MANUAL VENTILATION Flashcards
is a basic skill that involves airway assessment, maneuvers to open the airway, and application of simple and complex airway support devices and effective positivepressure ventilation using a bag and mask.
Manual ventilation
is the use of a machine to move the air in and out of the lungs.
Mechanical ventilation
is the standard method for rapidly providing rescue ventilation to patients with apnea or severe ventilatory failure.
Bag-valve-mask (BVM) ventilation
self-inflating bag (resuscitator bag)
attached to a nonrebreathing valve and then to a face mask that conforms to the soft tissues of the face.
should be used if further assistance is needed for oxygenation without contraindications to its use.
Positive end expiratory pressure (PEEP) valves
Successful BVM ventilation requires technical competence and depends on 4 things
Patent airway
Adequate mask seal
Proper ventilation technique
PEEP vale as needed to improve O2
Establishing a patent airway for BVM ventilation requires
*Keeping the oropharynx clear of physical obstructions
*Proper patient positioning and manual maneuvers to relieve tongue and soft tissue obstruction of the upper airway
*Airway adjuncts such as a nasopharyngeal or oropharyngeal airway to facilitate effective air exchange
GOAL
Rapid provision of successful ventilation and oxygenation
Indications for BVM
*Emergency ventilation: apnea, respiratory failure, or impending respiratory arrest
*Pre-ventilation and/or oxygenation or interim ventilation and/or oxygenation during efforts to achieve and maintain definitive artificial airways (ET)
Contraindications for BVM Ventilation
no medical contraindication
legal contraindication (do-not-resuscitate order or specific advance directive)
Complications of BVM Ventilation
gastric distention
should be inserted to evacuate the accumulated air in the stomach.
nasogastric tube
Additional Considerations for BVM Ventilation
Two-person bag-valve-mask (BVM) ventilation
Characteristics that predict difficult bag ventilation
Mask seal
Obesity/obstruction
Age
No teeth
Snoring
can increase alveolar recruitment and thus oxygenation if oxygenation is compromised even with 100% oxygen due to atelectasis
PEEP
PEEP should be used cautiously in patients who are
hypotensive or pre-load dependent
may help open the upper airway to maximize air exchange and establishes the best position to view the airway if endotracheal intubation becomes necessary.
Aligning the external auditory canal with the sternal notch
Head and neck positioning to open the airway
Sniffing position
only in the absence of cervical spine injury
The sniffing position
If there is concern for cervical spine injury:
Position the patient supine or at a slight incline on the stretcher.
Position yourself at the head of the stretcher.
Avoid moving the neck and, if possible, use only the jaw-thrust maneuver or chin lift without head tilt
to monitor end tidal CO2 levels to assess adequacy of ventilations.
waveform capnometry
handles the mask, because maintaining a proper mask seal is the most difficult task
more experienced operator
squeezes the bag.
Second operator
Traditional hand placement is the —–placing the middle, ring, and little fingers under the mandible and pulling the mandible upward, while the thumbs and index fingers and then press down against the mask.
“C-E” grip
An alternative, often preferred—. can be used in which the thenar eminences (muscles at the base of the thumb) hold the mask to the face.
Method 1,2
For each breath, steadily and smoothly squeeze the bag to deliver a tidal volume of
6-7 ml/kg (500ml)
If using a — volume bag, squeeze only halfway to obtain the correct tidal volume.
1000 ml
In cardiac arrest cases
do not exceed 8 to 10 breaths per minute (ie, one complete breath every 6 to 7.5 seconds).
the PEEP valve initially at
5 and increase
ventilation or oxygenation is still not adequate, prepare for other airway maneuvers such as a
supraglottic airway or endotracheal intubation
If endotracheal intubation is necessary, ventilate using maximum FiO2 through a nonrebreather mask for
3-4 minutes
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.
