Bag valve mask ventilation: Difference between revisions
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==Overview== | ==Overview== | ||
[[File:F4.png|thumb|Oral cavity and oropharynx.]] | |||
[[File:F6.png|thumb|Sagittal section through the head and neck showing the subdivisions of the pharynx.]] | |||
*Simple, life-saving skill that is critical in airway management | *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 | *Deliver oxygen at positive pressure via a bag containing oxygen connected to a mask placed over a patient's nose and mouth | ||
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==Indications== | ==Indications== | ||
*Respiratory failure | *[[Respiratory failure]] | ||
*Pre-oxygenation | *Pre-oxygenation | ||
*Emergent need to oxygenate/ventilate | *Emergent need to oxygenate/ventilate | ||
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*Mask connected to the bag | *Mask connected to the bag | ||
*Consider PEEP valve (provides PEEP between ventilations) | *Consider PEEP valve (provides PEEP between ventilations) | ||
*OPA/NPA/adjuncts to facilitate successful BVM ventilation | *[[OPA]]/NPA/adjuncts to facilitate successful BVM ventilation | ||
*Suction | *Suction | ||
*SpO2 monitor helpful | *SpO2 monitor helpful | ||
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==Procedure== | ==Procedure== | ||
[[File:PMC5062193 AER-10-643-g001.png|thumb|EC technique with modified chin lift.]] | |||
[[File:PMC5062193 AER-10-643-g003.png|thumb|EC technique with modified chin lift.]] | |||
[[File:PMC5304096 jcvtr-8-147-g001.png|thumb|Two-handed technique.]] | |||
==="EC" Hand Position=== | ==="EC" Hand Position=== | ||
*Thumb and index finger holding mask in a "C" position | *Thumb and index finger holding mask in a "C" position | ||
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*Other hand used to bag | *Other hand used to bag | ||
===2-person=== | ===2-person=== | ||
*This technique provides an objectively better seal than the "EC" hand position<ref>[pubmed.ncbi.nlm.nih.gov/20808210/] Joffe AM;Hetzel S;Liew. “A Two-Handed Jaw-Thrust Technique Is Superior to the One-Handed ‘EC-Clamp’ Technique for Mask Ventilation in the Apneic Unconscious Person.” Anesthesiology, U.S. National Library of Medicine, Oct. 2010. </ref> | |||
*One person holds the mask with both hands (lateral edges) | *One person holds the mask with both hands (lateral edges) | ||
*2nd person bags | **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=== | ===Rate=== | ||
*Adult bag at 10-12/min | *Adult bag at 10-12/min | ||
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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 | ||
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*Poor seal | *Poor seal | ||
**Remove dentures to intubate; keep them in to bag/mask ventilate | **Remove dentures to intubate; keep them in to bag/mask ventilate | ||
**For a beard | **For a beard smear lube to help create better seal or cut the center out of a tegaderm and apply to the patient's perioral area | ||
*Poor oxygenation/ventilation | *Poor oxygenation/ventilation | ||
**Readjust head-tilt-chin-lift or jaw thrust | **Readjust head-tilt-chin-lift or jaw thrust | ||
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*[[Intubation]] | *[[Intubation]] | ||
*[[Oropharyngeal airway]] | *[[Oropharyngeal airway]] | ||
{{Related Difficult Airway Pages}} | |||
==External Links== | ==External Links== | ||
===Videos=== | |||
*Medscape (1:33) https://www.youtube.com/watch?v=zUGw90iL0Qw | |||
*For Covid19 | |||
**WakeMed (1:22) https://www.youtube.com/watch?v=JT4RC1TsTPo | |||
==References== | ==References== | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] | |||
[[Category:EMS]] | |||
Latest revision as of 20:32, 17 April 2024
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
- This technique provides an objectively better seal than the "EC" hand position[1]
- 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 smear lube to help create better seal or cut the center out of a tegaderm and apply to the patient's perioral area
- Poor oxygenation/ventilation
- Readjust head-tilt-chin-lift or jaw thrust
- Utilize oropharyngeal airway/nasopharyngeal airway
- Overinflation of the stomach causing emesis/aspiration
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
External Links
Videos
- Medscape (1:33) https://www.youtube.com/watch?v=zUGw90iL0Qw
- For Covid19
- WakeMed (1:22) https://www.youtube.com/watch?v=JT4RC1TsTPo
References
- ↑ [pubmed.ncbi.nlm.nih.gov/20808210/] Joffe AM;Hetzel S;Liew. “A Two-Handed Jaw-Thrust Technique Is Superior to the One-Handed ‘EC-Clamp’ Technique for Mask Ventilation in the Apneic Unconscious Person.” Anesthesiology, U.S. National Library of Medicine, Oct. 2010.