if the patient’s chest is not inflating during the breathing task you should check the
If the Patient’s Chest Is Not Inflating During the Breathing Task, You Should Check the Airway
Airway Obstruction:
The first step in addressing a situation where the patient’s chest is not inflating during a breathing task, such as Bag-Valve-Mask (BVM) ventilation or mechanical ventilation, is to ensure the patient’s airway is open and free from obstructions. This is a critical step in ensuring effective ventilation and oxygenation.
1. Signs of Obstruction
- Audible Sounds: Listen for any sounds like gurgling, stridor, or wheezing that might indicate an obstruction in the airway.
- Visual Inspection: Look inside the mouth and throat for visible obstructions such as food, vomit, blood, or foreign bodies.
- Palpation: Gently palpate the neck to ensure there is no swelling or rigid structures causing obstruction.
2. Head-Tilt, Chin-Lift Maneuver
To open the airway of a patient who doesn’t have a suspected spinal injury:
- Head-Tilt: Place one hand on the forehead and apply gentle backward pressure to tilt the head back.
- Chin-Lift: Use the fingers of your other hand to lift the patient’s chin upwards and away from the chest. This method helps to displace the tongue away from the back of the throat, clearing the airway.
3. Jaw-Thrust Maneuver
For patients with potential spinal injuries:
- Correct Positioning: Place your fingers behind the angle of the patient’s jaw on both sides.
- Forward Thrust: Push the jaw forward without tilting the head. This opens the airway while maintaining spinal stability.
Equipment Malfunction
Check Ventilation Equipment:
Ensure that the equipment used for ventilation, such as a bag-valve mask (BVM) or mechanical ventilation system, is working properly.
1. Bag-Valve Mask (BVM) Issues
- Mask Seal: Check that the mask fits snugly over the patient’s nose and mouth. A faulty seal can result in air escaping rather than filling the lungs.
- Valves and Connections: Examine the valves and connections to ensure that they are properly attached and functioning. Ensure the bag itself inflates and deflates smoothly.
- Obstructions in Tubing: Inspect the tubing for kinks or blockages, ensuring a clear path for air to flow from the bag to the patient’s lungs.
2. Mechanical Ventilation Check
- Correct Settings: Verify that the machine settings, such as tidal volume and ventilation rate, are appropriate for the patient’s needs.
- Alarm Checking: Pay attention to any alarms or alerts from the machine, which may indicate issues like disconnections or leaks.
- Circuit Check: Ensure the ventilator circuit is intact, and there are no disconnections or leaks that may interrupt airflow.
Position and Technique
Improper positioning or technique during the ventilation can also cause inadequate chest inflation.
1. Positioning the Patient
- Supine Position: Make sure the patient is lying flat on their back, allowing for optimal airway alignment.
- Head Elevation: Slightly elevate the head if needed, using a small pillow or folded cloth under the head to maintain an open airway.
2. Ventilation Technique
- Proper Hand Placement: Position your hands correctly on the bag or ventilator controls to ensure efficient delivery of breaths.
- Controlled Squeeze: Apply steady, even pressure to the bag when squeezing it, coordinating with the patient’s natural breathing rhythm if possible.
Review of Patient Conditions
Beyond technical issues and obstructions, certain medical conditions can affect chest inflation.
1. Pulmonary Conditions
- Asthma/Bronchospasm: Tightening of airways due to asthma or bronchospasm can hinder proper lung inflation. Administer bronchodilators as necessary.
- Pneumothorax: Collapsed lung due to air in the chest cavity could prevent chest rise. This condition needs immediate medical attention.
- Atelectasis: Ensure lungs have not collapsed due to obstruction or poor inhalation technique.
2. Other Conditions
- Obesity or Increased Body Mass: May require additional adjustments or positioning to ensure effective ventilation.
- Chest Wall Rigidity or Injury: Conditions like broken ribs or muscular rigidity can impede chest movement. Ensure comfort and manage pain to facilitate breathing.
- Fluid Accumulation: Check for signs of fluid in the lungs or chest cavity that may inhibit lung expansion.
Reassess and Monitor Continuously
Ongoing Assessment:
After checking and addressing potential causes of poor chest inflation, continue to monitor the patient closely.
1. Vital Signs
- Respiratory Rate and Effort: Keep track of the breathing rate and the amount of effort the patient needs to breathe.
- Pulse Oximetry: Use a pulse oximeter to ensure that the oxygen saturation levels are within normal range, showing effective breathing.
- Cardiac Monitoring: Consider ECG monitoring to assess cardiac function, which may contribute to ventilation issues.
2. Patient Feedback
- Conscious Patient Communication: Ask the patient to describe any sensations of breathlessness, difficulty, or pain that may indicate other underlying issues.
3. Regular Reassessment
- Frequent Checks: Continue to check the equipment, patient condition, and airway patency regularly.
- Team Assistance: Engage additional clinical staff if needed to assist with ventilation or address complications.
In summary, ensuring the patient’s chest inflates appropriately during breathing tasks involves a comprehensive approach: confirming the airway is open, equipment is functioning properly, and patient-specific factors are considered. Continuous monitoring, adjustment, and assessment are crucial in obtaining desired ventilation outcomes. Keep practicing effective ventilation techniques, and remember that persistence and thoroughness can significantly impact patient care outcomes.