Student Project SGD B-5

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1. Airway First thing that we do is assessing the airway for any obstructions. The most common cause of airway obstruction is the tongue. There are 2 kinds of airway obstruction: partial and total. In partial obstruction cases, the patients can still cough and speak. We shouldnt interfere; instead just instruct the patient to continue coughing or talking, since ability to speak indicates adequate ventilation is still occurring. The signs of complete airway obstruction are: high-pitched, stridorous sounds during inhalation, weak and ineffective coughing, respiratory distress, inability to speak, and cyanosis. The management of airway problems is as follows: Open the patients airway using the head-tilt and chin lift method: Place one hand firmly on the patients forehead; apply firm pressure downwards, at the same time apply backward pressure to tilt the head. Hook the fingers of the other hand under the bony part of the chin; lifting up the chin. In the event of trauma, use the jaw thrust without head tilt. Jaw-thrust maneuver: if cervical spine injury is suspected, open airway by grasping angles of victims lower jaw without tilting the head. In cases where liquids are involved, tilt the patients head to his side. If C-spine is intact, use recovery position, rolling over the patient to his sidejust like a normal sleeping position. Special maneuvers exist in managing airway obstruction problems. Heimlich maneuver is the first stop in these cases. Place the thumb of one fist on the patients navel, then grab the fist with another hand and quickly thrust the patients abdomen inward and upward. If the patient is unconscious, straddle the patient and thrust the patients abdomen inward and upward using the heel of the palm up to 5 times. Open the mouth and perform a finger sweep technique, sweeping the back of the tongue with index finger in hooking motions. Attempt rescue breathing. Repeat the sequence until the patient resumes or until definitive help arrives. 2. Breathing Assess breathing by leaning over the patients open mouth and looking down at the chest for any rise or fall of breathing. Place an ear near the patients mouth, listening for the breathing or feeling the flow of air over the cheek. Perform for 3-5 seconds. 1. Mouth to mouth; the airway is maintained by using the head tilt and chin lift method. Pinch the patients nose shut. Seal your lips around the patients mouth.

Give 2 slow breaths initially. There should be good chest rise and fall. If not reposition the patients airway and attempt to ventilate again. If there is still no movement of air, presume that the patient has a foreign body airway obstruction and attempt to clear it. 2. Mouth to mask; a clear mask with or without a one way can be used as an adjunct to mouth to mouth ventilation. When possible the mask should be attached to supplemental oxygen. There are two techniques to achieve an effective seal with the mask: Cephalic Technique (used when there is more than 1 provider) and Lateral Technique (when there is only one provider, this technique must be used to allow the provider to perform one-person CPR). Bag-mask ventilation; when ventilating a patient use supplemental oxygen. The adult bag mask is usually a 1600ml self inflating bag with a non-rebreathing valve attached to a face mask. There should be reservoir for oxygen and tubing to connect to an oxygen source. Cricoid pressure application; can be used to minimize gastric insufflations associated with ventilation.

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3. Circulation Assess circulation by checking for the carotid pulse. The carotid pulse is located in the groove lateral to the trachea. Check the pulse for no more than 10 seconds. If a pulse is present, rescue breathing can continue with 1 breath every 4-5 seconds. If a pulse is absent, start chest compression. The method of chest compression: 1. Proper hand position is on the lower half of the sternum. 2. Push hard, push fast. Allow the chest to recoil after each compression. 3. The rate is 80-100 compressions per minute. 4. For 1-rescuer CPR, the ratio is 20:2. For 2-rescuer CPR, the ratio is 15:2.