ACLS Chapter One, Airway Management, Part Two

T/F: The single rescuer may have difficulty maintaining an airtight seal.

.True

What is the approximate volume of the self-inflating bag?

1,600 mL.

A pediatric patient is said to be in respiratory arrest if his or her respiratory rate is less than per minute.

10.

What peak flow rate and percent of oxygen should a flow-restricted oxygen-powered ventilation device be capable of delivering?

100% at up to 40 L/min.

What oxygen liter flow should you use when performing mouth-to-mask ventilations?

15 L/min.

What is the maximum time you should apply suction to a patient?

15 seconds at a time.

How much vacuum should a suction device be able to generate?

300 mm Hg.

What kind of valve should the bag-valve-mask device have?

A non-jam valve that allows a maximum of oxygen inlet flow of 15 L/min.

When should oxygen be given to a child in respiratory distress?

Always.

You are suctioning a patient and the tubing becomes clogged. What should you do?

Attempt to clear the clog by suctioning water.

Before beginning artificial ventilations of any kind, what should you consider?

Body substance isolation.

If while ventilating a patient the chest does not rise and fall, what should you do after repositioning fingers and mask?

Check for obstruction.

What is the main disadvantage of a battery operated suction unit?

Discharged batteries.

What two types of portable suction devices are there?

Electrical and hand operated.

T/F: Never insert a suction catheter without suction.

False.

T/F: Children with a partial airway obstruction should be removed from their parents and placed in a supine position.

False. Children should be assisted to the sitting position and can remain with the parents.

T/F: Position self at the side of the patient's head for optimal performance of bag-valve-mask device.

False. You should be positioned at the top of the patient's head.

What two types of suction catheters are there?

Hard or rigid (tonsil tip) and soft (French).

Describe how you can deliver oxygen to a child who will not tolerate a nasal cannula or facemask.

Hold tubing 2 inches from the child's face or place the tubing into the bottom of a paper cup and hold it near the child's face.

If while ventilating a patient the chest does not rise and fall, what should you do after repositioning the head?

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

What precautions should you take in ventilating a patient with suspected trauma or neck injury?

Immobilize the head and neck. Have an assistant immobilize, or immobilize between your knees.

What characteristics should the self-refilling bag have?

It should be easy to clean and sterilize.

What is the emergency medical care for a child with complications associated with the tracheostomy tube?

Maintain an open airway, ventilate and suction as needed, maintain a position of comfort and transport.

In order of preference, the four methods for ventilating a patient by the rescuer are:

Mouth-to-mask. Two-person bag-valve-mask device. Flow-restricted, oxygen-powered ventilation device. One-person bag-valve-mask device.

Complete airway obstruction is an extreme emergency. You must be able to recognize the signs of complete airway obstruction. What are they?

No crying noise, no coughing noise, inability to speak, cyanosis.

Seven items can be assessed to determine respiratory status in a pediatric patient. What are they?

Note chest expansion/symmetry; effort of breathing; nasal flaring; retractions; grunting; respiratory rate/quality; and stridor, crowing, or noisy respirations.

How far should you insert a soft catheter into the pharynx?

Only as far as the base of the tongue.

How far should you insert a rigid catheter when suctioning?

Only as far as you can see.

What adjunctive airways may be necessary to effectively ventilate with the bag-valve-mask device?

Oropharyngeal or nasopharyngeal airways.

What type of ventilatory device is contraindicated in children?

Oxygen-powered ventilation devices.

Stridor, crowing, or noisy respirations are all signs of what type of respiratory distress?

Partial airway obstruction.

The proper treatment for a child in respiratory distress and altered mental status will include the following:

Provide oxygen and assist ventilation with a bag-valve-mask device.

What is the purpose of suctioning?

Remove blood, other liquids, and food from the airway.

If while ventilating a patient, the chest does not rise and fall, what is the first thing you should do?

Reposition the head.

What are the components of the bag-valve-mask device?

Self-inflating bag, one-way valve, facemask, oxygen reservoir. To perform most effectively, it needs to be connected to oxygen.

In infants and children, should this time be shorter or longer?

Shorter, more specifically, less than 10 seconds; children have less capacity to tolerate hypoxia.

What is the procedure for handling a patient producing frothy secretions as rapidly as suctioning can remove?

Suction for 15 seconds, ventilate for 2 minutes, then suction for 15 seconds, and continue in that manner. Consult medical direction for this situation.

After performing the head-tilt/chin-lift, you note secretions in the patient's oropharynx. What do you do?

Suction.

You are bagging a patient and hear a gurgling sound with each ventilation. What should you do?

Suction.

What kinds of things may suctioning prove inadequate to remove?

Teeth, foreign bodies, food.

Artificial ventilation is inadequate when____ ,____ , and____ .

The chest does not rise and fall with ventilation, the rate is too slow or too fast for the age of the patient, and the heart rate does not return to normal.

You are adequately ventilating a patient when____ ,____ , and____ .

The chest rises and falls with each ventilation, the rate is appropriate to the age, and the heart rate returns to normal.

What is the most common technique for opening the airway?

The head-tilt/chin-lift maneuver.

What technique would you use for opening the airway when you suspect spinal injury?

The jaw-thrust maneuver.

What should you do if the patient has secretions or emesis that cannot be removed quickly and easily by suctioning?

The patient should be logrolled and the oropharynx should be cleared.

When using two hands to secure a mask for ventilation, which fingers hold the mask down?

The thumbs.

When might you use a soft suction catheter rather than a rigid?

To suction the nasopharynx, endotracheal tubes.

T/F: The bag-valve-mask device provides less volume than mouth-to-mask.

True.

T/F: Two rescuers using the bag-valve-mask device will be more effective than one.

True..

If while ventilating a patient the chest does not rise and fall, what should you do after checking for obstruction?

Use alternative method of artificial ventilation, e.g. pocket mask, manually triggered device. If necessary, consider the use of adjuncts such as oral or nasal airways.