Confirmation by auscultation for bilateral breath sounds and chest raise, absence of sounds over epigastrium on
manual ventilation, ETCO2 and colour of the patient.
Dr Denise Gomez, who was with the air ambulance crew, said she noticed a line in an oxygen cylinder was not switched on, but the inquiry heard Mr Larkin was already receiving
manual ventilation and it would have made no difference.
Rapid sequence induction was performed using IV midazolam 0.2 mg (0.02 mg/kg) and suxamethonium 20 mg (1.7 mg/kg); he improved with
manual ventilation with a self-inflating bag and 40% oxygen.
On
manual ventilation, there was resistance to ventilate.
One explanation is that
manual ventilation during winter is less frequent and done for shorter periods of time.
Resultantly the trachea was mobilized to a distance of 1.5 cm all around to allow the insertion of a rigid bronchoscope size 6 while keeping the patient on
manual ventilation and foreign body removed with difficulty using grasping forceps.
Manual ventilation with a manual resuscitator should always be available in the event the ventilator suffers a mechanical failure, and at any time during the transport it should be possible to switch immediately from mechanical ventilation to
manual ventilation through a mask or, if necessary, an endotracheal tube.
We performed
manual ventilation, the P[sub]ET CO[sub]2 decreased, and a small elevation in airway pressure was perceived.
During
manual ventilation decreased resistance was noted and TVs were as low as 42 ml, PIPs were as low as 11 cm [H.sub.2]O, and AP mean was as low as 7 cm [H.sub.2]O.
Inspired oxygen was increased to 100% and
manual ventilation was started.
An adult rebreathing circuit was connected and
manual ventilation was initiated immediately at a rate of 4-6 respirations per minute and peak inspiratory pressure of approximately 20 cm [H.sub.2]O.