Bag valve mask ventilation: Difference between revisions
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===2-person=== | ===2-person=== | ||
*One person holds the mask with both hands (lateral edges) | *One person holds the mask with both hands (lateral edges) | ||
**With double | **With double EC technique, index fingers and thumbs of both hands form C over mask and digits 3-5 lift the jaw at the rami of mandible | ||
**Can also press thumbs and thenar eminences over lateral edges of mask and use digits 2-5 to lift jaw at the rami of the mandible | **Can also press thumbs and thenar eminences over lateral edges of mask and use digits 2-5 to lift jaw at the rami of the mandible | ||
**Important to life jaw into mask and not press mask down into jaw; can occlude the airway and cause difficulty with ventilation | **Important to life jaw into mask and not press mask down into jaw; can occlude the airway and cause difficulty with ventilation | ||
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*Infants 30/min | *Infants 30/min | ||
*Neonates 40-60/min | *Neonates 40-60/min | ||
===Tidal Volume=== | ===Tidal Volume=== | ||
*Avoid hyperinflation | *Avoid hyperinflation | ||
**Average bag volume is approximately 1600 cc; only necessary to delivery approximately 500 cc | |||
*Bag until chest rise is seen | *Bag until chest rise is seen | ||
Revision as of 23:17, 25 November 2020
Overview
- Simple, life-saving skill that is critical in airway management
- Deliver oxygen at positive pressure via a bag containing oxygen connected to a mask placed over a patient's nose and mouth
- Oxygenation and ventilation prior to definitive airway placement or bridge to sedative metabolization
Indications
- Respiratory failure
- Pre-oxygenation
- Emergent need to oxygenate/ventilate
Contraindications
No absolute contraindications
Difficult BVM (MOANS)
- Mask seal
- Obesity
- Aged
- No teeth
- Stiffness (resistance to ventilation)
Equipment Needed
- Bag connected to oxygen at 15L/min
- Mask connected to the bag
- Consider PEEP valve (provides PEEP between ventilations)
- OPA/NPA/adjuncts to facilitate successful BVM ventilation
- Suction
- SpO2 monitor helpful
Children
- Proper-sized mask (covers nose and chin)
- Proper bag (enough to see chest rise)
Procedure
"EC" Hand Position
- Thumb and index finger holding mask in a "C" position
- Thumb superior and index inferior
- 3rd, 4th, 5th finger hold the mandible and perform a jaw thrust
- Other hand used to bag
2-person
- One person holds the mask with both hands (lateral edges)
- With double EC technique, index fingers and thumbs of both hands form C over mask and digits 3-5 lift the jaw at the rami of mandible
- Can also press thumbs and thenar eminences over lateral edges of mask and use digits 2-5 to lift jaw at the rami of the mandible
- Important to life jaw into mask and not press mask down into jaw; can occlude the airway and cause difficulty with ventilation
- 2nd person bags
Rate
- Adult bag at 10-12/min
- Children 16-20/min
- Infants 30/min
- Neonates 40-60/min
Tidal Volume
- Avoid hyperinflation
- Average bag volume is approximately 1600 cc; only necessary to delivery approximately 500 cc
- Bag until chest rise is seen
Complications
- Poor seal
- Remove dentures to intubate; keep them in to bag/mask ventilate
- For a beard can smear lube to help create better seal
- Poor oxygenation/ventilation
- Readjust head-tilt-chin-lift or jaw thrust
- Utilize oropharyngeal airway/nasopharyngeal airway
- Overinflation of the stomach causing emesis/aspiration