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  • Apnea, respiratory depression, hypoxia, cardiac, respiratory or neurologic failure


  • Appropriate mask size: An appropriate mask completely covers the patient’s nose and mouth without mask edges hanging off the face or covering eyes

  • Bag: Self-inflating or anesthesia (flow-inflating) bag


  • Position patient’s head by either chin lift (stable cervical spine) or jaw thrust (unstable cervical spine) to maximize upper airway diameter.

  • Place mask over patient’s mouth and nose and hold tight against face using C-E hold (see Figure 26-1). The thumb and 2nd finger form a “C” shape over the mask while the 3rd, 4th, and 5th fingers of the same hand form an “E” over the mandible, effectively pulling the patient’s jaw up to meet the mask. Be careful not to compress the soft tissues below the mandible

  • Squeeze bag to push air into patient’s lungs

    • ✓ Self-inflating bag: Simple to use, pop-off valve limits amount of pressure delivered, no air reaches patient unless bag is squeezed, delivers room air unless attached to an oxygen reservoir

    • ✓ Anesthesia bag: Requires experienced operator, requires oxygen reservoir, can deliver blow-by oxygen, continuous positive airway pressure (CPAP), or assisted breaths

  • Goal rate of delivered breaths: 8–10 breaths per minute

    • ✓ Unsecure airway during one-person cardiopulmonary resuscitation (CPR): Deliver 2 breaths for every 30 compressions

    • ✓ Unsecure airway during two-person CPR: Deliver 2 breaths for every 15 compressions

    • ✓ Secure airway during CPR: 8–10 breaths per minute

  • Chest-wall rise indicates adequate delivery.

  • Listen for air leak around mask as each breath is delivered. If an air leak is heard, it can be due to hand position, wrong mask size, or fatigue. Try the following—reposition C-E hold, use two hands for C-E hold with a second provider squeezing the bag, or switch providers.

Figure 26-1

A and B: C-E Hold for Bag Valve Mask Ventilation.



  • Upper airway obstruction in a patient with spontaneous respirations

  • Used to stent tongue away from posterior pharynx

  • Can be used in conscious patients

  • Do not use in patients with severe head or facial injuries, or concern for basilar skull fracture


  • Appropriately sized NP airway: To estimate appropriate NP airway length, measure the distance from naris to tragus

  • Lubrication jelly


  • Apply lubrication jelly to insertion end of NP airway.

  • Insert NP airway into patient’s naris with gentle posterior pressure until the flange rests on the naris edge.

  • The NP airway should glide in easily. If resistance is encountered, check NP airway size, lubrication, or patency of nasal passage

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