1. New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation and Bag-Mask Ventilation Jeffrey M. Elder, M.D. Deputy Medical Director

2. You Must Become and Expert!

3. 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

4. Patients that Desaturate Extremes of Age – young and old Co-Morbid patients – CHF, COPD, DM, Chronic illness Pregnancy Morbid Obesity

5. Desaturation after paralysis

6. Successful BMV Depends on 3 things – A patent airway – Adequate mask seal Too large a mask better than too small – Proper ventilation

7. 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%

8. 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

9. 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

10. 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

11. Ventilation High Airway pressure from: – Short inspiratory time – Large tidal volumes – Incomplete airway opening – Increased airway resistance – Decreased compliance

12. 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

13. Opening the Airway

15. 1 Hand Mask Hold

16. 2 Handed Technique

17. Airway Adjuncts

18. Peter DeBlieux, M.D. LSU Emergency Medicine Manual of Emergency Airway Management, 3 rd Edition. Walls, R. and Murphy, M. 2008.