Ambu bag

BY: JESSA ANNE R. BORRE

BSN- IV

ENDOTRACHEAL
INTUBATION

provides

a passage for gases to flow

between a patients lungs and an
anaesthesia breathing system .
allows one to provide positive pressure
ventilation.
protects the lung from contamination from
gastric contents and nasopharyngeal
matter such as blood.

ENDOTRACHEAL TUBE

Is

a medical procedure in which a tube is

placed into the windpipe (trachea) through
the mouth or nose. In most emergency
situations it is placed through the mouth.

Whether

you are awake (conscious) or not

awake (unconscious), you will be given
medicine to make it easier to insert the
tube.

Endotracheal intubation

Open

the airway to give oxygen, medicine, or

anesthesia
Support breathing with certain illnesses, such as
pneumonia, emphysema, heart failure, or collapsed
lung
Remove blockages from the airway
Protect the lungs in people who are unable to protect
their airway and are at risk for breathing in fluid
(aspiration). This includes people with certain types of
strokes, overdoses, or massive bleeding from the
esophagus or stomach.

Endotracheal intubation is done to:

Bleeding
Infection
Trauma

to the voice box (larynx), thyroid

gland, vocal cords and windpipe (trachea),
or esophagus
Puncture or tearing (perforation) of body
parts in the chest cavity, leading to lung
collapse

RISKS INCLUDE:

ET

Tubes can be:

Cuffed
Uncuffed

Cuffed

ET tubes are used in children >8 y/o

The cuff when inflated maintains the ET tube in
proper position and prevents aspiration of contents
from GI Tract into respiratory tract.
In children, <8 uncuffed ET tubes are used because
the narrow subglottic area performs the function of
a cuff and prevents the ET tube from slipping.

TYPES:

Cuffed et tube

Uncuffed et tube

bag valve mask, abbreviated to BVM

and sometimes known by the proprietary
name Ambu bag or generically as a
manual resuscitator or "self-inflating bag",
is a hand-held device commonly used to
provide positive pressure ventilation to
patients who are not breathing or not
breathing adequately.

Respiratory

Failure

Failure of ventilation
Failure of oxygenation
Failed

intubation

Indications

BVM

ventilation is absolutely contraindicated in the

presence of complete upper airway obstruction.

BVM

ventilation is relatively contraindicated after

paralysis and induction (because of the increased risk
of aspiration).

Contraindications

Figure : Mechanisms of the manual resuscitators: A and B in the

normal conditions, C and D in the presence of big negative pressure
in the breathing circuit.

Positioning
Place towels under the patients head to
position the ear level with the sternal notch.
Extend

the patients head slightly.

Anybody ( almost ) can be

oxygenated and ventilated with a bag
and a mask
The art of bagging should be
mastered before the art of intubation
Manual ventilation skill with proper
equipment is a fundamental premise
of advanced airway Rx

Golden Rules of Bagging

Requires practice to master

One hand to

maintain face seal

position head
maintain patency
Other

hand ventilates

BVM Ventilation

Observe

the chest rise and fall

Good bilateral air entry
Lack of air entering the stomach
Feeling the bag
Pulse oximetry

BVM Ventilation:
Assessment of Efficacy

Upper

airway obstruction
Lack of dentures
Beard
Midfacial smash
facial burns, dressings, scarring
poor lung mechanics( resistance or
compliance )

Predictors of a Difficult Airway :

Bag-Valve-Mask Ventilation

Technique
Open

the airway (head-tilt chin-lift maneuver or the jaw thrust).

In patients with suspected cervical spine injury, do not perform a head-tilt;

rather, only perform a chin-lift maneuver.
Use an airway adjunct.

Place an OPA in unresponsive patients without a gag reflex. 6

If the patient is awake, place one or two NPA ( because of the risk of intracranial
placement, avoid the use of a NPA in patients with significant head and facial trauma).6
Place

the mask on the patients face before attaching the bag.4

Cover

chin.

the nose and the mouth with the mask without extending it over the

Change
Hold

the size of the mask, as appropriate, to create a good seal.

the mask in place using the one-hand E-C technique, as shown below.

Contd.
Use

the non dominant hand.

Create

a C-shape with the thumb

and index finger over the top of
the mask and apply gentle
downward pressure.

Hook

the remaining fingers

around the mandible and lift it
upward toward the mask, creating
the E.

Alternate one-hand
technique.

Two-hand technique
If a second person is available to provide ventilations by compressing the bag

Create two opposing semicircles with the

thumb and index finger of each hand to form a
ring around the mask connector, and hold the
mask on the patients face. Then, lift up on the
mandible with the remaining digits.

Alternatively, place both thumbs

opposing the mask connector, using
the thenar eminences to hold the
mask on the patients face, while
lifting up the mandible with the
fingers.
No matter which technique is being used, avoid
applying pressure on the soft tissues of the

Ventilation

volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult)

Ventilate

at a rate of 10-12 breaths per minute. (for a patient with perfusing

rhythm)
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 patients breaths. In a
patient with tachypnea, assist every few breaths.

Ventilate

with low pressure and low volume to decrease gastric distension.

Cont..
Maintain

cricoid pressure consistently .

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. 1
Care must be taken to avoid excessive pressure, which can result in
compression of the trachea.
Assess

the adequacy of ventilation.

- Observe for chest rise, improving color, and oxygen

saturation.
- Monitor for air leak.
- Be cognizant of increasing gastric distention .

Aspiration

- The best way to prevent aspiration is with good technique,

including low-pressure, low-volume ventilation with slow
insufflation. Newer bags have built-in pressure valves.
The green zone includes pressures up to 20 cm of water
and corresponds to the lowest risk of gastric distention.
Hypoventilation
Hyperventilation

Complications