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
- Practice Pearls
- Videos
- Anatomy review
- Drugs review
- Further reading