal notch may help open the upper airway to maximize air exchange and establishes the best position to view the airway if endotracheal intubation becomes necessary.
The degree of head elevation that best aligns the ear and sternal notch varies eg, none in children with large occiputs, a large degree in obese patients.
Insert an oropharyngeal airway How To Insert an Oropharyngeal Airway Oropharyngeal airways are rigid intraoral devices that conform to the tongue and displace it away from the posterior pharyngeal wall, thereby restoring pharyngeal airway patency. Do two-person BVM ventilation if possible. NOTE: The accompanying video presents the one-person technique first.
In the two-person technique, the more experienced operator handles the mask, because maintaining a proper mask seal is the most difficult task. The second operator squeezes the bag. Using both hands, hold the mask between your thumbs and index fingers placed on either side of the connector stem. Next, lower the mask over the chin and allow it to seal along the two malar eminences. Cover the bridge of the nose, the two malar eminences, and the patient's lower lip by the mask to achieve a proper seal.
Stretching the internal portion of the mask before placing it over the nose and mouth can help create a tighter seal. Traditional hand placement is the "C-E" grip, placing the middle, ring, and little fingers the "E" under the mandible and pulling the mandible upward, while the thumbs and index fingers create a "C" and then press down against the mask.
An alternative, often preferred, method 1, 2 References Bag-valve-mask BVM ventilation is the standard method for rapidly providing rescue ventilation to patients with apnea or severe ventilatory failure. See also Airway Establishment and Control Place the thenar eminences the base of the thumbs in the palm along each lateral edge of the mask. Then lower the mask onto the face and place the other 4 fingers under the mandible.
Press the mask to the face with the thenar eminences while pulling the mandible upward with the fingers. Head tilt may be applied concurrently. This technique is easier to perform, allows the use of stronger hand muscles to maintain a proper seal, minimizing fatigue, and enables 4 fingers rather than 3 to lift the mandible accomplishing chin lift and jaw thrust.
If using the traditional hand placement, provide a head tilt—chin lift maneuver Step-by-Step Description of Procedure Part of pre-intubation and emergency rescue breathing procedures, the head tilt—chin lift maneuver and the jaw-thrust maneuver are 2 noninvasive, manual means to help restore upper airway patency If your hands are large enough, place your little fingers behind the mandibular rami to do a jaw-thrust maneuver Step-by-Step Description of Procedure Part of pre-intubation and emergency rescue breathing procedures, the head tilt—chin lift maneuver and the jaw-thrust maneuver are 2 noninvasive, manual means to help restore upper airway patency We also use third-party cookies that help us analyze and understand how you use this website.
These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience. Necessary Necessary. Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website.
These cookies do not store any personal information. Non Necessary non-necessary. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies.
It is mandatory to procure user consent prior to running these cookies on your website. Uncategorized uncategorized. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. Analytics analytics.
0コメント