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Contents loading... Editors loading... Categories loading... When refering to evidence in academic writing, you should always try to reference the primary (original) source. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Introduction[edit | edit source]A bag valve mask (BVM), sometimes referred to as an Ambu bag, is a handheld tool that is used to deliver positive pressure ventilation to any subject with insufficient or ineffective breaths. It consists of a self-inflating bag, one-way valve, mask, and an oxygen reservoir.[1][2]  Method of Use[edit | edit source]The following steps[2] must be followed to ensure correct use of the BVM: An oropharyngeal airway may be inserted to prevent airway occlusion when the patient is supine. The rescuer should be at the patient’s head. A good seal must be achieved with the mask and the face. The pointed end of the mask must be over the nose, and the curved end just below the lower lip. A one-person technique requires the "E-C seal" method where the first and second digits form a "C" over the mask with the thumb pressing down by the nasal bridge, the second digit over the bottom of the mask by the mouth, and your remaining three digits forming an "E" over the mandible to hold the mask tight. There should be no gaps between the mask and the face. You can also perform the “head-tilt chin lift” maneuver or a “jaw-thurst” if indicated to maitain airway patency. In a two-person technique, the second rescuer squeezes the bag while the first rescuer uses the same E-C technique with both hands. This is more effective in delivering the required tidal volume and also creates a better seal.[3] Ensure that the soft tissue around the neck is not compressed by the rescuer's fingers. Indications[edit | edit source]It is indicated for hypercapnic respiratory failure, hypoxic respiratory failure, apnea, or altered mental status with the inability to protect the airway.[2] It's usage is advocated while delivering breaths during cardiopulmonary resuscitation.[4] Also, patients who are undergoing general anesthesia for elective surgery may require bag mask ventilation.[2] Contraindications[edit | edit source]There are no contraindications for bag mask ventilation.[2] References[edit | edit source]
Of all the fundamental skills employed by EMS, few are more crucial than the ability to ventilate a patient. When a patient can’t breathe, the bag-valve mask (BVM) enables rescuers operating within almost any environment or situation to deliver lifesaving oxygen to the patient’s lungs. Provided there is adequate gas exchange at the alveolar level and adequate circulation to the tissues, artificial ventilation via the BVM in the hands of a skilled practitioner can keep a patient alive indefinitely. Performed incorrectly, however, BVM ventilation can accelerate hypoxia and exacerbate the airway obstruction that naturally occurs during profoundly depressed levels of consciousness. This can result in serious injury or death. A properly sized mask should cover the nares and mouth without gaps. Here’s a quick walk-through on how to achieve the most beneficial outcome from this basic, yet critically important skill. 1. Recognize the need to ventilate a patient, and do so immediately. Hypoventilation occurs when the rate of spontaneous ventilations falls below 8 per minute or when the tidal volume falls below approximately 300 cc per breath. In either case, assisted ventilations become necessary. Although apnea or hypoventilation may be corrected when the cause is reversed (e.g., administration of naloxone in recognized narcotic overdoses), artificial ventilation is necessary in these instances to prevent hypoxia/anoxia and subsequent ischemic injury to the brain during the intervals between cause recognition, medication administration and the onset of therapeutic effect. 2. Position the patient, position the airway and maintain the proper airway position. Lay the patient supine. If a stretcher is available, position the patient on it quickly, with the patient ideally elevated to the rescuer’s mid-abdomen. In any circumstance, adequate space must be available for rescuers to move freely and comfortably around the patient, including enough area at the head for a rescuer to kneel or stand. The patient shouldn’t be crowded or obstructed by equipment or other obstacles. A rescuer should be positioned at the crown of the patient’s head, facing toward the patient’s feet. The rescuer’s thumbs should be placed on each of the patient’s cheeks, parallel with the midline of the body. Three or four fingers from each of the rescuers hands should be placed behind or on the angle of the jaw, and the jaw should be firmly thrust straight forward, pushing the chin toward the ceiling or sky. This will lift the posterior aspect of the tongue off the back of the oropharynx, thereby creating an open airway. For patients in which trauma isn’t suspected, the head may be tilted back slightly to further open the airway. Maintain this position throughout the duration of the resuscitation effort. 3. Assist positioning with an adjunct. A properly-sized nasopharyngeal airway (NPA) adjunct should be placed in a patient with a gag reflex, or an oropharnygeal (OPA) in patients without a gag reflex. This will assist in keeping the tongue from falling onto the back of the throat and obstructing the airway. 4. Select a properly sized mask. When placed on the patient’s face, a properly sized mask will completely cover the nares and mouth without any gaps between the mask and face. The mask shouldn’t spill over the sides of the face because air may escape during ventilation. 5. Seal the mask to the face. The rescuer positioning the airway should take the mask, place the apex of the narrow portion on the bridge of the nose and seal the mask to the patient’s face by positioning the rescuer’s thumbs on each side of the mask above the cheeks while continuing to thrust the jaw forward, bringing the jaw into the mask. This effectively seals the mask to the face and maintains a patent airway. 6. Ventilate the patient. While the rescuer positioned at the crown of the patient’s head maintains airway position and mask seal with two hands, a second rescuer should encircle the bag with two hands and provide steady, regular ventilations at a volume of approximately 800 cc (adult). The ventilation should last approximately one second and be provided every five seconds for a target rate of 10 ventilations per minute. Both rescuers should watch the chest for adequate rise, and a third rescuer should periodically auscultate the lungs to ensure adequate ventilation. Provide high-flow supplemental oxygen, if available, to the reservoir bag. Pulse oximetry and capnography should be also utilized, if available. A nasopharyngeal airway helps ensure an open airway during BVM use. The proper size nasopharyngeal airway should be gauged by the distance from the nare to the ear lobe. Common BVM Pitfalls Conclusion Monthly hands-on, scenario-based drills using the techniques described here should be practiced with your crew to guarantee you’re able to effectively work together to build the foundation for a successful resuscitation outcome. This small investment of time can mean a lifetime for your patients. What are the most common problems when using a bag valve mask BVM?The complications include barotrauma from too much lung inflation and gastric insufflation which can lead to vomiting and aspiration.
How should you ventilate a patient with a bag valve mask?The mask is manually held tightly against the face, and squeezing the bag ventilates the patient through the nose and mouth. Unless contraindicated, airway adjuncts such as nasopharyngeal and/or oropharyngeal airways are used during BVM ventilation to assist in creating a patent airway.
Does a bag mask provide positive pressure or mechanical ventilation?A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.
What does a bag valve mask provide?Bag-valve-mask (BVM) ventilation is an essential emergency skill. This basic airway management technique allows for oxygenation and ventilation of patients until a more definitive airway can be established and in cases where endotracheal intubation or other definitive control of the airway is not possible.
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Which of these is negatively affected when you properly provide bag valve mask ventilations?
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