LAB A: BAM Q&A Flashcards
What are the first 3 pieces needed for a BAM kit?
- MVU, Mask, and Flex Tube
- OPA + NPA (3 sizes for each)
- Colorimetrhc CO2 detector
What are the next 3 pieces for a BAM kit?
- O2 flowmeter
- O2 tubing
- Stem wing nut + O2 source
What are the next 3?
- Flex tube + HEPA + HME
- Bite Block
- LMA + iGel
What are the last 2 things?
- O2 therapy device (nonrebreathing mask)
- Lubricant for devices
What are the first 4 pieces needed for airway suction kit?
- Suction source (wall)
- Suction regulator
- 2 lengths of connection tubing
- Safety collection trap
What are the last 4 pieces needed for airway suction kit?
- Suction Collection Canister
- ETT Suction catheter (open + closed)
- Tonsil tip suction catheter
- Sterile water + bowl + Saline ampoules/syringe for tracheal installation.
Describe the effects of positive pressure inspiration on a bag.
Patient Valve –> Open
Exhalation valve port –> Not active on inspiration (closed)
Bag inlet valve –> Closed
Overpressure relief (reservoir) –> Open if reservoir full and pressurizing
Safety air inlet (Anti-suffocation valve) –> Safety Air inlet Closed, when bagger is squeezed, the Bag inlet valve is seated to allow pressurization of the MVU.
Describe the effects of Spontaneous inspiration on a bag
Exhalation valve port –> Open
Exhalation Valve port –> Not active on inspiration (closed)
Bag inlet valve –> Open
Overpressure Relief (Reservoir) –> Closed as spontaneous inspiration draws gas from res.
Safety Air Inlet –> Open as spontaneous inspiration draws gas from res.
What was the average volume variation between 1 hand vs 2 hand bagger method?
More volume delivered in 2 person vs 1 person bagger method.
When would one hand compression be necessary in hospital?
- When using bag + mask during a resuscitation
- During a transport of intubated patient
- While suctioning intubated patient.
- If a normal tidal volume for a ventilated patient is 5 – 10 ml/kg, would one-handed bagging be adequate for ventilation if you were the RRT?
- Depends on size of patient.
Ex: 70kg patient = 350-700mL Vt.
What is the cm change in delivered volume and resting volume with the addition of 10 cm H2O PEEP? What does this difference represent?
With PEEP, rest volume of test lung increases, but Vt remains the same.
Note: The volume delivered here needs more effort to deliver same amount of volume due to PEEP.
Why would an RT apply a PEEP valve to an MVU?
When patient would benefit, or the patient was pre-prescribed PEEP while attached to mechanical ventilator, and you need to temporarily ventilate them via resuscitator.
Give some clinical examples of when a PEEP valve is required.
When dealing with COPD and asthma patients, patients with ARDS, and more.
Is a smooth surface of a bag an advantage or disadvantage on a MVU bagger?
If it is too smooth, it can be slippery. Disadvantaged if wet (via mucous or vomit), could be hard to hold on to.
Compare the pros and cons of integrated vs accessory PEEP collars.
What’s better? An inflatable reservoir or hollow tube?
A reservoir. It permits high FiO2 to fill bag every time it recoils, and provides almost 100% O2 available to patient if they spontaneously breathe.
If a patient vomits into the MVU patient connection, how difficult would it be to clear the valve out? If you couldn’t clear it out, what is your next step?
Clean it quickly. Ensure MVU functioning upon reapplication to patient.
If you cannot clear it out, or there is a malfunction, have a backup one ready to go and switch it.
What is the patient connection for a mask and ETT?
Mask: 22mm female connection to receive patient connector of 22mm male MVU
ETT: 15mm male connection, connects with patient valve 15mm female.
Does oxygen flow directly into the body of the resuscitator unit? Why?
No. This can lead to patient threatening air-trapping, inability to exhale, or overinflation and increased WOB.
Only refills with oxygen when MVU recoils. FiO2 gas comes from reservoir to bag to patient.
Describe how/if Air is entrained into the MVU.
During recoil, MVU fills with oxygen from reservoir and small amount of air from safety air inlet.
FiO2 comes from reservoir, goes to bag, then to patient. Between 85-100% O2
Identify the exhalation port and describe the path of exhaled gas.
At patient valve, exhaled gases do not enter patient valve assembly. Exhaled gases leave patient and vented out the exhalation ports.
What is the function of the reservoir?
Reservoir: Filled with 100% oxygen that can be drawn from as the resuscitator body reinflates after delivering a positive pressure breath.
MVU recoil –> FiO2 remaining >0.85 value
What is the function of a pressure relief feature in an MVU? Why do all MVUs not have this feature?
limits the amount of positive pressure generated when a manual inspiration is delivered.
This reduces risk of too large of a breath, too high of pressure and can reduce incidence of insufflation (air to the gut).
What are the indications for use of an oropharyngeal airway?
- OPA maintains patent airway by lifting tongue off posterior pharyngeal wall.
- Also used as bite block when using ETT.
What are indications for use of a nasopharyngeal airway?
Maintains patent airway in same way as OPA, but in patients who cant open their mouth.
- When oral airway doesn’t work and there is oral trauma, it is used. Also can be used for nasotracheal suctioning.
List potential pharyngeal (OPA and NPA) airway complications.
- No inflatable cuff to protect lung from foreign material entering airway. Don’t protect the lower airway from aspiration.
- OPA: Should not be used used in semi-conscious or conscious patients. Can lead to vomiting and possible aspiration.
- NPA: Patients with basal skull fractures risk insertion of NPA into cerebral cortex.
How is an OPA sized?
From distance of lips to angle of jaw, using natural curve of OPA as measuring line.
How is NPA sized?
Should be inserted and proper length is found by measuring from tip of nose to ear lobe.
What is difference between berman and guedal OPAs?
Berman: 2 lateral channels vs 1 closed tube. Cross section of a berman airway would be sinilar to an l-beam.
Guedal: Single hollow lumen, composed of plastic.
What are contraindications of OPA/NPA use?
OPA - Conscious patients (or if too awake) –> Cough-gag-vomit + rejection of airway.
NPA - Basal skull injury risk, where no intervention via nares should be attempted.
How is iGel and King Tube picked sizing wise?
iGel –> Body weight
King tube –> Height
How do you know iGel and King Tube airway positioned well for optimal ventilation?
- iGel = upper teeth mark (black line)
- King tube = position anatomically.
Confirm proper position by chest movement and verification of CO2 by capnography and ausculation.
Ensure adequate seal occurs + secure tube to patient via tape or other means.
What happens if you use these devices on a patient with RODS?
Difficult device use.
- Restricted mouth opening
- obstruction
- Disruption or distortion
- Stiff lungs
What are hazards with iGel or King Tube?
- Esophageal perforation
- Lack of a seal + failure to ventilate
- Asporation
- Relatively contraindicated in awake patients
- Can cause cough, gag, or vomiting in awake patient.
- LMA should be used if patient unconscious or after paralytic agents been given.
Describe the reasons why you may select a supraglottic airway over conventional bag mask ventilation.
- Primary rescue adjunct in the airway crisis, inability to mask ventilate, anatomic difficult airway – facial configuration, etc.
- Potential backup device for difficult pediatric airways
- Rescue device in cases of failed bag-mask ventilation
- Difficult intubation as a bridge intervention during a failed airway.
What is successful bag mask ventilation dependent on?
Patent airway + good mask seal + component skills of RT to maintain patient/mask interface + ventilate adequately and optimally to meet patient’s needs.
