Oxygen can be added by hooking the valve up to anoxygen supply. Since the rescuer’s breath dilutes theoxygen flow in artificial ventilation, adjust the flowrate to increase oxygen concentration. At 5 liters perm i n u t e , t h e o x y g e n c o n c e n t r a t i o n w i l l b eapproximately 50 percent. At 15 liters per minute, thisconcentration will increase to 55 percent.The mask has an elastic strap so it can be used onconscious, self-ventilating patients to increase oxygenconcentration.SUCTION DEVICESThe patient’s airway must be kept clear of foreignmaterials, blood, vomitus, and other secretions.Materials that remain in the airway may be forced intothe trachea and eventually into the lungs. This willcause complications ranging from severe pneumoniato a complete airway obstruction. Use suction toremove such materials.In the field, a Hospital Corpsman may have accessto a fixed (installed) suction unit or a portable suctiondevice. Both types of suction devices are equippedwith flexible tubing, suction tips and catheters, and anon-breakable collection container.Maintenance of suction devices consists of testingthe suction pressure regularly and cleaning the deviceafter each use.Before using a suction device, always test theapparatus. Once the suction pressure has been tested,attach a suction catheter or tip. Position the patient onhis side, and open the patient’s mouth. This positionpermits secretions to flow from the patient’s mouthwhile suction is being delivered. Use caution inpatients with suspected neck or spinal injuries. If thepatient is fully and securely immobilized on abackboard, the backboard may be tilted to place thepatient on his side. If you suspect such injuries but thepatient is not immobilized, suction as best you canwithout turning the patient. Carefully insert the suctiontip or catheter at the top of the throat (fig. 4-25). DONOT push the tip down into the throat or into thelarynx. Apply suction, but for no more than a fewseconds, since supplemental oxygen or ventilationscease while suctioning, keeping oxygen from thepatient. Suction may be repeated after a few breaths.CRICOTHYROIDOTOMYA cricothyroidotomy, often called an emergencytracheotomy, consists of incising the cricothyroidmembrane, which lies just beneath the skin betweenthe thyroid cartilage and the cricoid cartilage. In mostcases, the cricothyroid membrane can be easily locatedby hyperextending the neck so that the thyroid notch(Adam’s apple) becomes prominent anteriorly.Identify the position of the thyroid notch with the indexfinger. This finger descends in the midline to theprominence of the cricoid cartilage. The depression ofthe cricothyroid membrane is identified above thesuperior margin of the cricoid cartilage (fig. 4-26).Make a small lateral incision at the base of the thyroidcartilage to expose the cricothyroid membrane. Excisethis membrane (taking care not to go too deeply) andinsert a small-bore air line into the trachea.4-28Figure 4-25.—Proper insertion of suction tip.Figure 4-26.—Anatomical structures of the neck to identifythe cricothyroid membrane.
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