Breathing Devices. Chapter 8 KNOWLEDGE OBJECTIVES SKILL OBJECTIVES. 6. List four precautions to take when using oxygen.

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1 KNOWLEDGE OBJECTIVES Chapter 8 Breathing Devices 1. Identify four advantages of using airway breathing devices. 2. Describe how to use a resuscitation mask to ventilate a nonbreathing person. 3. Describe how to use a bag-valve-mask resuscitator to ventilate a nonbreathing person. 4. Identify when it is appropriate to administer supplemental oxygen. 5. Describe the steps required to administer supplemental oxygen. 6. List four precautions to take when using oxygen. 7. Explain the purpose of an oropharyngeal airway. 8. Explain how to use an oropharyngeal airway. 9. Describe when it is appropriate to use suctioning. 10. List the five steps to follow when using a suction device. 11. Define the key terms for this chapter. SKILL OBJECTIVES After reading this chapter and completing the course activities, you should be able to 1. Demonstrate on a manikin how to use a resuscitation mask to ventilate a nonbreathing person. 2. Demonstrate on a manikin how to use a bag-valve-mask resuscitator to ventilate a nonbreathing person. 3. Demonstrate how to prepare the equipment to administer oxygen to a breathing or a nonbreathing person. 4. Make appropriate decisions about care when given an example of an emergency in which a person is having difficulty breathing. 131

2 OUTLINE Introduction 157 Breathing Device 157 Resuscitation Masks 157 Bag-Valve-Mask Resuscitators 159 Supplemental Oxygen 161 Oropharyngeal Airways. 168 Clearing the Airway 168 KEY POINTS Four advantages of Breathing Devices 1. Maintain an open airway. 2. Perform rescue breathing. 3. Limit the potential for disease transmission. 4. Increase the oxygen concentration in a person's bloodstream. Criteria for a Resuscitation Mask Transparent, pliable. One-way valve. 15 mm or 22 mm coupling assembly. Able to deliver supplemental oxygen. Withstand extreme temperatures. Easily assembled and used. Using a Resuscitation Mask Tilt the head back. Lift the jaw. Open the mouth. Ensure a proper seal. Supplemental Oxygen Delivery System Components Oxygen cylinder. Pressure regulator with flowmeter. Delivery device. Oxygen Delivery Devices Nasal cannula. Resuscitation mask. Bag-valve-mask. Nonrebreathing mask. Precautions During Oxygen Delivery Do not operate around flames or sparks. Do not stand cylinder upright. Do not use grease, oil, or petroleum products to lubricate. Check oxygen flow before placing delivery device on a casualty. Steps for Suctioning Turn the head to the side or roll if spinal injury suspected. Open the mouth. Remove large debris. Insert suction device into back of the mouth. Suction for no more than 10 seconds at a time. 132

3 LEARNING ACTIVITIES Matching Match each term with its definition. Write its letter on the line in front of the definition. Terms a. Flowmeter b. Nasal cannula c. Resuscitation mask d. Suctioning e. Oxygen cylinder f. Bag-valve-mask (BVM) resuscitator g. Nonrebreathing mask Definitions 1. The process of removing matter from a casualty's mouth or throat 2. A device that regulates oxygen delivery in litres per minute (lpm) 3. An oxygen delivery device best used by two rescuers because one person may have difficulty keeping the airway open while still maintaining a tight enough seal 4. A mask and reservoir combination 5. Used to administer oxygen to a casualty who is breathing, but can be ineffective in a casualty who has a bad cold 6. A piece of equipment with an internal pressure of approximately 2000 pounds per square inch 7. A pliable, dome-shaped device that fits over the casualty's nose and mouth, and is used in giving rescue breathing Short Answer Read each statement and write the correct answer or answers in the space provided. 1. The four items of equipment necessary for administration of supplemental oxygen are: What are the three steps to follow to maintain a good seal when using a resuscitation mask? The four safety precautions you should follow when administering oxygen are: The three unique characteristics that distinguish an oxygen cylinder from other gas storage cylinders are the:

4 CASE STUDIES Read the case studies and answer the questions that follow. Case 8.1 You are summoned to a scene where you find a 20-year-old man unconscious on the floor. He has vomited, and much of the vomitus remains in his mouth. He does not appear to be breathing. 1. T F The appropriate initial method for clearing the vomitus from this man's mouth is to use a commercial suction device. 2. After removing the vomitus, you determine that the casualty is not breathing but has a pulse of 60 beats per minute. Another first responder has arrived with oxygen and breathing devices. Which of the following breathing devices would allow you to ventilate this casualty with the highest concentration of oxygen? a. Nasal cannula b. Resuscitation mask c. Nonrebreathing mask d. Bag-valve-mask resuscitator 3. In providing artificial ventilation to this casualty, how many ventilations per minute would you give? a. 6 b. 12 c. 24 d Describe the five steps you would take in using a suction device to remove vomitus from this casualty's mouth Case 8.2 You respond to a call about a possible stroke casualty. You are the first to arrive and find a woman lying on the floor, unconscious. She is not breathing but has a strong pulse. 1. T F Because of the possibility of disease transmission, you should wait for your kit with your resuscitation mask to arrive before starting rescue breathing. 2. What concentration of oxygen can you deliver to this woman, using a flow of 10 or more litres per minute and using rescue breathing with a resuscitation mask? a percent b percent c percent d. 90+ percent 3. T F The proper placement for the resuscitation mask on this casualty is to have one rim of the mask between her lower lip and chin, and the opposite end of the mask covering her nose. 134

5 SELF-ASSESSMENT Circle the letter of the best answer. 1. An oropharyngeal airway is the correct size if it extends from the casualty's: a. Nose to the point of the chin. b. Nose tip to the earlobe. c. Earlobe to the corner of the mouth. d. Front teeth to the back of the tongue. 4. If you find that your hand is too small to completely compress the bag on a bagvalve-mask resuscitator, you can increase the amount of ventilation by a. Compressing the bag against your thigh. b. Increasing the litre of flow oxygen to the bag. c. Pressing the mask more firmly to the casualty's face. d. All of the above. 2. The first responder should assist a casualty's breathing when the casualty is a. Breathing at a rate of more than 30 breaths per minute. b. Wheezing. c. Coughing with each breath. d. Conscious, but unable to respond to verbal questioning. 5. When using a resuscitation mask, the best way to maintain an open airway is to a. Tilt the person's head back. b. Lift the jaw upward. c. Keep the person's mouth open. d. All of the above. 3. Which is an advantage of using a resuscitation mask to provide artificial ventilation? a. It reduces the volume of air needed to extend the casualty's lungs. b. It prevents airway obstruction from occurring as a result of facial injuries. c. It reduces the risk of disease transmission between rescuer and casualty. 6. A pressure regulator should not be lubricated with a petroleum product because of the danger of: a. Contamination of the oxygen. b. An explosion. c. Loosening the oxygen cylinder valve. d. Inaccurate readings from the oxygen flowmeter. d. All of the above. 135

6 7. When you manually sweep secretions from a casualty's mouth to clear the airway, you should: a. Lift the neck and tilt the head back. b. Use the triple airway manoeuvre. c. Roll the casualty onto one side and sweep the mouth. d. Pull the jaw forward to move the tongue before sweeping the mouth. 8. Which step do you take when using a manual or mechanical suction device? a. Keep the casualty's head turned to the side. b. Sweep debris from the mouth before suctioning. c. Suction for no more than 10 seconds at a time. d. All of the above. 9. The O-ring should be placed on the oxygen cylinder a. After the regulator is in place. b. After you have examined the pressure regulator. 10. Which is a sign of hypoxia? a. Cyanosis b. Wheezing c. Slow heart rate d. All of the above 11. Which of the following breathing devices would you use in caring for a casualty who is breathing only 4 times per minute? a. Nasal cannula. b. Nonrebreathing mask. c. Bag-valve-mask resuscitator. d. a or b. 12. Which of the following devices would you use to care for a fire fighter who has inhaled smoke and is not breathing? a. Nasal cannula. b. Resuscitation mask. c Bag-valve-mask resuscitator. d. b or c. c. After you have opened the cylinder for 1 second. d. After you verified oxygen flow. 136

7 13. Which of the following is an advantage of using a resuscitation mask to provide artificial ventilation? a. It reduces the volume of air needed to expand the casualty's lungs. b. It reduces the risk of disease transmission between the rescuer and casualty. c. It prevents airway obstruction from occurring when facial injuries are involved. d. All of the above. 14. Which of the following is NOT a criteria for an effective resuscitation mask? a. It includes a two-way exhalation valve. b. It has an inlet for delivery of supplemental oxygen. c. It works well in conditions of extreme heat and cold. d. It has a pliable, transparent mask. 15. Which of the following is often difficult for a single rescuer using a bag-valvemask resuscitator? a. Assembling the device for use with supplemental oxygen. b. Squeezing a sufficient volume of air from the bag to effectively ventilate the casualty. c. Maintaining a tight enough seal and open airway. d. Seeing the area of the casualty's face under the mask clearly enough to detect vomiting if it occurs. 16. Which of the following breathing devices would you use in caring for a casualty who is not breathing. a. Nasal cannula. b. Resuscitation mask. c. Bag-valve-mask resuscitator. d. b or c. 17. Which concentration of oxygen does a bag-valve-mask resuscitator deliver? a. 16 percent. b. 18 percent. c. 21 percent. d. 23 percent. 137

8 18. Which of the following criteria should a resuscitation mask meet? a. Be made of transparent, pliable material. b. Have a one-way valve. c. Withstand extreme temperatures. d. All of the above. 19. Which of the following is often difficult for a single rescuer using a bag-valvemask resuscitator? a. Assembling the device for use with supplemental oxygen. b. Squeezing a sufficient volume of air from the bag to effectively ventilate the casualty. c. Maintaining a tight enough seal and open airway. d. Seeing the area of the casualty's face under the mask clearly enough to detect vomiting if it occurs. 20. An advantage of using a resuscitation mask is- a. It reduces the volume of air needed to expand the casualty's lungs. b. it delivers a greater oxygen concentration than a BVM. c. It prevents airway obstruction from occurring when facial injuries are involved. d. It reduces the risk of disease transmission between the rescuer and casualty. 138

9 Answers to Exercises Unit 8-Breathing Devices Matching: (Pg. 156) 1. d 2. a 3. f 4. g 5. b 6. e 7. c. Short Answer: 1. Oxygen cylinder; pressure regulator; flowmeter; delivery device. (Pg. 162) 2. Tilt the casualty's head back.; Lift the casualty's jaw with both hands.; Keep the casualty's mouth open with your thumbs. (Pg. 158) 3. Do not operate around open flame or sparks.; Do not stand the cylinder upright unless it is secured.; Do not use grease, oil, or petroleum products on the pressure regulator.; Always check to see that oxygen is flowing before placing a device on a person's face. (Pg. 166) 4. Green or white colour; yellow-diamond symbol with word "Oxidizer"; three holes in the cylinder valve allowing for the attachment of only an oxygen pressure regulator. (Pg. 165) Case Study 8.2: 1. F (Pg. 157) 2. c (Pg. 162) 3. T. (Pg. 158) Self Assessment: 1. c (Pg. 168) 2. a (Pg. 164) 3. c (Pg. 158) 4. a (Pg. 160) 5. d (Pg. 158) 6. b (Pg. 102) 7. c (Pg. 161) 8. d (Pg. 169) 9. c (Pg. 165) 10. a. (Pg. 161) 11. c. (Pg. 162) 12. d. (Pg. 170) 13. b. (Pg. 158) 14. a. (Pg. 158) 15. c. (Pg. 160) 16. d (Pg.??) 17. c (Pg.??) 18. d (Pg.??) 19. c (Pg.??) 20. d (Pg.??) Case Study 8.1: 1. F (Pg. 169) 2. d (Pg. 162) 3. b (Pg. 102) 4. Turn the casualty's head (or body) to one side.; Open the casualty's mouth.; Sweep large debris out with your fingers.; Insert the suction tip into the back of the casualty's mouth (only as far as it can be seen).; Suction for no more than 10seconds at a time. (Pg. 169) 139

10 PRACTICE SESSION: Using a Resuscitation Mask for Rescue Breathing Assemble the mask Attach one-way valve to mask. Position the mask Kneel behind person's head. Place rim of mask between lower lip and chin. Cover casualty's mouth and nose with mask. Seal mask and open airway Place your thumbs on each side of mask to hold it in place. Place fingers of both hands along casualty's jawbone. Tilt head back. Apply downward pressure with thumbs while lifting the jaw upward with fingers. 140

11 Begin rescue breathing Give 1 slow breath every 5 seconds (once every 3 seconds for a child or infant). Watch chest to see that breaths go in. Recheck pulse and breathing every minute. 141

12 PRACTICE SESSION: Using a Bag-Valve-Mask Resuscitator (BVM) for Rescue Breathing - (Two Rescuers) First rescuer-assemble the BVM Attach bag and valve to mask. Position the mask Place mask so that it covers casualty's mouth and nose. Seal mask and open airway Place your thumbs on each side of mask to hold it in place. Place fingers of both hands along casualty's jawbone. Tilt head back. Apply downward pressure with thumbs while lifting jaw upward with fingers. 142

13 Second rescuer-begin ventilations Squeeze bag smoothly until casualty's chest rises. Give 1 ventilation every 5 seconds (once every 3 seconds for a child or infant). Watch chest to see that ventilations go in. Recheck pulse and breathing every minute. 143

14 PRACTICE SESSION: Oxygen Delivery Check the cylinder See that label is marked "Oxygen. Clear the valve Remove protective covering and save plastic gasket. Open cylinder for 1 second to clear the valve. Attach the pressure regulator See that it is marked "Oxygen Pressure Regulator." 144

15 Put plastic gasket into valve at top of cylinder. Place regulator on cylinder. Seat the three metal prongs into valve. Hand tighten screw until regulator is snug. Open the cylinder 1 full turn 145

16 Check the pressure gauge Determine how much pressure is in cylinder. Attach the delivery device Attach plastic tubing between flowmeter and delivery device. Adjust the flowmeter Turn flowmeter to desired flow rate. Verify oxygen flow Listen and feel for oxygen flow through delivery device. 146

17 Place the delivery device on casualty 147

18 148