ACLS case: Respiratory Arrest
When using a bag valve device, deliver approximately ___mL tidal volume sufficient to produce chest rise over __ second
600 1
suction attempts should not exceed __ seconds
10
The universal connections present on all airway devices allow you to connect any ventilation bag to numerous adjuncts. Valves and ports may include:
- one way valves to prevent the patient from re-breathing exhaled air -oxygen ports for administering supplementary oxygen -medication ports for administering aerosolized and other medications -suction ports for clearing the airway - ports for quantitative sampling of End tital CO2
what should be monitored while suctioning?
-HR -pulse -O2 sats -clinical appearance
when to use a soft catheter for suctioning
-aspiration of thin secretions from the oropharynx and nasopharynx -performing intratracheal suctioning -suctioning through an in place airway (i.e. NPA) to access the back of the pharynx in a patient with clenched teeth
steps for endotracheal suctioning
-gently insert the catheter into the ET tube. Be sure the side opening is not occluded during insertion -apply suction by occluding the side opening only while withdrawing the catheter in a rotating or twisting motion
what interventions should be kept in mind when it comes to respiratory arrest?
-giving supplementary oxygen -opening the airway -providing basic ventilation -using basic airway adjuncts (OPA, NPA) -suctioning
what are the basic airway skills used to ventilate a patient?
-head tilt chin lift -jaw thrust without head extension (suspected cervical spine trauma) - mouth to mouth ventilation -mouth to nose ventilation -mouth to barrier device (using a pocket mask) ventilation -bag mask ventilation
When is the NPA used?
-patients with a gag reflex -trismus -massive trauma around the mouth -wiring of the jaws -patients who neurologically impaired with poor pharyngeal tone or coordination leading to upper airway obstruction
when should you give O2 according to ACLS?
-patients with acute cardiac symptoms -respiratory distress *monitor O2 sats and ensure to titrate to 94% or higher
Difference between a soft catheter vs a rigid catheter when it comes to suctioning
-soft flexible catheters may be used in the mouth or nose. available in sterile wrappers and can also be used for deep ET suctioning -rigid catheters (i.e. Yankauer) are used to suction the oropharynx. these are better for suctioning thick secretions and particulate matter
what do you do if there is any drastic change in HR, SPO2 or clinical presentation
-stop suctioning immediately - administer O2 until vital return to their normal
Be aware of the following when using an NPA:
-take care to insert the airway gently to avoid complications. the airway can irritate the mucousa or lacerate adenoidal tissue and cause bleeding, with possible aspiration of clots into the trachea. Suction may be necessary to remove blood or secretions -an improperly sized NPA may enter the esophagus. With active ventilation, such as BVM, the NPA may cause gastric inflation and possible hypoventilation -my cause laryngospasm and vomiting, even though it is commonly tolerated in semiconscious patients -use caution in patients with facial trauma because of the risk of misplacement into the cranial cavity through a fractured cribriform plate
When is the OPA used?
-to keep the airway open during BVM ventilation when providers may unknowingly push down on the chin blocking the airway -during suctioning of the mouth and throat -in intubated patients to prevent them from biting and occluding the ET tube
With respiratory arrest, give __ breath every __-__ seconds (__-__ breaths per minute) using a BVM
1 5-6 10-12
how long should it take to do a pulse check?
5-10 seconds
TRUE OR FALSE: The use of cricoid pressure in cardiac arrest is recommended
FALSE, it is NOT recommended for it may impede ventilation and interfere with placement of a advanced airway
What is the most reliable method of confirming and monitoring placement of an ET tube
continuous waveform capnography
with oropharyngeal suctioning, how far can you insert the catheter?
do not insert it any farther than the distance from the tip of the nose to the earlobe
why should the suction catheter not go beyond the tip of the ET tube?
it may injure the endotracheal mucousa or stimulate coughing or bronchospasm
when to use a rigid catheter in suctioning
more effective suctioning of the oropharynx, particularly if there is thick particulate matter
what is the respiration rate with any advanced airway?
one breath every six to eight seconds
with oropharyngeal suctioning, gently insert the catheter into the oropharynx beyond the ________
tongue
Define respiratory arrest
where respirations are completely absen or clearly inadequate to maintain effective oxygenation and ventilation. A pulse is present (do not confuse agonal respirations with adequate respirations)