Once you gain access to the patient and begin
your initial assessment, your first course of
action is to establish an open airway. The
most common impediment to an open airway
is the tongue. When a patient becomes
unconscious, the muscles relax. The tongue
will slide back into the pharynx and obstruct
the airway.
Airway adjuncts, devices that aid in
maintaining an open airway, may be used
early in the treatment of the unresponsive
patient and continue throughout your care.
The two most common airway adjuncts are
oropharyngeal (OPA) and nasopharyngeal
(NPA) airways.
Suctioning a patient involves the use of a
vacuum device to remove blood, vomitus, and
other secretions or foreign materials from the
airway in order to prevent aspiration or
obstruction of the airway. A Yankauer suction
catheter is a rigid catheter used to clear the
pharyngeal airway In the event of copious,
thick secretions or vomiting.
French catheters are flexible plastic tubes.
They are identified by a “French” number. The
larger the number, the larger the catheter. A
14 French catheter is larger than an 8 French
catheter. French catheters are designed to be
used in situations when a rigid tip cannot be
used such as when a suctioning device must be
passed through an NPA or, in the case of
tracheobronchial suctioning, through an ET
tube.
Administration of oxygen is one of the most
important and beneficial treatments a care
provider can give. Conditions that may require
oxygen include respiratory and cardiac arrest,
shock, lung disease, and hypoxia. Hypoxia is
an insufficient supply of oxygen to the brain.
Hypoxia may be indicated by cyanosis and a
deterioration of the patient’s mental status.
O2 is administered to assist in the delivery of
artificial ventilations to nonbreathing patients and
to breathing patients for a variety of conditions. A
flow meter, on an O2 tank in the field or from a
gas port in the hospital, allows control of the flow
of oxygen in liters per minute (lpm).
For the patient who is breathing adequately
and requires supplemental oxygen, there are
various O2 delivery devices available. In
general, however, the non-rebreather mask
and the nasal cannula are the two devices most
commonly used.
The non-rebreather mask is a face mask and
reservoir bag device that delivers high
concentrations of O2. The patient’s exhaled
air escapes through a valve and is not
rebreathed. A non-rebreather mask can
deliver high flow O2 concentrations of 90 to
100% at 15 lpm.
A nasal cannula provides low concentrations of
oxygen of 24 to 44% at 6 lpm through two prongs
that rests in the patient’s nostrils. Patients who
have chest pain or signs of shock need higher
concentrations of O2 than what can be provided by a
cannula. However, some patients will not tolerate a
mask-type device because they feel “suffocated” by the
mask. For the patient who refuses to wear an oxygen
mask, the cannula is better than no O2 at all. The
cannula should be used only when a patient will not
tolerate a non-rebreather mask.
A bag-valve-mask (BVM) or “ambo-bag” is a hand
held device with a face mask and self-refilling bag
that can be squeezed by hand to provide artificial
ventilations or positive pressure ventilations (PPV)
to a patient and is it often referred to as “bagging”
the patient. The bag-valve-mask unit can be used
to ventilate a non-breathing patient and it is also
helpful in assisting ventilations in the patient
whose own respiratory attempts are not enough to
support life, such as a patient in respiratory failure
or a drug overdose.
Many different BVM units and systems are
available; however, all of them have the same
basic parts. The bag itself must be a self
refilling shell that can be easily cleaned. It
should also have a non-rebreathing, non-jam
valve. Most BVMs have a standard 15/22 mm
respiratory fitting to ensure a proper fit with
other respiratory equipment, face masks, and
endotracheal tubes. BVMs deliver PPV at high flow
O2 concentrations of up to 90 to 100% at 15 lpm.
The most difficult part of delivering BVM
ventilations is obtaining an adequate mask seal so
that air does not leak in or out of the mask.
Therefore, it is strongly recommended by the AHA
that BVM ventilations be performed by two
rescuers. One person is assigned to squeeze the
bag, while the other rescuer uses two hands to
maintain a mask seal.
The two person technique can be modified so
that the jaw-thrust maneuver can be used to
obtain an open airway on a patient suspected
of having a neck or spinal injury. When no Cspine trauma is suspected, an open airway can
be maintained by the head-tilt/chin-lift
maneuver.