Manual Ventilation Devices

Question 0

What are the indications for manual ventilation?

Answer 0

1- bridge to placement of more secure airway (ETT, supraglottic airway) 2- Anesthesia machine ventilator failure or circuit malfunction 3- Excessive sedation and respiratory depression in MAC case 4- Transporting pts to ICU or PACU 5- Any emergency code situation

Question 1

What is the most essential anesthesia skill?

Answer 1

• Positive Pressure Manual Ventilation: the ability to use your hands to breathe for a patient *Through AMBU or through the manual ventilation mode on the anesthesia machine

Question 2

What is the optimal position for mask ventilation?

Answer 2

• “Ramped” position: auditory canal at level of sternum (“Sniffing position”)

Question 3

What are the contraindications for manual ventilation?

Answer 3

1. Full stomach 2. Anticipated or known difficult airway 3. Facial trauma or anomalies of the face which would make mask ventilation difficult

Question 4

Supine airway anatomy: Obstruction is further increased with…

Answer 4

• Decreased pharyngeal muscle tone (sedation, muscle relaxants)

Question 5

What are indications for oral airways?

Answer 5

1. Edentulous patients 2. Down’s syndrome and pediatric patients with large tongues 3. Sleep apnea patients *Never really hurts to place one (be careful with loose teeth) *Make sure patient is deep enough

Question 6

What is proper insertion for NP airway?

Answer 6

1. Gentle insertion with bevel towards the septum, stop if resistance is felt 2. If using left nostril, insert with bevel towards the septum and turn 180 degrees when NP is about half way in

Question 7

When are NP airways contraindicated?

Answer 7

• Patients with basilar skull fracture

Question 8

When are NP airways indicated?

Answer 8

• Great for when patient can’t open mouth - Tolerated better for patients with intact gag reflex

Question 9

What is one complication of NP airways?

Answer 9

May cause nose bleeds! - Caution with anti-coagulated patients - Never force NP airway

Question 10

Describe chin lift, jaw thrust.

Answer 10

Using fingers to physically push the posterior angles of the mandible upwards

Question 11

How do you assess adequacy of ventilation technique?

Answer 11

1. Observe for bilateral chest movement - assess for chest rise 2. Listen for air leaks 3. ET CO2 tracing, if available

Question 12

Describe the “two handed technique”

Answer 12

Using the thumbs to stabilize the mask while the index and middle fingers are used to bring the angle of the jaw forward

Question 13

What are the risk factors for Difficult Mask Airway?

Answer 13

• Facial hair - Lack of teeth - Obesity, OSA - Facial anomalies ***Don’t forget the supraglottic airway option if you can’t mask, or go directly to intubation

Question 14

What are non-rebreathing valves?

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

Flow-inflating Ventilation Device

Answer 15

• Bag inflation dependent on oxygen flow rate and adjustment of pressure relief valve

Question 16

What is a circle breathing circuit?

Answer 16

• Gases flow in a circular pathway through separate inspiratory and expiratory channels - Carbon dioxide is removed through an absorbent

Question 17

What is the Adjustable Pressure Limit (APL) or “Pop Off” Valve?

Answer 17

• APL is used to control the pressure in the breathing circuit, which in turn adjusts bag filling - The only gas exit from the breathing system during spontaneous, assisted, or manually controlled ventilation if there are no circuit leaks is through “Pop Off” valve - Higher gas flows will pressurize the circuit more quickly