Safety First: Basic Breathing

 


Study Notes:

  1. 1. Are they breathing?

  2. 2.How good is it?

  3. 3. If absent or inadequate breathing, use BVM with oxygen to make the patient breath

  4. 4. If breathing is present and adequate, administer oxygen and move on to circulation

“Primary Breathing”

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“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

“In with the good air ...”

The primary B directs to assess and treat your patients breathing.

Again, you’re going to use the ‘look, listen and feel’ method. Bend down and put your head over their face. Look at their chest, listen to their mouth, and feel for their breath on your cheek for at least ten seconds. If they are breathing spontaneously, and adequately (good deep breaths at at least 10-12 per minute) then administer oxygen and move on.

Now pardon my rant here, but it always boggles my mind how stingy health care providers are with oxygen.

When I get a headache and I'm at work I'll often hop in the back of the ambulance, lie down on the stretcher, and put on a non-rebreather oxygen mask. As a (relatively) healthy young guy, lying still on a bed, I still find I get short of breath with anything less than a 10 litre flow in a non-rebreather mask. So why, oh why, would we put a non-rebreather on someone who is blue and gasping and then set it to 4 litres a minute?

Here's a street medic rule for you - if you put oxygen on someone who is sick ALWAYS put on a non-rebreather (not nasal cannulas!); AND, if you put on a non-rebreather, always put it to 15 litres until their SpO2 hits 100%.

If it doesn't hit 100%, leave it at 15. They can always turn it down in the ICU later. Remember, you've got hours until oxygen toxicity sets in, so DON'T BE CHEAP! Give'm the good stuff, and give'm lot's of it.  Once their sats come up to the high ninety's you can start to reduce the amount of oxygen slowly, making sure to keep their sats above 95.

If they are not breathing spontaneously, or adequately, then you need to breathe for them. Get your bag-valve-mask (BVM) out and start to ventilate them with a 100% O2 at 15 litres per minute (don't be cheap!!) until you get their SpO2 back up to at least into the 90's (preferably above 95).  Don’t forget your oral or nasopharyngeal airways, and (if you can) consider intubation ASAP.

Now you’re ready to work on ...