Studydroid is shutting down on January 1st, 2019



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Indications for manual ventilation 1 of 3
  • Apnea
    During codes
  • Respiratory arrest
  • CNS abnormalities- lesions, drugs
  • Obliterated hypoxic drive  


       

      
     
   
Indications for manual ventilation 2 of 3
  • Shallow inadequate ventilation- Hypopnea
    Myocardial infarction
  • CNS depression- Lesions, drugs, hypothermia
  • Depressed hypoxic drive
  • Neuromuscular disease
  • Fatigue- Lower airway obstruction, secretions
       

     
Indications for manual ventilation 3 of 3
  • During Special Procedures
    Prior to and after suctioning
  • Radiologic procedures- CXR, C-T scan, MRI
  • Ventilator malfunction
  • Patient transport 
Manual Resuscitators Design Standards

Card 1
Delivery of an adequate volume
ASTM recommends :
- 600 ml for adults
- 70-300 ml for children
- 20-70 ml for infants
AHA recommends :
- 800-1200 ml for adults           
Manual Resuscitators Design Standards

Card 2
  • Patient valve should not malfunction at flows up to 30 lpm.
  • Malfunctions due to vomitus should be able to be restored within 30 sec.
  • Must be able to retain proper function being dropped onto concrete from 1.0 m
Manual Resuscitators Design Standards

Card 3
  • If pressure limit is on adult resc it must have override capability that is readily apparel
  • Pediatric/infant resc must incorporate 40cm H2O pressure limit safety device. Override capability should exist that is readily apparent.
Manual Resuscitators Design Standards

Card 4
  • Adult resuscitators should be self-inflating
  • Resuscitators should refill fast enough to allow ventilation at high rates. Particularly true of infant/ped units.
  • Material should allow operator to feel changes in airway pressure
Manual Resuscitators Design Standards

Card 5
The patient valve should direct O2 or O2/air to pt while not permitting rebreathing of exhaled gases.
- Should have low restistence. Back pressure should be <5 cm H2O at flowrate of 50 LPM
- Should not jam at high flowrates
-Deadspace of device should not exceed :
     30ml for adults
     15ml for children
     7 ml for infants
Identify outside and inside diameter od standard anesthesia "universal connector
  • 22mm Outside diameter
  • 15mm Inside diameter
Key Points of Laerdal Bag
  • Patient valve- diaphragm and duckbill
  • Inlet valve- one way leaf
  • Volume- 1800 ml adult, 500ml child, 240 ml infant
  • O2 resevoir- bag
  • Max FIO2- up to 1.0
Key Points of PMR II Bag
  • Patient valve- diaphragm and leaf
  • Inlet valve- one way leaf
  • Volume- 2000 ml adullt
  • O2 resevoir- elephant bore tubing
  • Maximum FIO2 up to 1.0
Methods to determine effectiveness of manual ventilation
  • Chest expansion
  • Breath sounds
  • Patient color
  • Pulse oximetery
  • Capography (End tidal CO2)
  • ABGs
Variables that determine FIO2 from manual resuscitators
The O2 flowrate delivered to the bag
- Higher flowrate higher FIO2 - Lower flowrate lower FIO2 Whether or not O2 resevoir is used Bag refill time (Restricted vs unrestricited) -Longer refill time (Restricted refill) higher FIO2 -Shorter refill time (Unrestricted refill) lower FIO2
 
Identify two primary causes of upper airway obstruction
  • Soft tissue obstruction
  • Laryngeal obstruction
Clinical Signs of Upper Airway Obstruction : Partial Obstruction
  • Snoring or crowing sound (stridor)
  • Cyanosis
  • Diaphoresis (profuse sweating)
Clinical Signs of Upper Airway Obstruction : Total Obstruction
  • Marked inspiratory effort w/o air movement
  • Marked retractions
  • Extreme anxiety
  • Cyanosis
  • Unconsciuosness
Function and use of Oropharyngeal airway
  • Follows curvature of tongue and seperates it from posterior wall of pharynx
  • Distal tip lies at base of tongue above epiglotis
  • Tolerated poorly in conscious patients
Types of Oropharyngeal airways
Two common ones: - Gruedel- one center channel - Berman- I-beam construction two side channels - Both have external flange and body that conforms to shape of oral cavity.
Oropharyngeal Airway Sizing
  • Wth flange at lips the distal tip should extend to the angle of jaw
  • With distal tip pointed superiorly rotate airway 180 deg as it is advanced into position
Function and use of Nasopharyngeal Airway
  • Provides pasage from external nares to base of tongue seperating it from posterior wall of pharynx
  • Distal tip lies at base of tongue above epiglottis
  • Better tolerated in concious patient
Pharyngeo-Tracheal (PTLA) Lumen Airway Advantages
  • Mask to face seal not required
  • Tracheal intubation not a complication
  • Prevents aspiration from upper airway hemorrhage due to trauma
Esophageal Obturator Airway (EOA) Complications
  • Removal frequently followed by vomiting. cuffed endotrcheal tube should be placed prior to removal of EOA.
Normal Protective Reflexes
  • Pharyngeal reflex- gag/swallow reflex
  • Laryngeal reflex- Cause laryngospasm and associated closure of epiglottis
  • Tracheal reflex- cough reflex
  • Carinal reflex- cough reflex
Early AMBU Bag Details
  • Volume- 2000ml adult
  • No spontaneous breathing
  • Disadvantages-
  • Foam breaks down inside bag
  • High flowrates jam ptient valve in open position
5 Main Reasons for Manual Ventilation
  • Apnea
  • Shallow, inadequate ventilation (Hypopnea)
  • During special procedures
  • Ventilator malfunction
  • Patient transport
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