ventilation and emergency airway management Flashcards
What does ventilation mean
It’s the movement of air into and out of the lungs. It is caused by changes in intrapleural pressure and thus the volume of the lungs as the chest wall/diaphragm moves
What does resting tidal volume mean
The amount of air you move into or out of your lungs during a single respiratory cycle under resting conditions.
Average is 500mls
What are the 4 oxygen masks
Nasal cannula
Nebuliser mask
Simple face mask
Non-rebreather mask
What is the flow rate for the 4 oxygen masks
Nasal cannula - 2-4 I/min
Nebuliser mask - 6-8 I/min
Simple face mask - 8-10 I/min
Non-rebreather mask - 15 I/min (same as BVM)
When and why do we use a nasal cannula
Used for patient who need controlled or low Sp02
Chronic obstructive pulmonary disease
Exacerbation of cystic fibrosis, neuromuscular disorders, chest wall disorders or morbid obesity
People who have COPD may be on home 02 via nasal cannula
When and why do we use nebuliser mask
Used to administer drugs, it atomises the drug into small particles that is inhaled directly to target tissue
6I/min if patient has COPD
8I/min for all other patients
When and why do we use a simple face mask
Used for patients requiring moderate supplemental 02
Pneumonia, lung cancer, acute heart failure
When and why do we use a non breather mask
Used in patients requiring high levels of supplemental 02
Shock, sepsis, major trauma, near drowning, trauma in pregnancy, anaphylaxis, major head injury, active seizure,
When and why do we use a BVM
It is used in patients who are not ventilating, or hypo ventilating
Examples, cardiac arrest, respiratory arrest.nil ventilation, we have to ventilate them
Other examples, drug overdose, head injury, major trauma, foreign body obstruction. If you have a respiratory rate under 12 you will be considered ventilating
What are the indications of BVM
Acute respiratory distress
Hypoventilation, RR less than 10 or arrest requiring positive pressure ventilation
What are the contradictions of BVM
Spontaneously breathing patients with adequate tidal volume and an appropriate respiratory rate greater than 10
What are the complications of BVM
Gastric inflation
Pulmonary barotrauma
Undesirable cardiovascular effects such as hypotension, secondary to caval compression
What are the 3 sizes of mayo healthcare disposable resuscitators
Adult- >23kg / volume = 1500/1200mL / delivery pressure= 60(+10)cm H20
Paediatric 6.5-23kg / volume = 550/330 mL / delivery pressure= 40(+5)
Neonatal <6.5kg / volume = 300/160 mL / delivery pressure= 40(+5)
How can we monitor ventilation?
Capnography
What is Capnography
C02 is a product of metabolism, is transported via perfusion and expelled through ventilation
Also, end-tidal C02 monitoring allows you to measure all three simultaneously making it a very important part of our vital sign survey
What are the indications of Capnography
CPR
Sedation and procedural sedation
Endotracheal intubation
Ongoing monitoring of ventilation
What are the complications of Capnography
When performing effective CPR during cardiac arrest, EtCO2 values are not to be used to vary IPPV from the recommended rate
What is continuous positive airway pressure (CPAP)
It is a non-invasive ventilation used in spontaneously breathing patients. CPAP reduces the work of breathing, improves pulmonary gas exchange and is associated with decreased intubation rates and hospital length of stays
What are the indications of cpap
CCP
acute pulmonary oedema
Severe OR life threatening asthma
What are the contraindications of cpap
Patients under the age of 16
GCS score of below 8
Inadequate ventilation drive
Hypotension
Facial trauma
What are the complications of cpap
Aspiration
Gastric distension
Hypotension
Corneal drying
Barotrauma
What is PEEP/ positive end expiratory pressure
It is the pressure that will remain in the alveolar at the end of a respiratory cycle that is greater than the atmospheric pressure
It is just small attachment to the BVM to keep a small amount of pressure in the lungs of a patient who we are ventilating
What are the benefits of PEEP
Improves oxygenation in patients with acute respiratory distress
Reduces gas trapping by increasing lung compliance and therefore improving ventilation
