This document provides information on ventilation devices and oxygen used by first responders, including suction devices, oral/nasal airways, bag mask units, and supplemental oxygen. It describes how to properly use suction devices and oral/nasal airways, perform bag mask ventilation, and administer supplemental oxygen. Key steps are outlined for each skill, along with safety precautions and monitoring patient response. Adjunctive devices can enhance the effectiveness of resuscitation, but first responders must be able to ventilate without specialized equipment and never delay care while waiting for devices.

1. VENTILATION
DEVICES AND
OXYGEN
LESSON 8

2. INTRODUCTION
First Responders usually provide care for
airway and breathing without specialized
equipment or supplies
Adjunctive devices can enhance effectiveness
of resuscitation:
Suction devices help keep patient’s airway clear
Oral/nasal airways help ensure air reaches
patient’s lungs
Bag mask units for more effective ventilation
Supplemental oxygen

3. INTRODUCTION CONTINUED
Resuscitation adjuncts used depend on
training and job
Devices may not always be available
Be able to ventilate without special
equipment
Never delay care while waiting for
adjunctive equipment

4. SUCTION DEVICES
Used to clear blood, vomit, other substances from victim’s airway
Be familiar with equipment you may use

5. USING SUCTION DEVICES
Clear plastic tip is inserted into mouth or
nostrils
Suction tips vary from small, soft plastic
tips, to larger, more rigid tips
Some devices have suction control port at
base of tip
Be familiar with specific equipment you
may use

6. USES OF SUCTION
Useful if airway is fully or partially
obstructed
Most suction units inadequate for
removing solid objects

7. GENERAL PRINCIPLES OF
SUCTIONING
If patient vomits during ventilation, or
secretions/blood impede ventilation,
stop and quickly suction before
continuing resuscitation
Airway usually needs suctioning if you
hear gurgling sounds during breathing
or ventilation
Turn patient’s head to side to help drain
vomit or fluids before suctioning
If patient may have spinal injury, turn head and body
inline as a unit with help of other responders

8. SUCTION: SAFETY PRECAUTIONS
Prolonged contact with mucous
membranes can cause bruising,
swelling, bleeding
Never insert suction tip further than you
can see
Vigorous suctioning may stimulate gag
reflex
Do not suction infant too deeply and
suction mouth before nose
Use standard precautions

9. SUCTION IN AN INFANT
Watch for a decreased heart rate
If pulse is slow, stop suctioning and provide
ventilation
Don’t suction too deep in an infant
Always suction infant’s mouth before
nostrils
Suctioning nose may stimulate infant to inhale
fluid/secretions from mouth

10. SUCTIONING
(ADULT OR CHILD)

11. SKILL: SUCTIONING
Confirm suction device working and
produces suction
Turn victim’s head to one side and
open mouth

12. Sweep out solids and larger amounts of fluid
with finger.

13. Determine
maximum depth of
insertion.

14. Turn on or create suction.

15. Insert catheter tip into mouth, move tip as
you withdraw it.

16. SUCTIONING
After suctioning, reposition the victim’s
head with airway open
Resume rescue breathing or CPR

17. SUCTIONING
(INFANT)

18. Hold infant in
position for
suctioning
Head lower than
body
Turned to one side

19. Squeeze suction bulb and insert tip into
infant’s mouth.

20. Gradually release bulb to create suction as
you withdraw tip.

21. Move bulb aside, squeeze it with tip down to empty
Repeat if necessary
Repeat suctioning steps for each nostril
Resume rescue breathing or CPR

22. AIRWAY ADJUNCTS
Help keep victim’s airway open
Prevent obstruction by tongue more easily
than head position alone
Supplemental oxygen can be given
through mask or BVM with airway in
place

23. ORAL AIRWAYS
Use only with
unresponsive victim
without gag reflex
Can be breathing or
not
Available in variety of
sizes
Victim can be
suctioned with airway
in place

24. SIZING AND PLACEMENT OF ORAL AIRWAYS
Proper placement is essential
Periodically reassess to confirm airway
remains in proper position

25. ORAL AIRWAY
INSERTION

26. Choose correct size.
Choose correct size.

27. Insert with tip pointing toward roof of mouth.

28. When tip reaches back of mouth and you feel resistance, rotate airway 180
degrees.
When tip reaches back of mouth and you feel
resistance, rotate the airway 180 degrees.

29. Continue to insert until flange rests on lips.

30. ORAL AIRWAY IN CHILDREN
Alternate technique for inserting an oral
airway in infants/children:
Select proper size
Measure from corner of patient’s lips to bottom of
earlobe or angle of jaw
Open patient’s mouth
Use a tongue blade to press tongue down
and out of way
Insert airway in the upright (anatomic)
position

31. NASAL AIRWAYS
Use with responsive
victim
Use with
unresponsive victim
with gag reflex
Use with
unresponsive victim
with mouth or jaw
injuries or tightly
clenched teeth

32. NASAL AIRWAYS
Less likely to cause gagging and vomiting
than oral airways
Difficult to suction
If needed, suction using small flexible suction
catheter

33. NASAL AIRWAY
INSERTION

34. Choose correct size.

35. Lubricate airway.

36. Insert into right nostril with bevel toward
septum.
Insert straight
down

37. Insert straight back, sliding along floor of
nostril. Insert until flange rests against nose.

38. AFTER INSERTION OF NASAL
AIRWAY
Continue to keep patient’s airway open
with head tilt–chin lift or jaw thrust
Suction through nasal airway with small
flexible suction catheter if needed

39. BAG MASK VENTILATION
Bag mask units are more effective for
providing ventilations
Victim receives air from atmosphere (21%
oxygen) rather than exhaled air (16% oxygen)

40. COMPONENTS OF BVM UNIT
self-inflating bag
oxygen
reservoir bag
one-way valve

41. USING BVM: SEALING MASK
Open airway and
position mask on
victim’s face
If alone, hold mask in
one hand and
squeeze bag with
other
Use C-clamp technique
If there is a second
rescuer, hold mask
with both hands

42. USING BVM: GIVING
VENTILATIONS
Rescue breaths delivered by squeezing
bag
Squeeze 1 L bag about ½ to ⅔ of volume
Squeeze 2 L bag about ⅓ of volume
Squeeze bag over 1 second (watch victim’s
chest rise)

43. USING BVM: GIVING
VENTILATIONS CONTINUED
Give ventilation every 5-6 seconds in adult
Give ventilation every 3-5 seconds in infant
or child
If supplemental oxygen, give smaller
ventilations

44. MONITOR BAG MASK
VENTILATIONS
Do not over-ventilate patient
Watch for rise and fall of patient’s chest
Feel for resistance when squeezing
bag
If air escapes around mask,
reposition mask and fingers
If problems occur, use alternate
technique

45. USING BVM: SUPPLEMENTAL
OXYGEN
Use supplemental oxygen with BVM if possible
Attach oxygen reservoir bag to valve on bag
and oxygen tubing
Use device same way

46. USING BVM: MASK AND BAG SIZE
Choose correct size mask for victim
Use right size bag
500 mL for newborns
750 mL for infants/small children
1200 mL for large children/adolescents
1600 mL for adults

47. BVM: RESCUE
BREATHING

48. Assemble BVM and position and seal mask
over victim’s mouth

49. Squeeze bag to provide ventilations
Recheck pulse about every 2 minutes
If no signs of circulation, call for AED and
start CPR

50. SUPPLEMENTAL OXYGEN
Can supply up to 100% oxygen
Should be used along with other BLS
techniques
Victims with serious medical conditions
will benefit

51. SUPPLEMENTAL OXYGEN:
EQUIPMENT
Pressurized cylinder
Pressure regulator
Flowmeter
Oxygen tubing
Oxygen delivery device

52. SAFETY AROUND OXYGEN
No smoking or open flame near oxygen
source
Never use grease, oil, or adhesive tape on
equipment
Never expose oxygen cylinder to
temperature over 120°F
Never drop cylinder or let fall against
another object
Never use non-oxygen regulator on
oxygen cylinder

54. OXYGEN DELIVERY
DEVICES
Nasal Cannula
Resuscitation mask
Nonrebreathing mask
Bag-mask

55. NASAL CANNULA
Use with breathing
victims who do not
require high
concentration of
oxygen
Oxygen concentration
depends on flow rate
1 to 6 LPM delivers
24% to 50% O2
Note:
The Nasal
Cannula
is placed
entirely in
front of
patient

56. RESUSCITATION MASK
Use for nonbreathing
victims
Some have oxygen
port
Provides 30% to 60%
oxygen with flow rate
of 10 LPM

57. NONREBREATHIN
G MASK
Use with breathing
victim
80% to 95% oxygen
with flow at minimum
of 8 LPM
Adjust flow rate to
keep reservoir from
collapsing completely
when victim inhales

58. BAG-MASK UNITS
Delivers oxygen
through tube or
reservoir
Up to 100% oxygen
Can also use with
breathing victim

59. OXYGEN ADMINISTRATION
If you are alone with patient do not stop
providing BLS to set up oxygen
equipment
Wait until patient is more stable or until
another rescuer can help
Once oxygen set up, continue to monitor
oxygen flow rate, tank pressure, and
victim’s condition

60. OXYGEN
ADMINISTRATIO
N

61. Check equipment.

62. Remove any protective seal. Point cylinder
away. Open main valve for 1 second.

63. Remove any protective seals and attach
regulator.
Lining up the
pins is a critical
step
Don’t
forget the
washer

64. Open main cylinder valve.

65. Check pressure regulator gauge.

66. Attach oxygen tubing to flowmeter and
oxygen delivery device.

67. Set flowmeter at correct rate:
1 – 6 LPM for nasal cannula
10 LPM for face mask
10 -15 LPM for BVM or nonrebreathing mask

68. Confirm oxygen is flowing.
Position delivery device on victim.
Monitor pressure gauge.
Fill
the bag
before placing on
the patient