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New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation 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%

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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

100 nonrebreather
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
Patients that Desaturate
  • Extremes of Age – young and old
  • Co-Morbid patients – CHF, COPD, DM, Chronic illness
  • Pregnancy
  • Morbid Obesity
successful bmv
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
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
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
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
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
ventilation1
Ventilation
  • High Airway pressure from:
    • Short inspiratory time
    • Large tidal volumes
    • Incomplete airway opening
    • Increased airway resistance
    • Decreased compliance
ventilation2
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
slide18

Peter DeBlieux, M.D. LSU Emergency Medicine

  • Manual of Emergency Airway Management, 3rd Edition. Walls, R. and Murphy, M. 2008.
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