Chapter 1. Bag-Mask Ventilation

• • To ventilate and oxygenate a patient.

  • A ventilation face mask may be used with an oropharyngeal or nasopharyngeal airway during spontaneous, assisted, or controlled ventilation.

Relative

• • In patients with full stomach, cricoid pressure must be maintained to avoid vomiting and aspiration.

• • Ventilation bags (manual resuscitator) come in 2 types: self-inflating bag and flow-inflating (“anesthesia”) bag.

  • Ventilation bags used for resuscitation should be self-inflating.

  • Ventilation bags come in different sizes: infant, child, and adult.

  • Face masks come in many sizes.

  • A ventilation mask consists of a rubber or plastic body, a standard connecting port, and a rim or face seal.

  • Supplemental oxygen can be attached to ventilation bags to provide oxygen to the patient.

• • Vomiting and aspiration.

• • Bag-mask ventilation gives the clinician time to prepare for more definitive airway management.

  • Good technique involves preserving good mask-face seal, inflating the chest with minimal required pressure, and maintaining the optimal patency of the upper airway through manipulation of the mandible and cervical spine.

  • The clinician should only use the force and tidal volume necessary to cause the chest to rise visibly.

  • The mask should extend from the bridge of the nose to the cleft of the chin, enveloping the nose and mouth but avoiding compression of the eyes.

  • The mask should provide an airtight seal.

  • The goal of ventilation with a bag and mask should be to approximate normal ventilation.

• • Sedation may be required before beginning.

• • A neutral “sniffing” position without hyperextension of the neck is usually appropriate for infants and toddlers.

  • Avoid extreme hyperextension in infants because it may produce airway obstruction.

  • In patients with head or neck injuries, the neck must be maintained in a neutral position.

• • The upper airway consists of the oropharynx, the nasopharynx, and supraglottic structures.

  • The cricoid cartilage is the first tracheal ring, located by palpating the prominent horizontal band inferior to the thyroid cartilage and cricothyroid membrane.

  • Cricoid pressure occludes the proximal esophagus by displacing the cricoid cartilage posteriorly. The esophagus is compressed between the rigid cricoid ring and the cervical spine.

Sequence

• • Open the airway via chin lift/jaw thrust maneuver.

  • Seal the mask to the face.

  • Deliver a tidal volume that makes the chest rise.

E-C Clamp Technique

• • Tilt the head back and place a towel beneath the head.

  • If head or neck injury is suspected, open the airway with the jaw thrust technique without tilting the head.

  • • If a second person is present, have that person immobilize the spine.

• • Apply the mask to the face.