Colors For CPR with an Advanced Airway

Summary of Colors

The SmartMan colors are easy to understand. The real time feedback produces the colored bars each time you do something on the manikin. You always aim to produce bright green bars. As the colors move from left to right (from bright green to red) it is worse for the patient.

QUICK REVIEW

On Airway SmartMan you can practice CPR when you have established an advanced airway. The colors and what they mean are the same as indicated in the section on chest compression and ventilations. When you perform CPR on SmartMan, the screen will show both the bars for the chest compressions and the bars for inspirations.

With an advanced airway in place, you perform continuous chest compressions for 2 minutes and a second person performs ventilations every six seconds or about every 10th compression.
Another way to say that is:

200 Continuous Chest Compression
1 ventilation every 10 compressions

The person performing the compressions does not stop or slow down for the ventilation. However that person does help the other person by counting out loud and performing compressions at the correct rate and depth.
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The person performing the ventilations must perform the ventilation so that the air goes into the lungs on the release of the chest. This means only a 0.3 second window is available. (Work out the maths: Compression at a rate of 100 per minute = 0.6 of a second for each compressions. Half down and half up leaves us with 0.3 seconds for the chest recoil.)

In order to master this skill, you need to know whether you started pushing air into the lungs before the chest started to rise (too early), whether you started to push the air into the lungs after the chest started to rise and thus giving yourself much less time (too late) or you gave the breath just right.

You also need to know the volume of air that actually made it into the lungs.

SmartMan will provide all of this information to you in colors. Information related to the ventilation is shown in the bottom part of the display; information related to chest compressions is in the top part of the active display.

COLORS FOR COMPRESSIONS. Please go to the section on chest compressions color detail.

COLORS FOR VENTILATIONS. Please go to the section on ventilation color detail.

TIMING OF VENTILATIONS

VENTILATION Timed Correctly: Ventilation bars will be the same as in all other SmartMan ventilation displays. Bright green for correct inspiration rate and correct volume.

VENTILATION Timed Incorrectly: With airway management and continuous chest compressions, the requirement on the person performing ventilations is much greater. To be able to provide the ventilation when the chest is rising, you must receive feedback and develop a strategy to time the ventilation correctly. SmartMan gives you the feedback so you know if you have started too soon or too late in relation to when the chest starts to rise.

TIMING VENTILATIONS WITH RISE OF CHEST

*Too Early*. If you started to press the BVM BEFORE the chest reached its deepest part, then an orange bar will show to the left of the hollowed out bar. See right as an example.
*Too Late*. If you started to press the BVM AFTER the chest reached its deepest part, then a red bar will show to the right of the hollowed out bar. See example to the right.
*Correct Timing.* If you began to provide air as the chest started to rise, there will be no bar on either side of the main vertical bar and the bar will be solid.

Even if you begin squeezing the BVM too early or you end too late, you may still have put air into the lungs. This is not optimal for the patient as it creates intra-thoracic pressure and can lead to difficulties for a victim. Thus the colored bar will be hollowed out. The color will still represent the volume and rate of inspiration. Thus a hollowed out bar lets you now that the air that went into the lungs was not optimal.

The combinations of too early and too late combine with the variations in inspiration volume and inspiration rate. These are shown below.

Timing Correct; Volume correct; Rate of Inspiration correct;	Timing too early Volume correct; Rate of Inspiration correct	Timing too late Volume correct Rate of Inspiration correct
Timing Correct Volume correct; Rate of Inspiration too fast	Timing too early Volume correct; Rate of Inspiration too fast	Timing too late Volume correct; Rate of Inspiration too fast
Timing Correct Volume incorrect; Rate of Inspiration correct	Timing too early Volume incorrect Rate of Inspiration correct	Timing too late Volume incorrect Rate of Inspiration correct
Timing Correct Volume correct; Rate of Inspiration too slow	Timing too early Volume correct Rate of Inspiration too slow	Timing too late Volume correct Rate of Inspiration too slow

A SCREEN EXAMPLE FOR VENTILATION TIMING WITH CHEST RISE
At the end of the cycle, the screen will provide an exact timing of the ventilation in hundredths of a second. This is the exact time in relation to when the air began to go into the lungs and the chest started to rise. The ideal is 0.00 seconds. This is indicated by the top number.

For example, if the top number is -.1, then the ventilation started too early; 1/10th of a second is 33% too early because the chest will only take 1/3 of a second to rise. If the number indicates .1 of a second then the ventilation started too late. 1/10th of a second is 33% too late.

Example from ALS

Close Up of a section

With this close up, it is easier to see the numbers.

Airway close up

The bottom number indicates the duration of the breath. The ideal duration for an inspiration is .3 of a second (the time it takes for the chest to recoil).

Links to More information on SmartMan Colors:

SmartMan Colors Summary
Color Detail for Compressions
(For 30:2 and Continuous Compressions)
Color Detail for Ventilations
(For Rescue Breathing and Ventilations delivered during CPR)
Color Detail for CPR
(For both 1 and 2 person CPR)

Quick Links

Colors For CPR with an Advanced Airway