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EMS Skills – Bag Valve Mask Ventilation


If a patient is not adequately
ventilating on his or her own, which may mean the patient is
not breathing at all or the patient is breathing but not
exchanging adequate amounts of air, it is necessary for the
EMT to support ventilations mechanically. For the EMT, the tool of choice
to ventilate a patient is a bag valve mask. The device consists of a
face mask, a one way valve, and a bag. Many bag valve masks will also
incorporate an oxygen reservoir as well. When utilizing a bag valve mask,
the EMT should always utilize manual airway
techniques, airway adjuncts, and supplemental oxygen to
deliver high concentrations of oxygen to the patient while
insuring a patent airway. Do not hesitate to suction
the airway if necessary. Also remember to take
appropriate cervical spine stabilization precautions
if warranted. Assembly of the bag valve mask
is relatively simple. Begin by expanding
the bag itself. Attach the action reservoir
bag, if included, and the face mask. Attach the oxygen tubing to the
bag valve mask and connect the other end to the regulator
on an oxygen cylinder or to a regulator within
the ambulance. Ensure the oxygen supply is on
and set the regulator at a high flow rate, typically
15 liters per minute. If the EMT is functioning alone,
he or she should use the E-C technique for
establishing a face mask seal over the patient’s face. Grasp the face mask using the
palm, thumb, and index finger to form a C over
the face mask. Place the face mask over the
patient’s nose and mouth. Utilize the remaining fingers
under the patient’s jaw to form an E and anchor the
hand to the face. Squeeze the bag with the other
hand delivering enough air to produce visible chest
rise in the patient. Release the bag and allow
it to refill with air. Squeeze again and repeat as
necessary at an appropriate rate determined by AHA standards
or local protocol. If at any time chest rise does
not occur when the bag is squeezed, reassess
the equipment, technique, and patient. In some instances, the rescuer
failed to maintain an adequate seal between the face mask
and the patient’s face. In other instances, the
patient’s airway may be occluded given a foreign body
or in proper positioning. When available, a second rescuer
should be utilized to assist in bag valve
mask ventilations. The second rescuer can utilize
the E-C technique with two hands to ensure a face mask seal
over the patient’s face while the primary rescuer
can use two hands to squeeze the bag.

Glenn Chapman

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