Airway and respiratory

[tniuqs]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137227/

[rock_shoes]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137227/

Excellent find Squint. Reading this article would be time well spent for everyone who uses a pulse oximeter as part of their patient assessment.

[armymedic571]

Be careful here; ventilation and oxygenation are not the same thing, a patient can be barely breathing but adequately oxygenated or breathing fine and inadequately oxygenated. The two are very different physiologic processess which most ambo's never pick up on.

If the patient is inadequately oxygenated then its appropriate to use a bag mask however do so at a slow rate; the good old ambo trick of "more is better" is not going to help you.

A cautionary note that there is nothing "magic" about oxygen and it is often given to patients who do not require it or in quantities above what is required. 2-4 litres on a nasal cannula will do for 90% of patients who actually require oxygen.

Should the breathing become adequate then stop bagging them, there's no point in continuing to do something they can do themselves

Do you SEE any evidence of head or spinal trauma? Although it is wise to state the absense of evidence does not indicate evidence of absense I would use a head tilt, chin lift. Most cardiac arrests are primary arrests which are cardiac in origin, traumatic arrests well, there should be some evidence of trauma.

Why are you inserting an NPA if the patient has a gag reflex?

History of COPD is most likely a red herring designed to make you withold oxygen.

Suction the airway and go from there; my guess is the old boy is going to require a lot of suctioning. I'd put him on a non-rebreather mask and see how that works, it may be entirely appropriate to just use that if he is getting good air exchange.

Great point on oxygenation vs ventilation. That is somethig that seems to be over looked in most programs.

I do have a quesiton for you though. Why not insert an NPA? (if indicated of course) A nasal pharygeal airway would be more suited for a patient with an intact gag reflex.