Difference between revisions of "Bag valve mask ventilation"

(Text replacement - "OPA" to "OPA")
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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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==Procedure==
 
==Procedure==
 +
[[File:PMC5062193 AER-10-643-g001.png|thumb|EC technique with modified chin lift.]]
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[[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 can smear lube to help create better seal
+
**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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==External Links==
 
==External Links==
 +
 +
===Videos===
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*Medscape (1:33) https://www.youtube.com/watch?v=zUGw90iL0Qw
 +
*For Covid19
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**WakeMed (1:22) https://www.youtube.com/watch?v=JT4RC1TsTPo
  
 
==References==
 
==References==
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[[Category:Procedures]]
 
[[Category:Procedures]]
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[[Category:Critical Care]]
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[[Category:EMS]]

Latest revision as of 17:55, 18 February 2021

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

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

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.