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The two person bag-valve-mask is the most effective method to administer ventilations with a BVM; however, it is not always practical for field application due to limited resources and limited space. The use of mouth to mask ventilations is also identified as a viable form of artificial ventilations, but the risk of cross contamination in mouth to mouth ventilations renders it less desirable to health care providers.
The airway is divided into two different anatomical locations; the upper airway and lower airway. The upper airway starts where air enters the body - the nose (Nares) and the mouth. Air will pass through the nose and is filtered and warmed before passing through the remainder of the upper airway and entering the lower airway. The upper airway ends at the Cricoid cartilage, the distal end of the larynx. The Thyroid cartilage is located at the proximal end of the larynx. Reference: Jeremy P. T. Ward; Jane Ward; Charles M. Wiener (2006). The respiratory system at a glance. Wiley-Blackwell. pp. 11–. ISBN 978-1-4051-3448-4. Retrieved 26 April 2010.
The "Jaw Thrust" maneuver should be used to open the airway of any patient who has suffered a traumatic injury
A nasal cannula used to administer O2 at flow rates from 2 - 6 LPM, delivering an O2 concentration so 28 - 44%
The patient would be hypercapnic as he is probably only ventilating dead space. The patient is not breathing deep enough for air exchange to occur in the alveoli, hence the elevated levels of carbon dioxide.
The pharynx or throat is often occluded by the tongue falling back and obstructing air flow. When air enters the nostrils it passes through the nasopharynx, then the oropharynx, and then the pharynx before it enters the trachea. Jaw thrust or chin lift will pull the tongue off the back of the pharynx to open the airway allowing air flow to the lungs. The trachea is too distal for the tongue to occlude it.
Adult respiratory distress syndrome involves non-cardiogenic pulmonary edema that presents 12-72 hours post injury or surgery. Congestive heart failure and cardiogenic shock, while they may occur from the ARDS, have an initial cardiac compromise. Flash pulmonary edema has a rapid onset and deterioration over as little as 30 minutes and is associated with renal dysfunction.
With both mouth-to-mouth and mouth-to-mask ventilation, it is relatively easy to maintain a good seal with the patient's mouth, allowing for delivery of adequate tidal volumes. Likewise, two person bag-valve-mask techniques dedicate one rescuer solely to ensuring adequate mask seal and the second rescuer to squeeze the ventilation bag with two hands (again allowing for adequate tidal volumes to be delivered). One person bag-valve-mask usage is a difficult technique to master, as the single rescuer must maintain a manual airway maneuver, an adequate mask seal, and squeeze the bag simultaneously.
While all of theses structures are in the same general area, the paramedic specifically utilizes the Cricoid cartilage. This is particularly important since this is the only "full ring" cartilage.
Within each air sac, the oxygen concentration is high, so oxygen passes or diffuses across the alveolar membrane into the pulmonary capillary. At the beginning of the pulmonary capillary, the hemoglobin in the red blood cells has carbon dioxide bound to it and very little oxygen. The oxygen binds to hemoglobin and the carbon dioxide is released. Carbon dioxide is also released from sodium bicarbonate dissolved in the blood of the pulmonary capillary. The concentration of carbon dioxide is high in the pulmonary capillary, so carbon dioxide leaves the blood and passes across the alveolar membrane into the air sac. This exchange of gases occurs rapidly (fractions of a second). The carbon dioxide then leaves the alveolus when you exhale and the oxygen-enriched blood returns to the heart. Thus, the purpose of breathing is to keep the oxygen concentration high and the carbon dioxide concentration low in the alveoli so this gas exchange can occur! Source:http://science.howstuffworks.com/environmental/life/human-biology/lung2.htm
This device is also known as a Combi-Tube
For air to be pushed out of the lungs, the trans thoracic pressure must rise above atmospheric (barometric) pressure. The diaphragm will relax and dome upward and the intercostal muscles will contract and pull the rib cage inward. This action increases the trans thoracic pressure above atmospheric pressure which forces air out.
12-15 LPM administered via a NBR or Non Rebreather mask is considered "100% O2"
A Metered Dose Inhaler is commonly used to treat Asthma, Chronic Obstructive Pulmonary Disease, and other respiratory problems.
