New Orleans EMS Airway Lecture Series: Lecture 2Oxygenation and Bag-Mask Ventilation
Jeffrey M. Elder, M.D.Deputy Medical Director
You Must Become and Expert!
100% Nonrebreather??
• What is the Fi02 that this device will deliver to your patient?
• Approaches 70%
• A tight fitting BVM in a spontaneously breathing patient will deliver close to 100% Fi02
Patients that Desaturate
• Extremes of Age – young and old
• Co-Morbid patients – CHF, COPD, DM, Chronic illness
• Pregnancy
• Morbid Obesity
Desaturation after paralysis
Successful BMV
• Depends on 3 things– A patent airway– Adequate mask seal• Too large a mask better than too small
– Proper ventilation
What type of mask to you have?
• Duck Bill inspiratory valve– Permits constant one way flow of oxygen
• One way expiratory valve– Prevents entrainment of room air/accumulation of
carbon dioxide
• Improves oxygenation and Fi02 can approach 97%
Goals of using the BVM
• BVM seal only if saturations < 100% with NRB
• 100% BVM bagging if saturations less than 90% or failure with BVM seal
Bagging the Patient
• Insufflates and distends the stomach increasing the risk of emesis and aspiration
• If performed – Use 1 hand
• If spontaneously breathing, use a mask seal technique
Ventilation
• Standard BVM = 1500cc of oxygen– Delivering the entire volume will insufflate the
stomach
• Goal = Deliver 10-12 reduced tidal breaths (500cc) per minute without insufflating the stomach
• Use 1 Handed Technique
Ventilation
• High Airway pressure from:– Short inspiratory time– Large tidal volumes– Incomplete airway opening– Increased airway resistance– Decreased compliance
Ventilation
• Minimizing Gastric Inflation:– Deliver each breath over 1 second– Tidal volume 500-600cc to produce chest rise– Sellick’s maneuver• Pressing cricoid cartilage posteriorly
– May impair ventilation and distort visualization
Opening the Airway
Opening the Airway
1 Hand Mask Hold
2 Handed Technique
Airway Adjuncts
• Peter DeBlieux, M.D. LSU Emergency Medicine
• Manual of Emergency Airway Management, 3rd Edition. Walls, R. and Murphy, M. 2008.