What is positive pressure manual ventilation?
- ability to use your hands to breathe for patient
- manual vs. mechanical
APSF Guidelines (7)
- reliable O2 delivery up to 100%
- reliable positive pressure ventilation
- backup ventilation equipment available & functioning
- controlled release of positive pressure in breathing circuit
- anesthesia vapor delivery
- adequate sxn
- standards for patient monitoring
- ACLS/PALS
Indications for manual ventilation
- bridge to placement of secure airway
- vent failure or circuit malfunction
- excessive sedation/resp depression in MAC cases
- transport
- emergency situation
contraindications of manual ventilation for GA
- full stomach
- difficult airway
- facial trauma/anomalies
insertion of oral airway
-insert ‘upside down’ and rotate 180 degrees as approach posterior pharynx
sizing of oral airway
-corner of mouth to tip of earlobe
standard mask sizes
- adult size 4-5
- peds size 0-3
what are the indications of oral airway
- edentulous patient
- Down’s or peds with large tongue
- sleep apnea
sizing of nasopharyngeal airway
-nose to earlobe
insertion of NP airway
- bevel towards septum
- stop if resistance felt
- left nostril- bevel towards septum and rotate 180 degrees
what are the indications of NP airway
- patient can’t open mouth
- intact gag reflex
what are the contraindications of NP airway
- nose bleeds- anti-coagulation
- basilar skull fracture
what are the risk factors for difficult mask airway?
- facial hair
- edentulous
- obesity
- OSA
- facial anomalies
non-rebreathing valve on manual ventilator device
- ensures exhaled gas does not mix with fresh gas
- exhaled gas escapes to atmosphere
why is there APL valve?
-only gas exit from breathing system during spontaneous, assisted, or manually controlled ventilation IF there are NO CIRCUIT LEAKS
how does the APL valve work?
- used to control pressure in breathing circuit -> adjusts bag filling
- high gas flows will pressurize circuit quickly
