Bite Sized Basics
Get the basics here on LITFL
Key points for BVM:
– if you have assistance then a 2 handed technique with an assistant compressing the bag is superior to 1 hand on mask and 1 hand on bag. Even if you were alone (which is unlikely in an Emergency Department) a 2 handed technique while compressing the bag between the inside of your upper limb and chest is an option. Interestingly this trial showed even anaesthetists ventilate better using the 2 handed technique compared to the traditional one handed C-E technique. Common sense supported by evidence.
– Use airway manoeuvres to improve the effectiveness of BVM eg jaw thrust, head tilt, chin lift. Lift the face to the mask … don’t push the mask into the face.
– Use an oral and/or nasal airway as a useful adjunct when performing BVM especially if experiencing any difficulty with ventilation. Use 1 oral and 2 nasal airways simultaneously to improve a difficult ventilation scenario.
– If you can’t ventilate despite using airway manoeuvres + 2 handed technique + airway adjuncts in situ, place an LMA and ventilate through this.
– If the use of BVM is an avoidable possibility (eg when about to perform a sedation procedure) assess for predictors of difficult mask ventilation.
Check out this great video from Reuben Strayer on the technique for performing BVM ventilation of a patient in the Emergency Department.
Beyond the Basics