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Airway management
Airway management
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Basic Ventilation

  1. 1. Basic Ventilation: D.Krishnakumar AVMC&H
  2. 2. BASIC AIRWAY SKILLS: • Head and chin lift, • Jaw thrust (with out neck extension if suspect c-spine injury), • Mouth to mouth ventilation, • Mouth to barrier device, • Bag mask ventilation.
  3. 3. Introduction: • The jaw-thrust maneuver is a first aid and medical procedure used to prevent the tongue from obstructing the upper airways. • This maneuver and the head-tilt/chin-lift maneuver are two of the main tools of basic airway management, and they are often used in conjunction with other basic airway techniques including bag-valve-mask ventilation. • The jaw thrust maneuver is often used on patients with cervical neck problems or suspected cervical spine injury. • The maneuver is used on a supine patient. It is performed by placing the Index and middle fingers to physically push the posterior aspects of the lower jaw upwards while their thumbs push down on the chin to open the mouth.
  4. 4. CON….. • When the mandible is displaced forward, it pulls the tongue forward and prevents it from obstructing the entrance to the trachea Jaw-thrust maneuver. • the jaw-thrust maneuver has been considered the better alternative (rather than the head-tilt/chin-lift maneuver) when a first aider suspects that the patient may have a spinal injury (especially one to the neck portion of the spine). • The International Liaison Committee on Resuscitation has reviewed various studies that found no spine-protecting advantage to the jaw-thrust maneuver. • Treatment Recommendation under Opening the Airway says, Rescuers should open the airway using the head tilt-chin lift maneuver. • The patient is in danger of pulmonary aspiration, he or she should be placed in the recovery.
  5. 5. Jaw thrust:
  6. 6. Mouth to mouth ventilation: • To use a pocket mask, position yourself at the victim's side. • This position is ideal when performing 1-rescuer CPR because you can give breaths and perform chest compressions without repositioning yourself every time you change from compressions to giving breaths. • Follow these steps to open the airway with a head tilt-chin lift and use a pocket mask to give breaths to the victim.
  7. 7. ONE RESCUER USING A POCKET MASK
  8. 8. Action • Position yourself at the victim's side. • Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct position. • Seal the pocket mask against the face. • Using your hand that is closer to the top of the victim's head, place the index finger and thumb along the edge of the mask. • Place the thumb of your other hand along the edge of the mask. • Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. • While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face. • Deliver each breath over 1 second, enough to make the victim's chest rise.
  9. 9. Head and chin lift:
  10. 10. Step-by-Step Description of Procedure • Head tilt–chin lift  Tilt the patient’s head back by pushing down on the forehead.  Place the tips of your index and middle fingers under the chin and pull up on the mandible (not on the soft tissues). This lifts the tongue away from the posterior pharynx and improves airway patency. • Be sure to pull up only on the bony parts of the mandible. Pressure to the soft tissues of the neck may obstruct the airway. • Jaw thrust  Stand at the head of the stretcher and place your palms on the patient’s temples and your fingers under the mandibular rami.  In patients with possible cervical spine injury, avoid extending the neck.  Lift the mandible upward with your fingers, at least until the lower incisors are higher than the upper incisors. This maneuver lifts the tongue along with the mandible, thus relieving upper airway obstruction. • Be sure to pull or push up only on the bony parts of the mandible. Pressure to the soft tissues of the neck may obstruct the airway.
  11. 11. Indications  Treatment of suspected upper airway obstruction in obtund or unresponsive patients.  Part of initial emergency treatment for apnoea or impending respiratory arrest.  Improvement of airway patency during BVM ventilation and sometimes during spontaneous breathing.  Confirmation of apnoea.
  12. 12. Contraindications  There is no medical contraindication to providing rescue breathing; however, a patient may have a legal contraindication (do-not-resuscitate order or specific advance directive in force). • Relative contraindications.  Suspected or actual cervical spine injury. • Tilting the head or otherwise moving the neck is contraindicated in a patient with a possible cervical spine injury, but maintaining an airway and ventilation is a greater priority. In the setting of a possible cervical spine injury, the jaw-thrust maneuver, in which the neck is held in a neutral position, is preferred over the head tilt–chin lift maneuver.
  13. 13. Complications  Spinal cord injury if the cervical spine has an unstable bony or ligamentous injury.  Exacerbation of mandibular injury.
  14. 14. Positioning  Position the patient supine on the stretcher.  Align the upper airway for optimal air passage by placing the patient into a proper sniffing position. Proper sniffing position aligns the external auditory canal with the sternal notch.  To achieve the sniffing position, folded towels or other materials may need to be placed under the head, neck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck.  In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck.  In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput.
  15. 15. Jaw thrust
  16. 16. Mouth to barrier device: • For mouth-to-mask breaths, use a pocket mask Pocket masks usually have a 1-way valve, which diverts exhaled air, blood, or bodily fluids away from the rescuer. • The1-way valve allows the rescuer's breath to enter the victim's mouth and nose and diverts the victim's exhaled air away from the rescuer Some pocket masks have an oxygen inlet that allows you to administer supplementary oxygen
  17. 17. Pocket masks are available in different sizes for adults, children, and infants Effective use of the pocket mask barrier device requires instruction and practice
  18. 18. Bag mask ventilation: • A bag-mask ventilation device consists of a ventilation bag attached to a face mask. These devices have been a mainstay of emergency ventilation for decades. • Bag-mask devices are the most common method of providing positive-pressure ventilation. • When using a bag-mask device, deliver approximately 600 mL tidal volume sufficient to produce chest rise over 1 second. • Bag-mask ventilation is not the recommended method of ventilation for a single healthcare provider during CPR (A single healthcare provider should use a pocket mask to give ventilation, if available.)
  19. 19. CON….. • It is easier for 2 trained and experienced rescuers to provide bag- mask ventilation. • One rescuer opens the airway and seals the mask to the face while the other squeezes the bag, with both rescuers watching for visible chest rise. • The universal connections present on all airway devices allow you to connect any ventilation bag to numerous adjuncts Valves and ports may include
  20. 20. CON…… • One-way valves to prevent the patient from rebreathing exhaled air. • Oxygen ports for administering supplementary oxygen. • Medication ports for administering aerosolized and other medications. • Ports for quantitative sampling of end-tidal CO2, • You can attach other adjuncts to the patient end of the valve, including a pocket facemask, laryngeal mask airway, laryngeal tube, esophageal-tracheal tube, and ET tube.
  21. 21. E-C clamp technique for holding the mask while lifting the jaw. Position yourself at the patient's head. Circle the thumb and first finger around the top of the mask (forming a "C") while using the third, fourth, and fifth fingers (forming an "E") to lift the jaw
  22. 22. Two-rescuer use of the bag-mask device. The rescuer at the patient's head tilts the patient's head and seals the mask against the patient's face, with the thumb and first finger of each hand creating a "C" to provide a complete seal around the edges of the mask The rescuer uses the remaining 3 fingers (the "E") to lift the jaw (this holds the airway open The second rescuer slowly squeezes the bag (over 1 second) until the chest rises. Both providers should observe chest rise.
  23. 23. THANK YOU

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