Ambu bag
BY: JESSA ANNE R. BORRE
BSN- IV
ENDOTRACHEAL
INTUBATION
provides
a passage for gases to flow
between a patients lungs and an
anaesthesia breathing system .
allows one to provide positive pressure
ventilation.
protects the lung from contamination from
gastric contents and nasopharyngeal
matter such as blood.
ENDOTRACHEAL TUBE
Is
a medical procedure in which a tube is
placed into the windpipe (trachea) through
the mouth or nose. In most emergency
situations it is placed through the mouth.
Whether
you are awake (conscious) or not
awake (unconscious), you will be given
medicine to make it easier to insert the
tube.
Endotracheal intubation
Open
the airway to give oxygen, medicine, or
anesthesia
Support breathing with certain illnesses, such as
pneumonia, emphysema, heart failure, or collapsed
lung
Remove blockages from the airway
Protect the lungs in people who are unable to protect
their airway and are at risk for breathing in fluid
(aspiration). This includes people with certain types of
strokes, overdoses, or massive bleeding from the
esophagus or stomach.
Endotracheal intubation is done to:
Bleeding
Infection
Trauma
to the voice box (larynx), thyroid
gland, vocal cords and windpipe (trachea),
or esophagus
Puncture or tearing (perforation) of body
parts in the chest cavity, leading to lung
collapse
RISKS INCLUDE:
ET
Tubes can be:
Cuffed
Uncuffed
Cuffed
ET tubes are used in children >8 y/o
The cuff when inflated maintains the ET tube in
proper position and prevents aspiration of contents
from GI Tract into respiratory tract.
In children, <8 uncuffed ET tubes are used because
the narrow subglottic area performs the function of
a cuff and prevents the ET tube from slipping.
TYPES:
Cuffed et tube
Uncuffed et tube
bag valve mask, abbreviated to BVM
and sometimes known by the proprietary
name Ambu bag or generically as a
manual resuscitator or "self-inflating bag",
is a hand-held device commonly used to
provide positive pressure ventilation to
patients who are not breathing or not
breathing adequately.
Respiratory
Failure
Failure of ventilation
Failure of oxygenation
Failed
intubation
Indications
BVM
ventilation is absolutely contraindicated in the
presence of complete upper airway obstruction.
BVM
ventilation is relatively contraindicated after
paralysis and induction (because of the increased risk
of aspiration).
Contraindications
Figure : Mechanisms of the manual resuscitators: A and B in the
normal conditions, C and D in the presence of big negative pressure
in the breathing circuit.
Positioning
Place towels under the patients head to
position the ear level with the sternal notch.
Extend
the patients head slightly.
Anybody ( almost ) can be
oxygenated and ventilated with a bag
and a mask
The art of bagging should be
mastered before the art of intubation
Manual ventilation skill with proper
equipment is a fundamental premise
of advanced airway Rx
Golden Rules of Bagging
Requires practice to master
One hand to
maintain face seal
position head
maintain patency
Other
hand ventilates
BVM Ventilation
Observe
the chest rise and fall
Good bilateral air entry
Lack of air entering the stomach
Feeling the bag
Pulse oximetry
BVM Ventilation:
Assessment of Efficacy
Upper
airway obstruction
Lack of dentures
Beard
Midfacial smash
facial burns, dressings, scarring
poor lung mechanics( resistance or
compliance )
Predictors of a Difficult Airway :
Bag-Valve-Mask Ventilation
Technique
Open
the airway (head-tilt chin-lift maneuver or the jaw thrust).
In patients with suspected cervical spine injury, do not perform a head-tilt;
rather, only perform a chin-lift maneuver.
Use an airway adjunct.
Place an OPA in unresponsive patients without a gag reflex. 6
If the patient is awake, place one or two NPA ( because of the risk of intracranial
placement, avoid the use of a NPA in patients with significant head and facial trauma).6
Place
the mask on the patients face before attaching the bag.4
Cover
chin.
the nose and the mouth with the mask without extending it over the
Change
Hold
the size of the mask, as appropriate, to create a good seal.
the mask in place using the one-hand E-C technique, as shown below.
Contd.
Use
the non dominant hand.
Create
a C-shape with the thumb
and index finger over the top of
the mask and apply gentle
downward pressure.
Hook
the remaining fingers
around the mandible and lift it
upward toward the mask, creating
the E.
Alternate one-hand
technique.
Two-hand technique
If a second person is available to provide ventilations by compressing the bag
Create two opposing semicircles with the
thumb and index finger of each hand to form a
ring around the mask connector, and hold the
mask on the patients face. Then, lift up on the
mandible with the remaining digits.
Alternatively, place both thumbs
opposing the mask connector, using
the thenar eminences to hold the
mask on the patients face, while
lifting up the mandible with the
fingers.
No matter which technique is being used, avoid
applying pressure on the soft tissues of the
Ventilation
volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult)
Ventilate
at a rate of 10-12 breaths per minute. (for a patient with perfusing
rhythm)
During
cardiopulmonary resuscitation (CPR), give 2 breaths after each series
of 30 chest compressions until an advanced airway is placed. Then ventilate at
a rate of 8-10 breaths per minute.
Give
each breath over 1 second.
If
the patient has intrinsic respiratory drive, assist the patients breaths. In a
patient with tachypnea, assist every few breaths.
Ventilate
with low pressure and low volume to decrease gastric distension.
Cont..
Maintain
cricoid pressure consistently .
to compress the esophagus and reduce the risk of aspiration. However,
it does not completely protect against regurgitation, especially in cases
of prolonged ventilation or poor technique. 1
Care must be taken to avoid excessive pressure, which can result in
compression of the trachea.
Assess
the adequacy of ventilation.
- Observe for chest rise, improving color, and oxygen
saturation.
- Monitor for air leak.
- Be cognizant of increasing gastric distention .
Aspiration
- The best way to prevent aspiration is with good technique,
including low-pressure, low-volume ventilation with slow
insufflation. Newer bags have built-in pressure valves.
The green zone includes pressures up to 20 cm of water
and corresponds to the lowest risk of gastric distention.
Hypoventilation
Hyperventilation
Complications
