Page 44 - PJ MED OPS Handbook 8th Ed

Breathing
Methods of Delivery:
• Nasal Cannula (NC): Flow rates from 1–6 LPM delivering between 24–44 percent oxygen
• Simple Face Mask (NRB without reservoir): Flow rates from 8–12 LPM delivering between
40–60 percent oxygen

NOTE: To avoid the accumulation of expired CO2, no fewer than 6 LPM should be delivered
through the SFM. A flow rate of 6–8 LPM is generally acceptable for pediatrics.

• Non-Rebreather (NRB) mask with reservoir: Flow rates from 10–15 LPM delivering between
80–100% oxygen

NOTE: To avoid the accumulation of expired CO2, no fewer than 8 LPM should be delivered
through the NRB.

• Bag valve mask (BVM) with reservoir: Flow rates from 10–15 LPM delivering between 60–
100 percent oxygen

PJ PEARLS:
• A pediatric BVM may be used on an adult, if available, as it provides acceptable tidal
volumes.
• The technique of BVM is one of the most basic and important skills to have.
• Ensure proper seal is made by using the “EC-clamp” technique.
• Deliver one breath every 6 seconds. This is best achieved by counting in your head “one
one-thousand, two one-thousand,” etc. and executing the next bag on the six one thou-
sand count.
• Only squeeze the bag partially with one hand enough to see chest rise and fall.
• Utilize the capnometer and pulse oximeter to further guide rate and volume, especially if
used for prolonged periods.

Needle Decompression (ND, or needle thoracentesis)

Indications:
• Symptomatic pneumothorax (MOI + respiratory distress)
• Tension pneumothorax (MOI + respiratory distress + shock)
• Bilateral needle decompression for patient with absent vital signs prior to declaring VSA

Signs/Symptoms in a patient with chest trauma:
• Respiratory distress
• Unexplained hypotension in trauma patient
• Unilateral absence of breath sounds
• Hypertympanic percussion over affected side
• Vital signs absent and pending cessation of care/CPR

42 n Pararescue Medical Operations Handbook / 8th Edition