Bag Mask Ventilation

Purpose (Description)

Indication

  • administration of high flow O2
  • provision of PEEP
  • provision of controlled ventilation
  • provision of augmentation of spontaneous ventilation

Contra-indication

Complications / Alerts

  • Complications
    • gastric distension
    • aspiration
    • claustrophobia
    • exhaled secretions and moisture can result in exhalation valve dysfunction and increased resistance to expiration
    • risk of barotrauma if pop off valve close as unable to feel lung compliance with self-inflating bags
    • if high free gas flows are not used high FiO2 will not be achieved
  • Pitfalls
  • Alerts
    • BMI > 30
    • presence of a beard
    • Mallampati score of three or four
    • age of 57+
    • severely limited jaw protrusion
    • snoring

Preparation

  • Permission (Consent) [PRINTOUT]
  • Place
  • Personel
  • Positioning
    • External auditory meatus to level of sternal notch
    • Head tilt / chin lift (beware C-spine injury possibility)
    • Jaw thrust
  • Equipment needed [PRINTOUT]
    • a pulse oximeter
    • oxygen source
    • bag-valve mask device
    • cushioned rim mask with variable sizes
    • nasopharyngeal and oropharyngeal airways
    • tongue blade
    • water-based lubricant
    • Yankauer suction with vacuum power source
    • Drugs

Procedure

  • Pain control (Analgesia & Sedation)
  • Prep
  • Process
    • High flow oxygen (e.g. 12–15 L/min) is attached to the system and it is attached to a mask or tube
    • appropriate mask size
    • place over mouth and nose
    • tight fit
    • open airway using two handed thumbs down technique (with an assistant bagging) in preference to the less effective one-handed C-E grip (best if OPA and NPAs in situ too)
    • the bag is used to deliver oxygen to a spontaneously breathing patient or the bag compressed to manually ventilate them via a mask or tube
  • Remember JAWS:

    • Jaw thrust
    • Airways (oral/nasal)
    • Work together
    • Slow, small squeeze — 6-7 cc/kg, over 1-2 seconds, at <12/min, using low pressure.
  • Problems?

Post Procedure Care

  • Documentation

Past the Basics

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