What would you do in this situation?

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Golden Eye

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A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask?

A male in a car crashes head on onto a tree and is still in the car, but unconscious.
Would you: stabilize the head then rapid extricate or perform your assessment then rapid extricate?

I have a question now for this.
When do you use a nasal cannula on a patient?
I know 1 would be a COPD patient, what are the others?

And when do you give a patient a BVM? When their respiration is low and they have an inadequate tidal volume? What if they're respiration is over 20? Do you just give them a non-rebreathing mask?

Thanks guys.
 
Golden Eye said:
A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask?

A male in a car crashes head on onto a tree and is still in the car, but unconscious.
Would you: stabilize the head then rapid extricate or perform your assessment then rapid extricate?

I have a question now for this.
When do you use a nasal cannula on a patient?
I know 1 would be a COPD patient, what are the others?

And when do you give a patient a BVM? When their respiration is low and they have an inadequate tidal volume? What if they're respiration is over 20? Do you just give them a non-rebreathing mask?

Thanks guys.
Click to expand...

#1 . Suction again and bvm. You can give them o2 by blow by or whatever you want but if they can't breath, what good will it do? Be very careful with infants and non rebreathers. Placing it near the face is safer than on the face.
#2 . Rapid is just that, rapid. Manually hold stabilization the best you can. Life over limb.
#3 . NC is preferable over non rebreather most of the time. If the patient only needs a little bit of o2, than use an NC.

And use a BVM if the pt needs one. If their respirs are 28 but SATS are maintaining , try using a bvm on an orientated person. It won't go well.
 
Apparently Mariemt doesn't believe in letting students look up their own answers. :)
 
My responses below, in red for clarity...
Golden Eye said:
A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask? I'd probably stimulate the baby first... then reassess and consider other interventions if necessary.

A male in a car crashes head on onto a tree and is still in the car, but unconscious.
Would you: stabilize the head then rapid extricate or perform your assessment then rapid extricate? I'm going to assess the scene first. I need to know what I'm going into, and assess the patient. Dead is still "unconscious" so I'm going to find out if I even need to be there.

I have a question now for this.
When do you use a nasal cannula on a patient? When the patient needs supplemental oxygen.
I know 1 would be a COPD patient, what are the others? You might not have to use oxygen on a COPD patient.

And when do you give a patient a BVM? When their respiration is low and they have an inadequate tidal volume? What if they're respiration is over 20? Do you just give them a non-rebreathing mask? I don't "give" a BVM to a patient. I use one if there's a need to ventilate the patient because they're not ventilating that well for themselves.

Thanks guys.
Click to expand...

If some of my answers seem a little snarky, sorry... It's that it sounds like you're still in school and have some questions. Your textbooks and lecture material should have the basic answers for the above. Many of us here remember what it was like to be brand new, but we don't want to spoon-feed you. Tell us what you would do and why you'd do it. You'll retain the info much better that way!
 
This isn't homework lol. It's a website I used, but it doesn't explain why I got them wrong.

And @above. The baby is already tactile stimulate, but is still having a hard time breathing.
So what would you do after that? I'm having a hard time deciding whether it's blow-by oxygen or ventilate it with a BVM.

So you would stabilize the patient's head then rapid extricate?

So BVM is only on a patient who's having a hard time breathing and it's below 12? What if it's over 20?
 
Last edited by a moderator:
Golden Eye said:
A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask?
Click to expand...
Merconium birth? How long after birth are we?
A male in a car crashes head on onto a tree and is still in the car, but unconscious.
Would you: stabilize the head then rapid extricate or perform your assessment then rapid extricate?
Click to expand...
Depends.

I have a question now for this.
When do you use a nasal cannula on a patient?
I know 1 would be a COPD patient, what are the others?
Click to expand...
When my assessment leads me to believe that the patient can benefit from oxygen, but that a non-rebreather is overkill.
And when do you give a patient a BVM? When their respiration is low and they have an inadequate tidal volume? What if they're respiration is over 20? Do you just give them a non-rebreathing mask?
Click to expand...
Never... BVMs aren't cheap, so why would I give the patient a BVM? What are they going to do with it once they have it anyways? I might use a BVM on a patient depending on the situation, but that's not really giving them one and wish'in them the best of luck.
 
Golden Eye said:
A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask?
Click to expand...


When you say "trouble breathing" you need to specify what that means, because babies can have "trouble breathing" in a variety of ways. Is the baby grunting? Having retractions? Tachypnea? Apneic?

Non rebreathers and other passive ventilation methods are absolutely worthless in neonates. It doenst matter what the pathology is, whether it is meconium, heart defect, normal transitioning, the answer for a neonate is NEVER NRB.

Babies need positive pressure ventilation. Far too many people spend too much time trying to intubate neonates when they should be bagging them instead.

For most newborns, peripheral cyanosis is completely normal. They have a normal PaO2 but sluggish blood flow in cool limb capillaries leads to increased oxygen extraction and relatively low SaO2.

Paramedics need to learn the NRP (neonatal resuscitation protocol). I wont repeat it here, but its very easy to learn. Pulse is extremely important in the assessment of a neonate. Paramedics need to be able to reasonably accurately estimate the pulse by either palpating the umbilical cord, femoral pulse, or auscultating the heart. You can have a baby who is apparently breathing normally, yet still need aggressive BMV vs CPR if the heart rate is low.

The key thing to remember in NRP is to ENSURE ADEQUATE VENTILATION FIRST and only then escalate to higher levels of support. Far too often I've seen people jump ASAP to CPR when they havent given good BMV maneuvers a chance to work.

One thing that can really help neonatal resuscitation is the use of a T piece CPAP device such as NeoPuff. The PEEP that it delivers helps avoid alveolar collapse. It cant deliver the same high PIPs that BMV can give you but the benefit in PEEP is worth it since high PIPs can damage neonate lungs especially if it is a premature baby. I have used it extensively and it can reduce your intubation rates by orders of magnitude.
 
JPINFV said:
Never... BVMs aren't cheap, so why would I give the patient a BVM? What are they going to do with it once they have it anyways?
Click to expand...

To free up your own hands?

"Here you go, sir. Use your left hand to firmly hold this mask over your nose and mouth, forming a tight seal with your skin. Lean your head back a little. Good. Now, use your right hand to squeeze this bag slowly as you breath in, and release it as you breath out. Good luck"
 
Halothane said:
To free up your own hands?

"Here you go, sir. Use your left hand to firmly hold this mask over your nose and mouth, forming a tight seal with your skin. Lean your head back a little. Good. Now, use your right hand to squeeze this bag slowly as you breath in, and release it as you breath out. Good luck"
Click to expand...

For good measure, why don't you just intubate yourself? This guy did it: [YOUTUBE]http://www.youtube.com/watch?v=bDRTzmuwMnQ[/YOUTUBE]
(good part of the video starts ~2:00 in)
so you can too.
 
Halothane said:
To free up your own hands?



"Here you go, sir. Use your left hand to firmly hold this mask over your nose and mouth, forming a tight seal with your skin. Lean your head back a little. Good. Now, use your right hand to squeeze this bag slowly as you breath in, and release it as you breath out. Good luck"
Click to expand...

I have actually done this. My last service didn't have cpap. We had a regular customer with Chf who was usually noncompliant with his meds and would get pretty bad. He preferred it to us doing it.
 
Golden Eye said:
A baby is born and is having trouble breathing (gasping) even after suctioning the mouth and has peripheral cyanosis.
Would you: suction the mouth again, give it blow by oxygen, ventilate it with a BVM, or give it a non-rebreathing mask?

A male in a car crashes head on onto a tree and is still in the car, but unconscious.
Would you: stabilize the head then rapid extricate or perform your assessment then rapid extricate?

I have a question now for this.
When do you use a nasal cannula on a patient?
I know 1 would be a COPD patient, what are the others?

And when do you give a patient a BVM? When their respiration is low and they have an inadequate tidal volume? What if they're respiration is over 20? Do you just give them a non-rebreathing mask?

Thanks guys.
Click to expand...

I believe your book has plenty of information regarding these scenarios.
 
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