Of all the fundamental skills employed by EMS, few are more crucial than the ability to ventilate a patient. Provided there is adequate gas exchange at the alveolar level and adequate circulation to the tissues, artificial ventilation via the BVM in the hands of a skilled practitioner can keep a patient alive indefinitely. Performed incorrectly, however, BVM ventilation can accelerate hypoxia and exacerbate the airway obstruction that naturally occurs during profoundly depressed levels of consciousness.
This can result in serious injury or death. A properly sized mask should cover the nares and mouth without gaps. Recognize the need to ventilate a patient, and do so immediately. Hypoventilation occurs when the rate of spontaneous ventilations falls below 8 per minute or when the tidal volume falls below approximately cc per breath. In either case, assisted ventilations become necessary. Although apnea or hypoventilation may be corrected when the cause is reversed e.
Position the patient, position the airway and maintain the proper airway position. Lay the patient supine. In any circumstance, adequate space must be available for rescuers to move freely and comfortably around the patient, including enough area at the head for a rescuer to kneel or stand. Three or four fingers from each of the rescuers hands should be placed behind or on the angle of the jaw, and the jaw should be firmly thrust straight forward, pushing the chin toward the ceiling or sky.
This will lift the posterior aspect of the tongue off the back of the oropharynx, thereby creating an open airway. Maintain this position throughout the duration of the resuscitation effort.
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This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information. If your hand is large enough, place your little finger behind the mandibular ramus to do a jaw-thrust maneuver How To Do Head Tilt—Chin Lift and Jaw-Thrust Maneuvers Part of pre-intubation and emergency rescue breathing procedures, the head tilt—chin lift maneuver and the jaw-thrust maneuver are 2 noninvasive, manual means to help restore upper airway patency If using a mL volume bag, squeeze only halfway to obtain the correct tidal volume.
In cardiac arrest cases, do not exceed 8 to 10 breaths per minute ie, one complete breath every 6 to 7. Observe for proper chest rise during ventilations; in practice, you can use a tidal volume just large enough to cause the chest to rise.
Monitor the patient, checking breath sounds and, if possible, end-tidal carbon dioxide and pulse oximeter. Pulse oximetry may not be useful during cardiac arrest due to poor peripheral perfusion.
Assess if adequate ventilation is continuous and sustainable or is requiring too much physical effort. If available, use waveform capnography, an excellent indicator of mask seal and proper ventilation. Set the PEEP valve initially at 5 and increase as needed to improve oxygen saturation. However, avoid PEEP in hypotensive patients.
If ventilation or oxygenation is still not adequate, prepare for other airway maneuvers such as a supraglottic airway or endotracheal intubation. Continue bag-valve-mask BVM ventilation until either a definitive artificial airway eg, endotracheal tube is achieved or spontaneous ventilation is adequate eg, following naloxone administration for an opioid overdose.
If a patient becomes more conscious or a gag reflex returns while doing BVM ventilation with an oropharyngeal airway in place, remove the oropharyngeal airway and provide continued treatment as appropriate.
A nasopharyngeal airway may be better tolerated. If endotracheal intubation is necessary, ventilate using maximum FiO2 through a non-rebreather mask for 3 to 5 minutes before inserting the tube if feasible; if this is not feasible because intubation must proceed immediately, pre-oxygenate the patient by giving 5 to 8 vital capacity breaths using a PEEP valve. Doing so may damage the eyes or cause a vagal reaction. Neither excessive force nor rapid insufflation should be used to ventilate; doing so increases gastric distention, compromising ventilation.
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Test your knowledge. Prior to beginning tracheal intubation, it is important to first correctly position the patient, prepare the medical equipment, and do which of the following additional actions? More Content.
Click here for Patient Education. Successful BVM ventilation requires technical competence and depends on 4 things:.
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