Bag valve mask ventilation: Difference between revisions
 
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==Overview==
==Overview==
*simple, life-saving skill that is critical in airway management
[[File:F4.png|thumb|Oral cavity and oropharynx.]]
*deliver oxygen at positive pressure via a bag containing oxygen connected to a mask placed over a patient's nose and mouth
[[File:F6.png|thumb|Sagittal section through the head and neck showing the subdivisions of the pharynx.]]
*oxygenation and ventilation prior to definitive airway placement
*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==
==Indications==
*respiratory failure
*[[Respiratory failure]]
*pre-oxygenation
*Pre-oxygenation
*emergent need to oxygenate/ventilate
*Emergent need to oxygenate/ventilate


==Contraindications==
==Contraindications==
No absolute contraindications
{{Difficult BVM}}
{{Difficult BVM}}


==Equipment Needed==
==Equipment Needed==
*Bag connected to oxygen at 15L/min
*Bag connected to oxygen at 15L/min
*mask connected to the bag
*Mask connected to the bag
*consider PEEP valve  
*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
====Children====
====Children====
*proper-sized mask (covers nose and chin)
*Proper-sized mask (covers nose and chin)
*proper bag (enough to see chest rise)
*Proper bag (enough to see chest rise)


==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
**thumb superior and index inferior
**Thumb superior and index inferior
*3rd, 4th, 5th finger hold the mandible and perform a jaw thrust  
*3rd, 4th, 5th finger hold the mandible and perform a jaw thrust  
*other hand used to bag
*Other hand used to bag
===2-person===
===2-person===
*one person holds the mask with both hands (lateral edges)
*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>
*2nd person bags  
*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===
===Rate===
*adult bag at 10-12/min  
*Adult bag at 10-12/min  
*children 16-20/min
*Children 16-20/min
*infants 30/min
*Infants 30/min
*Neonates 40-60/min
 
===Tidal Volume===
===Tidal Volume===
*avoid hyperinflation
*Avoid hyperinflation
*bag until chest rise is seen
**Average bag volume is approximately 1600 cc; only necessary to delivery approximately 500 cc
*Bag until chest rise is seen


==Complications==
==Complications==
*poor seal
*Poor seal
*poor oxygenation/ventilation
**Remove dentures to intubate; keep them in to bag/mask ventilate
*overinflation of the stomach causing emesis/aspiration
**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==
==See Also==
*[[Intubation]]
*[[Intubation]]
*[[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

Oral cavity and oropharynx.
Sagittal section through the head and neck showing the subdivisions of the pharynx.
  • 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

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 technique with modified chin lift.
EC technique with modified chin lift.
Two-handed technique.

"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
  • Overinflation of the stomach causing emesis/aspiration

See Also

Airway Pages

External Links

Videos

References

  1. ↑ [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.
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