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Now let's cover the particulars of the bag valve mask. And I think it's important for us to talk about several aspects while not deliberating too long about why we would use a bag valve mask, what it is for, and some pitfalls that we can accidentally get into if we're not aware of what to do with it or how to use it properly. So I'm just gonna kinda ago through them as systematically as I can and explain how we use it, why we use it and with what adjuncts we use it with. Okay. So there's a couple of different sizes that we should make note of. As you can see, there's clearly a difference between these two bag valve masks. One is for infant. The other is for child and adult. They deliver different amounts of air into the lungs and they have a different size mask, usually that incorporates with the size of the bag valve or the actual area of the bag itself. But ideally you get the right size tool for the right size job. Now moving right along, some aspects to think about here. You can see that this bag valve has a reservoir attached to it. Many times they do right out of the bag from the manufacturer. This reservoir allows us to fill it with 100% oxygen so that when we deliver the rescue breath to the patient, we're delivering a higher concentration of oxygen into the body of the patient so that it can compensate for any of their other things that are going on. Now if we hook up the oxygen tubing to the oxygen inlet and we do not see the reservoir bag inflating at an appropriate rate; a little trick of the trade, I like to put my thumb over the outlet here which seals this bag system off and only allows the reservoir to fill at that point. The 02 should be on high flow so that we fill that up, and we can continue to keep it inflated while we're delivering our rescue breaths to the patient. However, you may be in a system or in an environment that does not have high flow 02 regulators. In that case, I would suggest pulling off the reservoir and using it as a room air only bag valve device. So that's what this would look like here. Now when it comes to sealing the mask over the face of the patient, there's a couple of points I'd like to make. Look at the shape of this mask. You see that you have this apex that goes over the nose of the patient with a bell on the other end that's wider, and this should seal around the chin and face of the patient under their bottom lip. So it would look like this. We're gonna bring the apex part over the bridge of the nose while the bell portion fits over their mouth and seals around the bottom side of their chin. We're also going to use a specific method called the CE method of holding the mask and sealing the mask. Now we're going to put the C with the stem of the actual bag valve right there. This index and thumb finger is what helps me balance the pressures on the right side of the face of the patient. It's not the E that balances the other side. It's the palm of my hand that's gonna help get the pressure on the other side of the mask. The E portion of my fingers is literally just to grab the mandible or jawline of the patient's chin and jaw and actually draw their jaw up into the mask, drawing their face up into the mask. We can sometimes see mistakes where people think they're supposed to push the mask down over the face of the patient and that's how we get a good seal. When in reality, that's not true. We're actually making the seal with our fingers and our palm of our hand while we grab the jawline and pull it up into the mask. We're pulling up into the mask and then getting a good seal and delivering a good rescue breath with the bag valve mask. However, there can be facial features. There can be external, internal, and then there can be traumatic facial features that cause problems with sealing the mask. If we run into this situation and we have a second rescuer, as I do here, that's already doing chest compression or other activities, we could always incorporate then into this effort. Jody, I'm having a hard time getting a good seal here. Could you see if you could seal that mask, and I'll concentrate on the actual squeeze of the bag. So he's able to use two hands now to seal the mask appropriately. And then when he says, okay, I've got it, I'm gonna attempt to squeeze the bag. And I had probably better see a chest rise and fall. And if I do not see a chest rise and fall, that air did not go in. No matter how bad I want it to, no chest rise, no chest fall, we did not give the patient a breath. Now on a side note from there. If there's no way that we can possibly seal this mask to the face of this patient, there's other adjuncts available. It starts getting into advanced life support and advanced airways, but I think it's worth mentioning because many of you use them. We have the superglottic airways that are designed to fit with the actual stem of the bag valve without the mask that could help deliver a secured airway with a rescue breath. We have the more traditional endotracheal tubes that are also designed with the actual stem of the bag valve mask. And this too can assist us when, for whatever reason, the actual mask is not fitting and not sealing. I'm gonna say this; if you can't get a rescue breath successfully in with a bag valve mask, don't use it. Put it aside. Get a regular rescue mask and try to give a rescue breath that way. If that works better for you, it's gonna be better for you to deliver a mouth to mask rescue breath than it is for us to spend a ton of time trying to get a successful rescue breath in and failing. The patient is gonna become anoxic, which means they're gonna run out of oxygen, and we're gonna be doing more harm than good. And so I think it's just vitally important that if you believe you're supposed to use one of these and your protocol state to use it, it's a tool that you just have to practice with. I believe everybody can get proficient with it, but not if you don't practice. And practice makes perfect. So if you fit into that category where you're supposed to use one of these, or you see the benefits of using a bag valve mask, I suggest you get your mannequin out, get your bag valve mask out, and start practicing so that you can become a well-versed rescuer in the airway management arena.
This lesson will focus on how to use your bag valve mask, why we might use it instead of the traditional mouth to mask rescue technique, and any concerns that may come with using a bag valve mask (BVM).
There are three sizes of bag valve mask systems – infant, child and adult. There are many mask sizes and styles as well from neonate and infant all the way up to adult. Having the correct size mask helps to create a good seal for the breaths or ventilations. Having the proper size bag ensures enough air is given without an unnecessary risk of too much air into the lungs.
Pro Tip #1: If you only have the adult-size bag valve system, it is not recommended to use on infants or children. Giving too much air can cause trauma to the lungs as well as a decrease in blood flow to the heart. Therefore, for best patient care, using the appropriately sized bag valve for each patient is recommended.
Some aspects to be aware of concerning bag valve masks:
Pro Tip #2: If you don't see the oxygen reservoir bag inflating, or if it's inflating too slowly, put your thumb over the outlet inside the mask. This will seal the bag system so no oxygen is escaping, and the reservoir will fill more quickly.
When sealing the mask over the patient's face, there are a couple important points to note:
Warning: Do not push the mask down onto the patient's face. This will not provide a proper seal and may even block the airway. It's your fingers and palm that creates the seal, and it's the drawing of the mandible into the mask that provides the proper head tilt, chin lift before delivering your ventilations.
When a second responder comes in handy: If certain facial features are complicating the sealing of the mask, incorporate the second responder into the effort.
Responder one uses two hands to create the seal, while responder two provides the ventilations using the bag.
Warning: If you do not see the patient's chest rise and fall, your seal is not tight or the airway is not open, and the patient is not receiving the life-saving oxygen they need.
Pro Tip #3: If there is no way to get a proper seal, there are other adjuncts available, but these may be considered advanced life support techniques in your area.
Both options are possibilities if the mask isn't fitting or sealing properly.
Pro Tip #4: If you're not able to deliver ventilations successfully using the bag valve mask, don't use it. Set it aside and use a regular rescue mask with a one-way valve and deliver breaths with the mouth to mask technique. Don't waste time that the patient doesn't have, as they are likely becoming anoxic by the second.
The benefits of using a bag valve mask:
Another important note: Bag valve masks work best when incorporated into the team approach.
Bag valve masks require practice to perfect. So, if you're supposed to be using one as part of your own particular protocol or if you simply see the benefits of using it when compared to the traditional mouth to mask rescue technique, practice as much as you can first.
What do they say about practice? It makes perfect. And perfect use of the bag valve mask could mean the difference between life and death.