© Surf Life Saving Australia – Version 1 SLSA Advanced Resuscitation / PUAEME003B Administer Oxygen in an Emergency Situation 23.1 SLSA Advanced Resuscitation

© Surf Life Saving Australia – Version 1 SLSA Advanced Resuscitation / PUAEME003B Administer Oxygen in an Emergency Situation 23.

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SLSA Advanced Resuscitation PUAEME003B Administer Oxygen In An Emergency Situation

Chapter 23 – Advanced Resuscitation and Oxygen Administration


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UNIT 23 – ADVANCED RESUSCITATION AND OXYGEN ADMINISTRATION


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Advanced ResuscitationWhy Use Oxygen? (pg162)

The Components Of Oxygen Resuscitation Equipment (pg162)

Administering Oxygen Therapy (pg164)

Setting Up Oxygen Resuscitation Equipment (pg165)

Equipment Maintenance (pg166)

Administering Suction* (pg167)

Automatic Oxygen-Powered Resuscitator* (pg167)

Oropharyngeal Airways (pg168)

*These 2 sections are NOT part of the SLSA Advanced Resuscitation Certificate. They can be trained and utilised by qualified personnel ONLY

Page numbers refer to the SLSA First Aid & Emergency Care Manual


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Prerequisites

• A candidate must be a minimum age of 15 years old on the date of final assessment, AND

• Hold the PUAEME001A ‘Provide Emergency Care’ Competency, found in the SLSA 32nd Edition Training Manual:

– Unit 3 – Anatomy and Physiology– Unit 4 – Basic First Aid– Unit 5 – First Aid– Unit 6 –Resuscitation– Unit 7 – Basic Oxygen

• Also from SLSA FAEC Manual– Chapter 8 – Respiratory Emergencies


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Patients likely to benefit from oxygen include those with the following conditions:

Why use Oxygen?

• Unconsciousness• Shock• Blood loss• Chest pain• Shortness of breath, including asthma• Circulatory distress• Severe pain• Injuries• After resuscitation• Absent breathing


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Oxygen Safety

• Never use oxygen near an open flame• Never use oxygen near cigarettes• Never use grease or oil with oxygen equipment• Oxygen promotes combustion• Do not tamper with oxygen equipment• Store in a cool place• Store oxygen bottles lying flat, or securely fastened if

upright• Use only medical oxygen• Do not use when delivering a shock via a defibrillator

Safety precautions when using oxygen:


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Components of Oxygen Resuscitation Equipment• Protective case• Medical oxygen cylinder• Cylinder cradle• Cylinder yoke• Sealing washer • Locating pins• Thumb screw• Cylinder key wheel• External cylinder connection• Contents gauge


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Components of Oxygen Resuscitation Equipment• Regulator• OP airways• Airbag• Oxygen reservoir bag• Tubing• Control valves• Anaesthetic masks• Therapy masks• Chalk• Gloves• Pens, pencils & paper

Other equipment (optional):• Automatic oxygen-

powered resuscitator• Suction


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Components of Oxygen Resuscitation EquipmentRoutine check of equipment:• ‘Crack’ cylinder to clean (if not attached)• Check sealing washer• Insert cylinder and locate• Ensure thumb screw is firmly done up• Check contents of cylinder• Check tubing• Check therapy and anaesthetic masks• Check oropharyngeal airways• Check for chalk, pens/pencils and paper,

gloves, spare sealing washer


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Components of Oxygen Resuscitation EquipmentRoutine check of equipment (cont’d):• Check flow of oxygen• Check there is no odour from oxygen• Check operation of oxygen nipples• Check airbag (5 checks)• Close cylinder valve and drain oxygen from system• Check additional equipment (eg Suction, etc)

The SLSA Oxygen Equipment Policy is located on SLSA website at www.slsa.com.au


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Components of Oxygen Resuscitation EquipmentChecking Suction (optional):• Remove large suction tubing and hold near open end• Turn suction lever fully on• Test for suction• Turn lever off• Remove catheter and fit to large tubing• Turn suction lever fully on• Test for suction again• Turn lever off• Return to case in original position


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Components of Oxygen Resuscitation Equipment

• As per oxygen equipment plus:

– Block off powerhead/ demand valve outlet with 1 hand and trigger the device

– Check for valve release

– Check for blockages

Automatic oxygen-powered resuscitator (optional):


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Administering Oxygen Therapy• Check oxygen before each use• Place unit in appropriate

position to operate• Connect therapy mask to tubing

and turn on oxygen• Place mask on patient’s face

– Adjust accordingly• Reassure the patient

If a conscious patient does not want to use the mask, they can hold the mask in front of their face, or remove the tubing from it and direct the oxygen flow around the mouth and nose


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Administering Oxygen Therapy• Increases oxygen received by patient from 16%-50%• Therapy setting (8L per minute)

– Oxygen in patient’s lungs almost 45%

• Resuscitation setting (14-15L per minute)

– Oxygen in patient’slungs slightly greater (i.e. >50%)

• Can be one-operator operation, preferred that two operators are used

Mouth-to-mask resuscitation with oxygen:


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Administering Oxygen Therapy

• Check airbags by blocking patient valve

• Check function of disc membrane on patient valve

• Check overflow of membrane of reservoir valve – (Laerdal bag only)

• Check air-intake membrane (rear valve of airbag)– (Laerdal bag only)

Airbag checks:


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Administering Oxygen Therapy

• Will supply the patient with up to 95% oxygen with flow rate of 14-15L per minute

• Possible for mouth-to-mask resuscitation with oxygen using therapy tubing whilst oxygen unit is being set up

Airbag oxygen resuscitator:


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Setting Up OxygenResuscitation Equipment• Inform others of who you are and your qualifications• Set up and place unit in appropriate position to operate• Anaesthetic mask to Airway operator

– If not already being used• Quickly check:

– Operation of patient valve– Valve to oxygen reservoir bag– Connection to oxygen supply

• Turn on oxygen to 14-15L per minute to allow inflation of airbag reservoir


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Setting Up OxygenResuscitation EquipmentProcedure:• Inform other operators airbag is ready• Attach patient valve with no change to Rescue Breathing

rate• Airbag oxygen resuscitator compressed with 2 hands

(for adult) using gentle squeezing motion• Squeeze airbag until chest rises

– Bag released and allowed to refill

The rise and fall of the patient’s chest should be watched at all times during this procedure by both Airway and oxygen airbag operators


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Setting Up OxygenResuscitation EquipmentProcedure (cont’d):• Remove oxygen equipment if not operating properly and

continue with Rescue Breathing• Recommended that 3 operators be present for operation

during CPR• Paediatric airbag (if available) should be used for children

– Compressed with 1 hand• Airbag resuscitators are not designed for infants, and

therefore should NOT be used on infants• Can use airbag without oxygen bottle

– Remove reservoir bag


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Setting Up OxygenResuscitation EquipmentOperational time:• Full ‘C’ cylinder (440-490 L)

– 50 minutes on Oxygen Therapy setting (8L per minute)– 30 minutes on Resuscitation setting (14-15L per minute)


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Equipment Maintenance

General care:• Machine kept clean and free of sand/foreign materials• Checked:

– After every teaching session– Before use each day

• Removed from service immediately if default found• Serviced at least every 12 months


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Care after use:• Used oxygen therapy masks sent to hospital

or disposed of• Tube• Anaesthetic masks• Patient valve• Rear valve• Airbag• Reservoir valve• Oxygen reservoir

Washed in warm soapy water for 2 minutes, then rinsed in fresh running water


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Equipment MaintenanceCare after use (cont’d):• Contaminated parts:

– Soaked in 70% alcoholic chlorhexidine or hypochlorite solution

– For at least 2 minutes– Rinsed and dried

• Operate all parts before storage to ensure they are operational

After every use, the resuscitator should be disassembled, cleaned, disinfected, reassembled and tested in an orderly sequence


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Storage:• In a cool place• Spare oxygen bottles kept near equipment• Away from busy areas, sand, dust• Away from oil and greaseDO NOT:• Store in enclosed space• Allow smoking or near naked flame• Leave pressure in systemEmpty cylinders should be filled without delay:• Half-full or less can be used for training


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Administering Suction (Optional)

Types of devices:• Electric• Foot pump• Vacuum bottle• Hand pump

Oxygen-driven suction consumes considerable oxygen (20-40L/min) It is essential that you close the valve immediately after use


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Administering Suction (Optional) Procedures:• Suction ONLY used in:

– unconscious patient, or– Semiconscious patient

Wearing gloves: • Attach suction catheter to suction tubing• Measure appropriate distance• Lubricate the catheter• Can repeat several times but no longer than 15 seconds

– Prevents hypoxia developing• Check area between teeth and cheek,

and under tongue

Where they can’t cough or swallow


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Automatic Oxygen-PoweredResuscitator (Optional)

Warning• Increased risk of distension• Increased risk of over-

inflation of lungs• Increased risk of damage

to middle ear

Can ventilate a non-breathing patient with 100% oxygen

Equipment only used by competent regular users


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Automatic Oxygen-PoweredResuscitator (Optional)Procedure:• Oxygen supply ON• Control lever ON (if necessary)• Adjust tidal flow and/or frequency (if necessary)• Clear airway• Open airway using head tilt/jaw support• Insert oropharyngeal airway (if qualified)


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Automatic Oxygen-PoweredResuscitator (Optional)Procedure (cont’d):• Place mask on face and

hold in position• Ensure adequate tidal

volume delivered• For breathing patient

– Adjust control lever (equivalent)


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Oropharyngeal Airways• Help keep airway clear in unconscious patient• Does not replace correct airway management practices• Inserted using

‘rotation’ method:– This method NOT

recommended for infants, or children under 8 years old

• Comes in various sizes

First Aiders must avoid direct contact with blood and other body substancesStrongly recommended to wear gloves and use a resuscitation mask


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Oropharyngeal AirwaysCare of OP airways:• Stored in a sterile state• Easily accessible in:

– First aid kit– Oxygen unit– First aid rooms

• Should be checked for deformities• If used for training purposes:

– Mark with ‘Training Use Only’– Washed after use in warm soapy water for

2 minutes minimum• OP airway appropriately disposed of after use on

patient


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Oropharyngeal Airways

Sizing:• Flange just past centre

of patient’s lips• Curve run along

patient’s jaw• Correct size = reaches

angle of patient’s jaw

Choosing the appropriate-sized OP Airway


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When to insert an OP airway:• Use is optional• <15 seconds to size and insert• Inserted into:

– Unconscious patient in lateral position after airway cleared, or

– During Rescue Breathing/CPR while patient on their back after stopping Rescue Breathing/CPR briefly

The OP airway should NOT be inserted during delivery of chest compressions


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Inserting of an OP airway into:

• Unconscious breathing patient = lateral position

• Non-breathing patient = lateral position or back

OP airways must be inserted ONLY into deeply unconscious or non-breathing patients


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Oropharyngeal AirwaysInserting an OP airway:• Open patient’s airway• Ensure clear airway• Choose appropriate sized airway• Lubricate airway• Insert OP airway using ‘rotation’ method

• Should slip easily into place

Precautions when inserting an OP Airway• Ensure lower lip is not pinched• Ensure OP airway does not push tongue backwards and block airway• Ensure adequate head tilt before inserting OP airway• Don’t force the OP airway


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Removing the OP airway:• Remove immediately if signs of rejection of OP airwayRemove by:• Sliding it out following its natural curve

Do not attempt to rotate airway on removal

IMPORTANTOP airways should not be used:• If patient is conscious or semiconscious• If correct size airway is not available• If there is a large amount of vomit


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Thank You

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© Surf Life Saving Australia – Version 1 SLSA Advanced Resuscitation / PUAEME003B Administer Oxygen in an Emergency Situation 23.1 SLSA Advanced Resuscitation