Need help with Airway Management

[leeksoldier]

Like, the differences between what masks to use and what not. Do you have any tips? For some reason, this chapter just isn't clicking.

 

[lampnyter]

"Under 8, Ventilate"

If a persons RR is under 8 use a BVM, 8-30 NRB, 30+ BVM

 

[8jimi8]

Ventilating on their own /s signs of respiratory distress, you can get away with a blow by, nasal cannula, simple mask, venturi mask, or non-rebreather.

If a patient is not able to maintain their own airway, then you must maintain it for them.

Anyone who is using accessory muscles to breathe, or who is breathing out of the range of "normal" rates for their age is a candidate for ventilatory assistance. Be that NIPAP, or Invasive techniques.

What exactly is not clicking for you?

Look for:

Work of breathing (breathing rate, equal bilateral expansion/excursion, use of accessory muscles)

SpO2%, adventitious breath sounds, limited ability to speak (1 word dyspnea... 1 sentence dsypnea)

Beware of: Absence of breath sounds

and of course there are situational environmental hazards, such as inhalation injuries from smoke... or CO poisoning (which will present with a high SpO2)

 

[leeksoldier]

Thanks! That helps. The whole chapter, was just confusing for me. I'm pretty sure it was because I was a little overwhelmed at first, but I've fixed that problem, so I'll reread the chapter and hopefully do better this time. I just wanted something that would help me understand a bit better, or put simply I guess. Thanks again!!!

 

[8jimi8]

Please feel free to post more specific questions.


Rereading your post, the answer as to... when to use what mask....


Each tool has a certain amount of "Fraction of Inspired Oxygen" that it can deliver.

Atmospheric levels of oxygen at sea level are approximately 22% Per nasal cannula you can consider the FiO2 to be increased from atmostpheric levels by approximately 4%/liter of Oxygen. I don't know the number on a simple mask, but I know that a Venturi mask can deliver an approximately measureable FiO2, these levels are adjustable on the mask itself, but require a certain amount of liter flow through the mask from the O2 bottle.


If a patient cannot maintain their O2 saturation > 92% with a nasal cannula, disease process must be considered and the patient could possibly require noninvasive positive pressure ventilation or further invasive techniques.

Each patient and disease process is different and there are many factors to consider, however you can probably forget about a simple o2 mask and work solely with nasal cannulas, venturi masks and NRBs for patients who are able to maintain their own airways.

Another adjunct for a pt who can maintain their own airway would be bipap or cpap.

Pts who cannot maintain their own airways need to be assisted with an OPA/NPA and BVM,

Or ventilated with any of the various rescue airways,

However the endotracheal tube is the gold standard of airway management.


Remember when you are administering oxygen to patients long term, FiO2 > 60% is considered a toxic level of oxygen administration.

 

[JPINFV]

"Under 8, Ventilate"

If a persons RR is under 8 use a BVM, 8-30 NRB, 30+ BVM

If I ever get an ambulance ride as a patient, I'm so going to screw with the crew, especially if they use rules like that instead of an assessment.

 

[usafmedic45]

If I ever get an ambulance ride as a patient, I'm so going to screw with the crew, especially if they use rules like that instead of an assessment.

LOL Been there, done that. Of course, I also threatened to cram the prefill up the medic student's *** when he overreacted to my HR being bradycardic.

 

[lampnyter]

If I ever get an ambulance ride as a patient, I'm so going to screw with the crew, especially if they use rules like that instead of an assessment.

I dont actually go by that. But for testing purposes and classroom practicals, i use that rule.

 

[MrBrown]

Oxygen does not provide clinical benefit to all patients and the difference between oxygenation and ventilation is very important to understand.

The good old ambo trick of "more is better" does not apply to giving oxygen.

Use the lowest flow and simplest device required to achieve an oxygen saturation of 95-97% or whatever works for the patient so they are not air hungry and do not have clinical signs of hypoxaemia.

Most patients require only a nasal cannula at 2-4lpm or a simple (ordinary) mask at 4-6lpm.

 

[Sandog]

The good old ambo trick of "more is better" does not apply to giving oxygen.

Never heard of that trick.

 

[MrBrown]

Never heard of that trick.

The good ole ambo trick of "more is better" is the notion that more of something is a good thing and in times gone by was liberally practiced by Ambulance Officers.

Some examples include IV fluid volumes, oxygen flow rate, hand ventilation rates and some drugs eg sodium bicarb, bretylium and lignoicaine (lidocaine) in cardiac arrest.

Evidence has now shown the good old ambo trick of "more is better" is now not so and should not be practiced anymore.

 

[Sandog]

The good ole ambo trick of "more is better" is the notion that more of something is a good thing and in times gone by was liberally practiced by Ambulance Officers.

Some examples include IV fluid volumes, oxygen flow rate, hand ventilation rates and some drugs eg sodium bicarb, bretylium and lignoicaine (lidocaine) in cardiac arrest.

Evidence has now shown the good old ambo trick of "more is better" is now not so and should not be practiced anymore.

Thanks for clarifying and I would tend to agree that the latter evidence is a more sound thinking. I was always told, the least invasive treatment is best, and I would assume that includes dosage.