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AIRWAY ADJUNTCS,

OXYGENATION, AND
VENTILATION
PRIMARY SURVEY SECONDARY SURVEY
Airway : Airway :
Open the airway Provide advanced airway
management (tracheal
Breathing : intubation, LMA, combitube)
Provide positive- Breathing :
pressure ventilation Confirm proper tube
Circulation : placement by primary (px)
and secondary (exhaled CO2,
Give chest compressions esophageal detector device)
Defibrillation : methods, check fo adequate
oxygnation and ventilation
Shock VF / pulse less VT Circulation :
Obtain iv access
Continue CPR
Provide rhythm cv tx
Differential Diagnosis
OVERVIEW
Objectives and techniques of respiratory support
Primary A-airway
Provide supplementary O2
Ensure a patient and protected airway : use
manual technique as needed
Ensure a patient & protected airway : Use simple,
non invasive airway adjuncts
Primary B-Breathing
Monitor the quality of oxygenation and ventilation
with non-invasive devices
Provide positive pressure oxygenation and
ventilation with manual techniques or non
invasive airway
OVERVIEW

Secondary A-airway
Establish a patent and protected airway with
invasive advanced airway devices
Confirm proper placement of these devices with
primary and secondary confirmation techniques
Secondary B-Breathing
Provide effective positive-pressure oxygenation
and ventilation using advance and airway devices
Secure the advance airway devices to prevent
displacement
Monitor oxygenation and ventilation
If the patient is
making spontaneous
breathing efforts, is
there evidence of
partial or complete
airway obstruction?
If spontaneous breathing is present,
patients is unconscious provide in
recovery position
PROVIDE SUPPLEMENTARY OXYGEN
WITH AIRWAY ADJUNCTS

Pt without respiratory distress :


O2 4 l/min-nasal canula
Pt with mild respiratory distress :
O2 6 l/min
Pt with severe respiratory distress, acute
congestive heart failure or cardiac arrest :
High flow O2, advanced airway devices & 100%
oxygen
Titrate oxygen up or down according to
PaO2 or SpO2
INDICATIONS FOR PROVISION OF
SUPPLEMENTARY OXYGEN
Pulse oximetry Interpretation Intervention
reading
95% - 100% Desired range O2 4 l/min nasal canule

90% - <95% Mild-moderate hypoxia Face mask

85% - <90% Moderate-severe Face mask w/ O2 reservoir


hypoxia assisted ventilation

<85% Severe to life-


threatening hypoxia Assisted ventilation
DELIVERY OF SUPPLEMENTARY
OXYGEN
DEVICE FLOW RATE DELIVERY O2
Nasal canula 1 L/min 21% - 24%
2 L/min 25% - 28%
3 L/min 29% - 32%
4 L/min 33% - 36%
5 L/min 37% - 40%
6 L/min 41% - 44%
Simple oxygen face mask 6-10 L/min 35% - 60%
Face mask w/ O2 reservoir 6 L/min 60%
(nonrebreathing mask) 7 L/min 70%
8 L/min 80%
9 L/min 90%
10-15 L/min 95% - 100%
Ventury mask 4-8 L/min 24% - 40%
10-12 L/min 40% - 50%
PRIMARY AIRWAY : ESTABLISH PATENT
AIRWAY VIA HEAD AND JAW POSITION

Overview
The unconscious pt with spontaneous
heart beat and compromised oxygenation
an ventilation
HEAD TILT CHIN LIFT
JAW THRUST
MAINTAIN A PATENT AIRWAY
USING AIRWAY ADJUNCTS

Oropharingeal airways

Nasopharingeal airways
Oropharyngeal airway
Holds the tongue away from
the posterior wall of the
pharynx
Facilitates suctioning of the
pharynx
Prevents the pt. from biting
and occluding a tracheal tube
Unconscious pt. with
spontaneously breathing
without gag reflex
Oropharyngeal airway
Complications :
Complete airway obstruction
Laringospasm
Vomiting
Oropharyngeal airway
insertion
Nasopharyngeal airway
The patients is spontaneously breathing,
have an intact cough and gag reflex
Nasopharyngeal Airway
Complications
Nasal mucosa injury
Laryngospasm
Nasopharyngeal Airway
Techniques
PROVIDE VENTILATION WITH

Mouth to barrier device


ventilation
Mouth to mask
ventilation
Bag-mask device
Without oxygen : tidal
volume 10 ml/kg in 2 s
Using O2 (>40%) : tidal
volume 10 ml/kg in 1-2 s
VENTILATION DEVICES
PROVIDE INDICATION AIRWAY CONTROL
WITH TRACHEAL INTUBATION

Indications
- Inability of the rescuer
to ventilate the
unconscious pt w/
less invasive methods
- Inability of the pts to
protect their airway
- Prolong need for
chest compression
during cpr
Ventilation and oxygenation must be provided
initially before laryngoscopy and tracheal
intubation attempts
Complications
Trauma
Vomiting and
aspiration
Main bronchus
intubation
Eshopageal
intubation
Reflex sympathetic
and para sympathetic
stimulation
Preventing complications of
tracheal intubation
Properly trained personnel
Limit intubation attempts to
20-30 s
RSI sequence (w/
premedication, sedation &
paralysis
A high-volume, low pressure
cuff tube
TECHNIQUE
In CPR, pt w/ tracheal
intubation :
VENTILATION
RESCUES should not
SYNCHRONIZED with
CHEST
COMPRESSION
ALTERNATIVE ADVANCED
AIRWAYS

-Laryngeal Mask Airway


- Combitube