Respiratory & Airway Part Four

Respiratory & Airway Part Four

Assessing Intubation Placement – end tidal CO2 detectors

  1. Disposable colorimetric
  2. Electronic monitor

Breath Sounds: listen for epigastric sounds after intubation. Apex of lungs right and left, mid clavicular right and left and mid axillary right and left

Movement and Use of O2 in the Body depends on (Fick Principle):

  • Adequate inspired O2
  • Movement of O2 from alveoli to capillaries to arteries _ Adequate RBCs
  • Proper tissue perfusion
  • Efficient off-loading of O2 at the tissue level

Oxygen Sources (Canisters) – all at

  • D 400L
  • E 660L
  • M 3450L

Flow meters

  • Bourden gage (no back flow protection)
  • Pressure compensated flow meter (must be upright)
  • Constant flow selector valve

Equation for tank life in minutes:
Tank pressure in PSI – 200 (minimum safe level) x Tank Factor = Tank life in minutes Liters/minute you’re using

COPD patients 1-3L via nasal cannula, 24-28 venturi mask Don’t apply to Premature infants

O2 Delivery Devices

Nasal Cannula No re-breathing inspired air 1-6 L/min, 24-44% O2
Simple face mask Requires tight seal, watch for hypercarbia 8-12 L/min, 40-60% O2
Nonrebreather No ambient air, never let bag deflate, they can’t breath 10-15 L/min, 60-100% O2
Venturi mask Mixes ambient air with O2, must be snug 24,28,35, or 40%
Nebulizer Delivers albuterol or other bronchodilators 8L/min O2

Ventilation: Patients whose breaths per minute are under 10 or over 30 need ventilatory assistance

  • Open airway
  • Overcome resistance in lungs
  • Maintain a closed system
  • Allow patient to passively exhale between breaths

Without O2 10 mL/kg or 700-1000 mL delivered over 2 seconds
With O2 6-7 mL/kg or 400-600 mL over 1-2 seconds

Mouth to Mouth 16-17% O2 Don’t do this, get your BSI
Mouth to Mask 16-17% or 50% with O2 Set O2 to 10, reduces risk of contamination
Bag Valve Mask Adult 1000-1600

Child 500-700

Infant 150-240

2 person best seal

O2 at 15 L/min

O2 Powered Device Burst of O2 with a button

100% @ 40L/min

limited to 30 cm of H20

Steady stream if you hold the button down. Watch for gastric distention
Automatic Ventilator


Can’t detect obstructed airways

Cricoid Pressure: Sellick Maneuver

  • Prevent gastric distention/regurgitation/aspiration pneumonia
  • Compresses esophagus between cricoid ring and cervical spine
  • Contraindicated in cervical spine injury

Ventilating Pediatric Patients:

  • Mask must fit securely bridge of nose to cleft of chin
  • Don’t hyperextend the neck
  • Folded towel under shoulders
  • Bag with at least 450 mL for children, 250 for infants
  • At least 20 breaths/min
  • Over 8 years old use adult BVM with extreme care
  • Watch for chest rise and fall, key to force and tidal volume
  • Broslow system/Broslow tape is a pediatric tape measure and a series of sets of equipment sized according to the measurement on the tape. Also see Handtevy.com

Ventilating Stomas: tight seal around the stoma. Seal mouth and nose if leaking

Tongue: most common cause of airway obstruction in an unresponsive patient. Epiglottis can occlude the airway at the level of the larynx

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