new orleans ems airway lecture series: lecture 2 oxygenation and bag-mask ventilation

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.