ACLS Respiratory Arrest + Airway Management

Technique of OPA Insertion (4)

1. Clear the mouth and pharynx of secretions, blood, or vomit 2. Select the proper size. Measure from corner of the mouth to angle of the mandible 3. Insert the OPA with curvature upward toward the hard palate 4. As the OPA passes through the oral cavity and approach the posterior wall of the pharynx, rotate it 180 into proper position. May also be inserted at a 90 degree angle to the mouth then turned down. The goal is to curve the device around the tongue so the tongue is not inadvertently pushed back. An alternative method is to insert the OPA straight in while using a tongue depressor or similar device to hold the tongue forward as the OPA is advanced.

Oropharyngeal Suctioning Procedure (2)

1. Measure. Do not insert any further than tip of nose to earlobe 2. Apply suctioning by occluding side opening while withdrawing with rotating or twisting motion

Technique of NPA Insertion (3)

1. Select proper size. Compare to diameter of patient's smallest finer. Measure from tip of nose to earlobe 2. Lubricate using water-soluble lubricant or anesthetic jelly. 3. Insert the airway perpendicular to the plane of the face. When you encounter resistance: - slightly rotate the tube to facilitate insertion - attempt placement through other nostril

Endotracheal Tube Suctioning Procedure (3)

1. Sterile technique 2. Do not insert beyond tip of ET tube 3. Apply suctioning by occluding side opening only while withdrawing catheter with rotating or twisting motion. Do not exceed 10 sections. Precede and follow suctions with short period of administration of 100% oxygen.

At what level should you maintain oxygen saturation?

94% or greater

What is respiratory distress?

A clinical state characterized by: - abnormal respiratory rate; e.g. tachypnea or effort - increased respiratory effort; e.g. nasal flaring, retractions, accessory muscle use - inadequate; e.g. hypoventilation, bradypnea

What is respiratory failure?

A clinical state of inadequate oxygenation, ventilation, or both. Also known as the end stage of respiratory distress

What is respiratory arrest?

Cessation (absence) of breathing

BLS Assessment: Respiratory Arrest

Deliver ventilations once every 5-6 seconds (10-12 breaths per minute) Use BVM or other advanced airway device Recheck pulse every 2 minutes

Primary Assessment: Respiratory Arrest

Determine if advanced airway is necessary. Ventilate patient once every 5-6 seconds.

Should you use a bag-valve mask with a single healthcare provider?

No, use a pocket mask.

How do you manage the airway of an unconscious/unresponsive patient who was known to be chocking and is now unresponsive and in respiratory arrest?

Open the mouth wide and look for a foreign object. If sighted, remove with your fingers. If not sighted, begin CPR. Check each time you open the airway to give breaths.

How do you do the E-C clamp technique?

Position yourself at patient's head. Circle thumb and first finger around top of mask ("C") then use third, forth, and fifth fingers ("E") to lift the jaw

How do you perform two-rescuer use of BVM?

Rescuer #1: Positioned at patient's head. Performs E-C clamp technique with both hands. Rescuer #2: Squeezes bag over 1 second. Both: Watch for chest rise.

What patient do you use an NPA for

conscious semiconscious unconscious patients with an intact cough and gag reflex trismus massive trauma around the mouth wiring of the jaws neurological impairment with poor pharyngeal tone or coordination

When should you not use an OPA? Why?

conscious or semiconscious patient may stimulate gagging and vomiting

How do you monitor placement of an ET tube?

continuous waveform capnography

Why is excessive ventilation an issue?

gastric inflation regurgitation aspiration increases intrathoracic pressure decreases venous return to the heart diminishes cardiac output low survival rate

How do you manage a respiratory arrest?

give supplementary oxygen open airway provide basic ventilation use basic airway adjuncts (OPA, NPA) suction

What are the basic airway opening techniques? (2)

head tilt-chin lift jaw thrust

What basic airway skills are used to provide ventilation? (6)

head tilt-chin lift jaw thrust without head extension mouth-to-mouth mouth-to-nose mouth-to-barrier bag-mask

Advanced Airways (4)

laryngeal mask airwaly laryngeal tube esophageal-tracheal tube ET tube

What is the most common cause of airway obstruction?

loss of tone in the throat muscles, which causes the tongue to fall back and occlude the airway

When should you suspect probably respiratory failure?

marked tachypnea bradypnea, apnea (late) increased, decreased or no respiratory effort poor to absent distal air movement tachycardia (early) bradycardia (late) cyanosis stupor, coma (late)

What universal connections are present on airway devices?

one-way valves (prevent rebreathing) oxygen ports (supplementary oxygen) medication ports (aerosolized + other meds) suction (clear airway) ports for quantitative sampling of end-tidal CO2

What are soft suctioning catheters used for?

oro or nasopharynx thin secretions ET tube deep suctioning, intratracheal suctioning suctioning through an in-place airway to access back of pharynx in patient with clenched teeth

What are rigid suctioning catheters used for?

oropharynx thick secretions and particular matter

What drug(s) will you need for a patient in respiratory arrest?

oxygen

What is severe respiratory distress an indication of?

respiratory failure

What are the clinical signs of respiratory distress? (7)

tachypnea increased respiratory effort (nasal flaring, retractions) inadequate respiratory effort (hypoventilation, bradypnea) abnormal airway sounds (stridor, wheezing, grunting) tachycardia pale, cool skin (EXCEPT sepsis = warm, red, diaphoretic) changes in LOC/agitation use of abdominal muscles

What causes excessive ventilation? (2)

too many breaths too large air volume

When is the jaw thrust maneuver indicated?

trauma patient with suspected neck injury

How do you know a patient is in respiratory arrest?

unconscious and unresponsive respirations are completely absent or clearly inadequate pulse is present DO NOT CONFUSE GASPS WITH ADEQUATE RESPIRATIONS

When is an OPA or NPA indicated to maintain airway patency?

unconscious with no cough or gag reflex

What patient do you use an OPA for?

unconscious, unresponsive patient with no cough or gag reflex during suctioning of the mouth and throat in intubated patients

Cervical Spine Trauma Precautions (3)

use jaw thrust without head extension use manual spinal motion restriction during airway manipulation use spinal immobilization devices during transport