6 - Resuscitation Devices

how to give rescue breaths without chest compressions

adult (pulse but no breathing)

• 1 breath every 6 seconds

child/infant (pulse but no breathing)

• 1 breath every 2-3 seconds

proper rescue breathing technique

• head-tilt, chin-lift, jaw thrust if spinal injury suspected

• watch for chest rise to confirm effective ventilation

• no excessive ventilation

CPR for adults, children, and infants

	adults	children	infants
compression-to-ventilation ratio	30:2	1 rescuer 30:2 2 rescuers 15:2	1 rescuer 30:2 2 rescuers 15:2
hand placement	center of chest, lower half of sternum	(same as adults)	(same as adults)
depth	2-2.4 inches	~2 inches	~1.5 inches
rate	100-120 compressions/minute	(same as adults)	(same as adults)
other pertinent info	allow full chest recoil have few interruptions	(same as adults)	(same as adults)

MR. SOPA (acronym)

if unable to get chest rise:

M	reposition MASK
R	REPOSITION patient
S	SUCTION airway
O	OPEN mouth (insert oropharyngeal airway)
P	increase PRESSURE
A	advanced AIRWAY

stroke volume for adults

~800 mL

stroke volume for infants

~200 mL

bag valve mask (BVM)

Bag Types	Ambu® adult mask bag unit hope bag resuscitation bag
Valve Types	diaphragm duckbill leaf spring-loaded valves disk/ball attached to spring

hazards of mechanical ventilation

• gastric distention (aspiration risk!)

• malfunctioning bag (vomit in valve)

• improper technique (hypoventilation, decreased cardiac output, barotrauma)

• spontaneously breathing patients (self-inflating bags)

gas-powered resuscitators

• used for pediatrics

• require 50 psi gas source

• operator/patient triggered

• pressure levels may be problematic with kids

• “T” piece resuscitators

  • control pressure

  • can deliver PEEP

ACLS team roles

• team leader

• airway manager

  • ventilation, intubation, supraglottic airway placement

• compressor

  • switch every 2 minutes

• defibrillator operator

  • applies pads, charges, delivers shocks

• medicine administrator

• recorder

ACLS airway transport

• oropharyngeal airway

indications

• manual ventilation

• prevention/treatment of upper airway

• treat obstruction

• bite block

• oral suctioning

measurement

• corner of mouth to angle of jaw

ACLS airway transport

• nasopharyngeal airway

indications

• alert, semi-comatose patients with intact gag reflex

• deep tracheal suctioning

• aid bronchoscope

measurement

• meatus of ear (ear lobe) to tip of patient’s nose

ACLS airway transport

• endotracheal tube (ETT)

• establishes patent airway

• parts:

  • tube cuff

  • pilot balloon

  • radiopaque line

ACLS airway support

• blind insertion airways

• laryngeal mask airway (I-Gel®)

• King airway

ACLS airway confirmation

initial confirmation	auscultate 5 points: abdomen anterior and lateral chest watch for chest rise
secondary confirmation	waveform capnograph (GOLD STANDARD) exhaled CO2 esophageal detector
definitive confirmation	chest x-ray 2-6 cm above carina aortic arch