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Flashcards in Manual Ventilation Devices Deck (27)
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Manual Ventilation Equipment includes:

1. Masks
2. Airway adjuncts (oral or NP airways)
3. Manual Ventilators (resuscitation devices) such as self inflating (Ambu bag) and non-self inflating (flow-inflating) bag


Basics of Non Rapid Sequence General Anesthesia Induction

1. Pre-Anesthesia Safety Check (APSF)
2. Apply monitors (Minimally: ECF, NIBP, Pulse Ox)
3. Pre-oxygenation
4. Induction Drugs (render patient unconscious and apnea and possibly paralyzed)
5. Mask ventialtion*********
6. Airways management Device Placement and securement


Positive Pressure Manual Ventilation

1. The ability to use your hands to breathe for a patient is an essential anesthesia skill.
-Through the use of manual ventilation device (AMBU)
-use of manual ventilation mode on anesthesia machine
2. Even more important that intubation
3. Worse case scenario: cant intubate, cannot ventilation (difficult airway algorithm)


Manual Ventilation Indications (5)

1. Bridge to placement of more secure airway (ETT, supraglottic airway)
2. Anesthesia machine ventilator failure or circuit malfunction
3. Excessive sedation and respiratory depression in MAC Case
4. Transporting patients to ICU or from satellite anesthesia locations to PACU
5. Any emergency code situations or loss of airway


Manual ventilation relative Contraindications for GA

1. Full stomach or increased risk of aspiration risk is number one*
2. Anticipated or known difficult airway=RSI
3. Facial trauma or anomalies of the face which would make mask ventilation difficult


Mask Ventilation Technique

1. Optimal "Ramped" Position
2. Use of oral or NP airways
3. Correct mask size and fit
4. Jaw Thrust and proper hand positions


Supine airway anatomy

1. Obstruction further increase with decrease pharyngeal muscle tone (due to sedation or muscle relaxants)
2. Ramping position will help alleviate this*


What position helps alleviate upper airway obstruction?

1. Bringing the EAC up to or at the sternal level will help alleviate upper airway obstruction and enhance intubation view


Oral airway positioning technique

1. Scissor mouth open and pull jaw forward
2. Insert airway "upside down" and turn 180 degrees as you approach posterior pharynx (this pushes tongue out of the way)
3. Flange should rest above teeth
4. Use tongue blade to displace tongue and insert airway if needed


Sizing oral airways

1. Flange should go from mouth to earlobe


Size and fit of mask

1. Proper size and fit to obtain a good seal
-should sit over the bridge of patient's nose without putting pressure on the eyes
-sides should seal just lateral to nasal folds with the bottom of the face mask sitting between lower lip and chin
-in the awake patient the mask if held in this position either by hand of by attaching a hardness behind head
-standard sizes 4-5 fit the majority of adults
-sizes 0-3 are for pediatric use


Who to use oral airways on?

1. Edentulous patients (lacking teeth)
2. Down syndrome and pediatric patients with large tongues
3. Sleep apnea patients
4. Never really hurst to place one (be careful with loose teeth)
5. Make sure patient is deep enough


What stage of anesthesia can laryngospasms occur in besides induction and emergence?

1. Second stage of anesthesia
2. Vocal cords slam shut to prevent liquid, blood, or anything from getting into lungs
3. When patients are deeply asleep they lose this protective airway reflex


Sizing of Nasopharyngeal Airways and insertion

1. Flange should reach from nose to earlobe
2. Gentle insertion with bevel towards septum (stop if resistance) is felt.
-If using left nostril, insert with bevel towards septum and turn 180 degrees with NP airway is about half way in


NP airways

1. Great for when patient cannot open mouth
2. Tolerated better for those with intact gag reflex
3. May cause nose bleeds- caution with anti coagulated patients- never force NP airway
4. Contraindicated in patient with basilar skull fracture


Chin lift, Jaw thrust

1. Use fingers to physically push the posterior angles of mandible upwards


Jaw Thrust one handed technique

1. Place correct sized mask over the nose and mouth
2. Use non dominant hand to position face mask, holding the body of mask between your thumb and index finger
3. Use your remaining 3 fingers to support the jaw, with your little fingers hooked behind the angle of mandible. Be careful not to place pressure on sub-mandibular tissues as they can occlude airway esp. in meds
4. Life the mandible upwards, towards and into the mask to create air-tight seal
5. Slight head extension may improve patency
6. Ventilate the patient with your dominant hand by squeezing the bag (when using vent, your bag will not fill if you don't have a good deal)
7. Continuously assess the adequacy of the technique by observing bilateral chest movement, listening for air leaks and assessing for chest rise and ETCO2 tracing


2 Handed Technique

1. Use the thumbs to stabilize the mask while the index and middle fingers are used to bring the angle of the jaw forward
-works better for small hands


Risk Factors for difficult mask airway

1. Facial hair
2. Lack of teeth
3. Obesity, OSA
4. Facial anomolies
-don't forget the supraglottic airway option if you can't mask or go directly to intubation


Self-inflating Devices: Closed Reservoir

1. Closed reservoir has a bag with a valve that will let air in if bag becomes empty. Oxygen accumulates in the reservoir bag.
2. The bag needs to be large enough to contain a tidal volume, or the balance of gas entering the bag will be air
3. Has non-rebreathing valve: important so that patient cannot rebreathe CO2 from the bag
4. Pressure limiting valve: 60 CmH2O. Children 45 cmH2O


Non-Rebreathing valves

1. Valve that ensures that exhaled gas does not mix with fresh gas entering the self-inflating bag and allows exhaled gas to escape into atmosphere


Self-Inflating Device: Open Reservoir

-open end allows air to enter
-some oxygen will be lost if flow is too high as it is open to atmosphere



-allows you to adjust PEEP on bag
-bigger patients may need more PEEP to keep alveoli open


Oxygen Reservoir

-usually either bags or lengths of large bore tubing
-allows accumulation of oxygen during the inhalation phase and release of the stored oxygen into the self inflating bag during exhalation when the bag is refilling
-increase FIO2


Flow-Inflating Device is dependent on what?

-oxygen flow rate and adjustment of pressure relief valve


Circle breathing circuit

-gas flow in a circular pathway through separate inspiratory and expiratory channels
-CO2 is removed through an absorbent


Adjustable pressure limit (APL) or "pop off" valve

-only gas exit from the breathing system during spontaneous, assisted or manually controlled ventilation if there are NO circuit leaks
-APL is used to control the pressure in the breathing circuit, which in turn adjusts bag filling
-higher gas flows will pressurize the circuit more quickly
-breathing system bag will become e actacile monitoring device*