Bag and mask Ventilation Presented by Sakun Rasaily,
(Pediatric Nurse, Pediatric ward , B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
i have prepared this ppt. from various Books as a refrences as well as uses of web pages and explain and modify in simplify language which are easily understand by medical or para medical personnel..thank you..
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
i have prepared this ppt. from various Books as a refrences as well as uses of web pages and explain and modify in simplify language which are easily understand by medical or para medical personnel..thank you..
We are having the broadest ranges of laryngoscopes available, including options to manage difficult airways, and improve procedural efficiency. For bulk orders feel free to visit our website.
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Mechanics and physiology of lung isolation/ one-lung ventilaion,
Anaesthetic implications of one-lung ventilation and management strategies
West zones of the lung
Ventilation-perfusion mismatch, V-Q
Hypoxic pulmonary vasoconstriction
Physiotherapy in surgery in abdominal and thoracic surgeryDrKhushbooBhattPT
Rehabilitation is one of the important aspect in pre and post surgery care.
This presentation is mainly focusing on the "thoracic and abdominal rehabilitation" and also gives details about assessment and management of "intercostal drains".
Weaning from mechanical ventilation , also called ventilator liberation, refers to the process of the patient assuming more and more of the work of breathing and finally demonstrating that ventilator support is no longer required.
Simply it means the process of withdrawing mechanical ventilatory support and transferring the work of breathing from the ventilator to the patient . Weaning can be accomplished with an endotrachel tube ( ETT) or a tracheostomy tube in place.
In the case of the ETT, the final step in the process is the removal of the tube( extubation). With a tracheostomy, the final step may be the ability to breath spontaneously for a designated period of time with the tube in place.
Weaning success is defined as absence of ventilatory support 48 hours following the extubation.
While the spontaneous breaths are unassisted by mechanical ventilation, supplemental oxygen, bronchodilators, low level pressure support ventilation or continuous positive airway pressure (CPAP) may be used to support and maintain adequate spontaneous ventilation and oxygenation.
Purpose
The purpose is to assess the probability that mechanical ventilation can be successfully discontinued.as
75% of mechanically ventilated patients are easy to be weaned off the ventilator with simple process.
10-15% of patients require a use of a weaning protocol over a 24-72 hours.
5-10% require a prolonged weaning plan.
1% of patients become dependent on chronic mechanical ventilation.
Indication
Improvement of the cause of respiratory failure.
Absence of major system dysfunction.
Appropriate level of oxygenation.
Adequate ventilatory status.
Intact airway protective mechanism.
Contraindication
Altered sensorium either drowsiness or restlessness.
Spo2 ˂90%
Rising PaCO2 with drop in PH
Tachypnoea ˃35/ min
Tachycardia ˃120 /min
Drop in systolic blood pressure
Sweating
Cold clammy skin
Signs of diaphragmatic weakness
Paradoxical abdominal wall movement
Assessment of readiness for weaning
Hemodynamic stability
Minimum inotropic support
Adequate cardiac output
Afebrile
Hematocrite greater than 25%
Respiratory stability
Improved chest x-ray
Arterial oxygen tension (PaO2) greater than 60mm Hg with fraction of inspired oxygen ( FiO2) less than 0.5
PaO2/FiO2 greater than 300 mm Hg
Positive end expiratory pressure (PEEP) less than 0-5 cm H2O
Vital capacity (VC) 10-15ml/kg
Spontaneous tidal volume (VT) 5ml/Kg
Respiratory rate less than 30 breaths/mim
Minute ventilation 5-10 L/min
Negative inspiratory pressure greater than -20cm H2O
Rapid shallow breathing index (RSBI) less than 105
metabolic factors stable
Electrolytes within normal range.
ABGs( Arterial blood gases) normalized
Other
Adequate management of pain and anxiety.
Patient is well rested
Weaning criteria
Weaning criteria are used to evaluate the readiness of a patient for a weaning trial and the likelihood of weaning success.
Clinical criteria
Ventilatory criteria
Oxygenation criteria
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamala
1. BAG and MASK VENTILATION
(BMV)
Sakun Rasaily, Staff Nurse
Pediatric –I
B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
2. PRESENTATION OUTLINE
• INTRODUCTION OF BMV
• EQUIPMENT & PARTS
• TYPES / ADVANTAGES/ DISADVANTAGES OF BAG
• INDICATIONS
• PROCEDURE
• TECHNIQUE
• CONTRAINDICATIONS
• COMPLICATIONS
• NURSING MANAGEMENT.
3. INTRODUCTION
BAG and MASK VENTILATION:
• This is the most important airway skill.
• A basic airway management technique that allows for
oxygenation and ventilation of patients until a more
definitive airway can be established.
• Also used in cases where endotracheal intubation or
other definitive control of the airway is not possible.
4. Contd...
• In the pediatric population, BMV may be the
best option for prehospital airway support.
BMV ventilation is also appropriate for elective
ventilation in the operation theatre when
intubation is not required, but it is now often
substituted by the laryngeal mask airway
6. PARTS OF BMV
The BMV consists of
1. The bag : a flexible air chamber , attached to a face mask via
a shutter valve which is squeezed to expel air to the patient.
2. Mask: a flexible mask to seal over the patients face,
3. Filter and valve : a filter & valve prevent backflow into the
bag itself (prevents patient deprivation and bag
contamination)
4. Oxygen Reservoir:
5. Pressure Gauge
6. Oxygen Connecting tube
7. Contd…..
• Provide a volume of 6-7 mL/kg per breath (approximately
500 mL for an average adult).
• For a patient with a perfusing rhythm, ventilate at a rate of 10-
12 breaths per minute.
• Adult size: 2 litres, Paediatric size:500 ml
8. TYPES OF BAG USED
1.Flow inflating bag (Anaesthesia Bag)
• Fills only when oxygen from a
compressed source flows into it
• Depend on a compressed gas source
• Must have a tight face-mask
seal to inflate
• Use a flow-control valve to
regulate pressure-inflation
9. 2.Self inflating bag (AMBU Bag)
• Fill spontaneously after they
are squeezed, pulling oxygen or
air into the bag
• Remain inflated at all times
• Can deliver positive-pressure
ventilation without a compressed
gas source.
• Require attachment of an oxygen reservoir to deliver 100%
oxygen
10. Advantages and disadvantages of types of bags
Advantages Disadvantages
Flow Inflating
Bag
•Delivers 100% oxygen at all times
•Easy to determine the adequacy
of seal
•Stiffness of lungs can be felt
•Can deliver PEEP or CPAP
•Requires a tight seal to remain
inflated
•Requires a gas source to
inflate
•No safety pop-off valve
•Requires more experience
Self Inflating
Bag
•Does not need a gas source to
inflate
•Pressure release valve/ Pop – off
valve set at 30 – 40 cm H20
•Easier to use
•Will inflate even without
adequate seal
•Requires a reservoir to deliver
100% oxygen
•Can not be used to deliver
100% free flow oxygen
11. THE THREE PILLARS OF AIRWAY
MANAGEMENT
:1Patency of Upper Airway : ( airflow integrity )
2Protection against aspiration
3Assurance of oxygenation and ventilation
13. PROCUDURE
• One hand to
• maintain face seal
• position head
• maintain patency
• Other hand for ventilation
14. BMV TECHNIQUE
• “Sniffing”position if C-spine OK
• Thumb + index finger to maintain face seal
• Middle finger under mandibular symphysis
• Ring and little finger under the angle of mandible
15. Bag and mask ventilation
Yes
No
Check for inadequate seal; reapply face mask
Chest Rise
No
Chest RiseYes
Check for blocked airway.
Reposition head, remove secretions, mouth slightly open
Chest RiseYes
No
Consider insufficient pressure. Increase pressure; consider intubation
16. Ventilate for 30 seconds
Rate 40-60 bpm
Increasing HR, visible rise and fall of chest
Check heart rate with stethoscope or umbilical palpation for 6 seconds
Less than 6 beats
(< 60bpm)
6-10 beats
(60-100bpm)
More than 10 beats
(>100 bpm)
•Continue ventilation
•Initiate chest compression
•Consider intubation
•Continue ventilation
•Consider intubation
•Check for
spontaneous
breathing
No Yes
•Continue positive pressure ventilation
•Consider intubation
•Consider OG tube insertion
•Need of post-resuscitation care
•Gradually discontinue
positive pressure ventilation
•Provide tactile stimulation
•Provide free flow oxygen
•Need of post-resuscitation care
17. WHY SNIFFING POSITION?
• Sniffing position allows for greater occipito-atlanto-
axial angulation.
• No exact definition has been established.
• However, 35 degrees neck flexion and 15 degrees
head extension is generally considered worldwide.
• Sniffing position prevents falling of tongue thus
preventing obstruction of the upper airway.
18. BMV DURING CPR
• 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
patient’s breaths. In a patient with tachypnea, assist every
few breaths.
• Ventilate with low pressure and low volume to decrease
gastric distension.
19. CRICOID PRESSURE
• Cricoid pressure consistencycy should be maintained not in all but in
emergency cases while appling BVM .
• It is the backward Pressure on cricoid cartilage with a force of 30-40
newtons
• This pressure is meant 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.
• Care must be taken to avoid excessive pressure, which can result in
compression of the trachea.
20. BMV VENTILATION: ASSESSMENT OF ADEQUACY
• Observe the chest rise and fall
• Good bilateral air entry
• Improving color
• Lack of air entering the stomach
• Feeling the bag
• Pulse oximetry (oxygen saturation)
21. CONTRAINDICATIONS
• In the case of complete upper airway obstruction.
• BVM ventilation is relatively contraindicated after paralysis
and induction (because of the increased risk of aspiration).
• Caution is advised in patients with severe facial trauma and
eye injuries.
• In addition, foreign material (e.g. gastric contents) in the
airway may lead to aspiration pneumonitis. In these
circumstances, alternative approaches, including endotracheal
intubation, may be necessary.
22. PREDICTORS OF A DIFFICULT
AIRWAY : BMV
• Upper airway obstruction
• Edentulous patients
• Beard
• H/O Snoring
• Obese
• Elderly >70 years
• Facial burns, dressings, scarring
• Poor lung mechanics
• resistance or compliance
23. DIFFICULT AIRWAY ADAGE
• The first response to failure of bag-mask ventilation is always
“better” bag-mask ventilation
• optimize airway position, triple airway maneuvre (head tilt,
chin lift, jaw thrust)
• place Oropharyngeal and Nasopharyngeal airways
• two-handed technique
• try lifting head off pillow to open airway
• Generate as much positive pressure as possible
without inflating the stomach
24. Contd...
If bag and mask still fails:
1. Intubate
2. If Cant ventilate, cant intubate
*Larngeal mask airway
*Cricothyroidotomy
*Needle Cricothyroidotomy and Transtracheal Jet
Ventilation
25. COMPLICATIONS OF BMV
Related to over-inflating or over-pressurizing the
patient, which can cause:
• Hypoventilation/ Hyperventilation
• Inflated air in the stomach (called gastric insufflation)
• Lung injury from over-stretching (called volutrauma)
• Lung injury from over-pressurization (called barotrauma)
• Lung aspiration
• Air Embolism
26. NURSING MANAGEMENT:
1. Promote respiratory function.
2. Monitor for complications
3. Prevent infections.
4. Provide adequate nutrition.
5. Monitor GI bleeding.
27. PROMOTE RESPIRATORY FUNCTION
1. Auscultate lungs frequently to assess for abnormal sounds.
2. Suction as needed.V/S recording and reporting.
3. Turn and reposition every 2 hours.
4. Secure ETT properly.
5. Monitor ABG value and pulse oximetry.
28. Suction of an Artificial Airway
1. To maintain a patent airway
2. To improve gas exchange.
3. To obtain tracheal aspirate specimen.
4. To prevent effect of retained secretions.
( Its important to OXYGENATE before and
after suctioning)
29. MONITOR FOR COMPLICATIONS
1. Assess for possible early complications
Rapid electrolyte changes.
Severe alkalosis.
Hypotension secondary to change in
Cardiac output.
2. Monitor for signs of respiratory distress:
Restlessness
Apprehension
Irritability and increase HR.
30. CONTD………
3. Assess for signs and symptoms of barotrauma(rupture of
the lungs)
Increasing dyspnea
Agitation
Decrease or absent breath sounds.
Tracheal deviation away from affected side.
Decreasing PaO2 level .
1. Assess for cardiovascular depression:
Hypotension
Tachy. and Bradycardia
Dysrhythmias.
31. • PREVENT INFECTION
1. Maintain sterile technique when suctioning.
2. Monitor color, amount and consistency of sputum.
• PROVIDE ADEQUATE NUTRITION
1. Begin tube feeding as soon as it is evident the patient will remain on the
ventilator for a long time.
2. Weigh daily.
3. Monitor I&O .
MONITOR FOR GI BLEEDING
1. Monitor bowel sounds.
2. Monitor gastric PH and hematest gastric secretions every shift.
32. • INTRODUCTION OF BVM
• EQUIPMENT & PARTS OF BVM
• TYPES / ADVANTAGES/ DISADVANTAGES OF BAG
• INDICATIONS
• PROCEDURE
• TECHNIQUE
• CONTRAINDICATIONS
• COMPLICATIONS
• NURSING MANAGEMENT.