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 Normal Rate
 Adult: 12 to 20/minute
 Child: 15 to 30/minute
 Infant: 25 to 50/minute
張靜初
 Regular Rhythm
 Adequate Quality
 Movement of air at mouth, nose
 Chest expansion adequate, symmetrical (equal)
 Breath sounds present, equal
 Minimum effort of breathing
 Adequate tidal volume (depth)
 Skin changes
 Pale, cool, clammy: Early sign
 Cyanosis: Late, unreliable sign
 Retractions of soft tissues above clavicles,
between ribs, below rib cage
 Flaring of nostrils
 “Seesaw” breathing in infants
 Decreased level of consciousness
 GCS <9
 Cerebral injury
 Surgery
 Medical problems
 Tongue
 Dentures
 Food stuffs
 Vomit
 Blood
 Secretions
 Suction
 Postural airway manoeuvres
 Basic life support chocking protocol
 Up to 5 back slaps
 Up to 5 abdominal thrusts
 Only if unconscious up to 5 chest thrusts
 If unsuccessful to clear airway then Basic Life
Support
 壓額抬下巴
 Remove any visible obstruction from the
victims mouth, including dislodged dentures.
Leave well fitting dentures in place
 Techniques
 Insert catheter into oral cavity without suction
 Insert only to base of tongue or end of tracheostomy
tube
 Apply suction, move catheter from side to side
 Suction no longer than 15 seconds in adults, 10
seconds in children, 5 seconds in infants
 Rinse catheter with saline or water to prevent
obstruction
Installed suction unit provides a
vacuum of >300mmHg.
 Never suction further than you can see.
 Always suction on the way out.
 Never suction for longer than 15 seconds.
 Always oxygenate the patient before and
after suctioning.
Mouth-to-mask with supplemental oxygen
2. Two-person bag-valve mask with oxygen
reservoir and supplemental oxygen
3. Flow restricted, oxygen-powered ventilation
device (manually-triggered ventilator)
4. One-person bag-valve mask with oxygen
reservoir and supplemental oxygen
1.
 Mouth-to-Mouth
Open airway
 Pinch nose closed or seal nose with cheek
 Take deep breath
 Seal lips around patient’s
mouth to create airtight seal
 Blow into patient’s mouth
rapidly for 1-2 seconds until
patient’s chest rises

 Mouth-to-Mask
 Connect mask to oxygen at 15 liters per minute
 Kneel directly above patient’s head
 Apply mask to patient’s face
 Place thumbs along sides of mask, index fingers of
both hands under patient’s mandible
 Blow into one-way valve for
2 seconds until patient’s chest rises
 Bag-valve mask
Self-inflating bag
 One-way valve
 Face mask
 Oxygen reservoir

Must be connected to oxygen to perform
most effectively
 BVM Issues
Provides less volume than mouth-to-mask
 Single rescuer may have difficulty maintaining airtight seal
 Two rescuers using device are more effective
 Oral or nasal airway should be inserted

 BVM Technique (Two Rescuer)
 Have assistant squeeze bag with two hands
until chest rises
 Ventilate every 5 seconds for adults, every 3
seconds for infants and children
 BVM Technique (One Rescuer)
› Form a “C” around ventilation port with thumb,
index finger
› Use middle, ring, little fingers under jaw to
maintain chin lift, complete seal
› Squeeze bag with other hand until
chest rises
› Ventilate every 5 seconds for
adults, every 3 seconds for infants
and children
1.NPA useful in trismus, biting, clenched jaws or
maxillofacial injuries.
2.Used with caution in suspected fracture of skull base.
3.NPA is better tolerated than OPA in not deeply
unconscious patients.
4.Insertion damages nasal mucosa, resulting in bleeding.
5.It is too long to stimulate laryngeal
or glossopharyngeal reflexes,
laryngospasm, retching, or vomiting.
 Used on responsive patients who need help
keeping tongue out of airway
 Insertion is uncomfortable for responsive patients
 Unresponsive patients who are snoring
 Unresponsive patients with gag reflex
Technique
 Measure from tip of nose to earlobe
 Ensure airway will fit through nostril
 Lubricate with water-soluble lubricant
 Insert with bevel toward base of nostril or
septum
 If resistance is met, try other nostril
 Do not use in patients with mid-face trauma or
possible basilar skull fractures
 Measure from corner of mouth to earlobe or
angle of jaw
 Used on unresponsive, apneic patients
without gag reflex
 Helps hold tongue away from back of throat
 Any patient in deep coma who cannot protect his
airway.(Gag reflex absent.).
 Any patient in imminent danger of upper airway
obstruction (e.g. Burns of the upper airways).
 Any patient with decreased L.O.C, GCS <= 8.
 Severe head and facial injuries with compromised
airway.
 Any patient in respiratory arrest
 Respiratory failure
1. Hypoventilation/Hypercarbia - Paco2 >
55mmhg
2. Arterial hypoxemia refractory to O2 - Paco2 <
70 on 100% O2
Pre-intubation
1. Preoxygenation; Achieved by providing 3
minutes of high-flow oxygen till SaO2 >95%
2. If spontaneous ventilation is insufficient,
assist ventilation with a bag-mask device.
Richard Lake
April 2004
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Richard Lake
April 2004
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1. Provide ventilation
2. Keep airway patent
3. Permits suction of airway secretions
4. Ensures delivery of a high concentration of O2
5. Provides a route for administration drugs
(NAVEL)
6. Facilitates delivery of a selected tidal volume
7. Protects airway from aspiration
 Trauma of the teeth, cords, arytenoid
cartilages, larynx and related structures.
 Ventilation withheld for unacceptably
long period
 Delayed or withheld chest compressions
 Esophageal or bronchial intubation
 Failure to secure the tube
 Failure to recognize misplacement of
the tube
 Hypertension and tachycardia can occur
from the intense stimulation of intubation
 Transient cardiac arrhythmias related to
vagal stimulation or sympathetic nerve
traffic may occur
1.Inexperienced providers use airway
devices for which they are adequately
trained.
2.Tracheal intubation require either
frequent experience or frequent
retraining.
1. Cricoid pressure: protect regurgitation
and ensure placement in tracheal
orifice.
2. Pressure with thumb and index fingers.
3. Avoid overzealous pressure to occlude
airway and impair tracheal intubation.
4. Maintain cricoid pressure until cuff tube
is inflated.
5. The BURP (Backward, Upward,
Rightward Pressure) technique.
1. Assist with tracheal tube insertion by
providing stiffness to tube and by allowing
direction of tube to be controlled better
during manipulation.
2. Stylet not extend beyond the distal end of
tube.
1. Difficulties in intubation occur because inability to
bring vocal cords into view through the laryngoscope.
2. Visualization is by flexing neck and extending head at
atlanto-occipital joint ("sniffing position").
3. Once vocal cords are seen, tube is placed and cuff is
just beyond the cords.
4. Tube lying at a depth marked 19-23 cm at front teeth.
5. Cuff inflated with just enough air to occlude airway
(usually 10 mL) 25-35cmH2O
6. An adequate seal confirmed by listening at larynx. Air
is added to cuff just until audible air leak around tube
disappears.
 D-displacement
 O-obstruction
 P-pneumothorax
 E- equipment
1.Confirm placement by auscultating at epigastrium,
midaxillary and anterior chest line on the right and
left sides of the chest.
2.Secondary confirm placement with ET CO2 or
esophageal detector (Class IIa).
3.Clinical signs of proper tube placement (such as
condensation in the tube, auscultateion at lungs
and abdomen, and chest rise) are not always
reliable indicators.
1. It depends on ability to aspirate air from lower
airways through a tube in cartilage-supported
rigid trachea.
2. Air is not aspirated because esophagus
collapses when aspiration is attempted.
3. Misleading results
in obesity, pregnancy or
status asthmaticus or
copious tracheal secretions.
Presence of exhaled CO2 indicates proper tracheal
tube placement.
A lack of CO2 on detector means that the tube is in
the esophagus.
 Always have a suction unit available.
 An intubation attempt should never exceed 30
seconds.
 Oxygenate the patient pre and post
intubation with a bag-valve-mask.(100% O2).
 Have sedative medication available if needed.
(e.g. Midazolam 15mg/3ml)
 Always recheck tube placement manually
guided by oxygen saturation readings.(Spo2).
輕微呼吸症狀的病人 (SaO2 95-100%)
 最高提供氧氣濃度到44%
 流速每調高1L/min,病患吸入O2分壓可增加4%.
 氣流量不超過5L/min

 AMI – 4L/min
 COPD – 2L/min
 張口呼吸將氣流經口不而不
經鼻子
 用在 SaO2 90-95%
 提供氧氣濃度 35-60%
 流速是 6-10L/min
 氣流量不超過6L/min
 不建議流速 < 6L/min
昏迷
CO2 retension
 用於需提供高濃度氧氣的狀況(CO
intoxication or low SaO2)
氣流為單向,最高提供氧氣濃度到95-100%
 流速6L/min
氧氣濃度到60%
 每分鐘增加1L的流速
濃度增加 10%
 流速10-15L/min
氧氣濃度 95-100%

 提供固定氧氣濃度
COPD給予太高氧氣濃度
降低呼吸趨動力
 流速4-8L/min
氧氣濃度到24-40%
 流速10-12L/min
氧氣濃度 40-50%

 Latex-free, silicone
rubber tube
connected to an
elliptical mask with
an inflatable outer
rim
 Re-useable up to 40
times (Autoclave)
 Open the mouth and press
the tip of the cuff upward
against the palate and
flatten the cuff against it
 Use index finger to guide
LMA, pressing backwards
along the palate towards
ears until resistance is felt
 The tip now rests in the
hypopharynx
 Use other hand to press
down on LMA tube while
removing index finger
 Inflate with 2-4 ml air to
seal (60 cm H20 maximum)
 Don’t hold the tube while
inflating the balloon, it
moves outward a little as it
seats properly
April 2004
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Can you save a life
if you have to?