New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation 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 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 cc to produce chest rise – Sellick’s maneuver Pressing cricoid cartilage posteriorly – May impair ventilation and distort visualization

Opening the Airway

1 Hand Mask Hold

2 Handed Technique

Airway Adjuncts

Peter DeBlieux, M.D. LSU Emergency Medicine Manual of Emergency Airway Management, 3 rd Edition. Walls, R. and Murphy, M