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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


Desaturation after paralysis
Desaturation after paralysis


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







  • Peter DeBlieux, M.D. LSU Emergency Medicine

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


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