Manual Ventilation

Question 1

Manual Ventilation Devices

Answer 1

Masks, airway adjuncts (oral & nasopharyngeal airways), manual ventilators (resuscitation devices) - self-inflating (ambu bag) and non self-inflating (flow-inflating)bags

Question 2

Non Rapid Sequence General Anesthesia Induction

Answer 2

Pre-Anesthesia safety check per APSF guidelines, apply monitors (at a minimum EKG, noninvasive BP, pulse ox), pre oxygenate, induction drugs, mask ventilation, airway management device placement & securement

Question 3

Total Lung Capacity

Answer 3

4-6 liters, though usually only use 500-700

Question 4

Manual ventilation relative contraindications for general anesthesia

Answer 4

Full stomach or other increased risk for aspiration, anticipated/known difficult airway, facial trauma or anomalies of the face

Question 5

Mask Ventilation Technique

Answer 5

ramped position, use of oral/nasophayngeal airways, correct mask size/fit, jaw thrust (external auditory canal at level of sternum) & EC hand positiong

Question 6

Oral airway placement technique

Answer 6

Open mouth, pull jaw forward, insert airway upside down and turn 180 degrees as your approach posterior pharynx, flange should rest above teeth

Question 7

Sizing oral airway

Answer 7

Flange at edge of lips and tip at ear lobe

Question 8

Proper size & fit to obtain a good seal for a mask

Answer 8

Sit over bridge of patient’s nose without putting pressure on eyes, sides should seal just lateral to nasal folds with bottom of the face mask sitting between lower lip and chin. Size 4-5 fits most adults, 0-3 for peds

Question 9

When to use oral airways

Answer 9

Edentulous patients, down’s syndrome, pediatric patients with larger tongues, OSA be careful of loose teeth

Question 10

Sizing nasopharyngeal airway

Answer 10

Flange should reach from nose to earlobe

Question 11

Insertion of nasopharyngeal airway

Answer 11

Bevel always toward septum, stop if resistance, if using left nostril turn 180 degrees when NP is about halfway in

Question 12

When to use nasopharyngeal airway

Answer 12

NOT IN BASILAR SKULL FRACTURES & careful with anti-coagulated patients, great for patients who cannot open mouth, with bad gag reflex

Question 13

Risk factors for difficult airway

Answer 13

Facial hair, lack of teeth, obesity, OSA, facial anomalies

Question 14

Non-rebreathing valve

Answer 14

Valve that ensures that exhaled gas does not mix with fresh gas entering the self-inflating bag and allows exhaled gas to escape into atmosphere

Question 15

oxygen reservoir

Answer 15

Allows accumulation of oxygen during inhalation phase and release of stored oxygen into self-inflating bag during exhalation – increases FiO2

Question 16

Adjustable Pressure Limit on circuit

Answer 16

Pop off valve - the only exit rom the breathing system during spontaneous, assisted of manually controlled ventilation IF there are no circuit leaks, used to control the pressure in the breathing circuit which adjusts bag filling, higher gas flows pressurize circuit more