Ventilation

mask. This feature makes it possible to use the device for things like CPR. It can

deliver up to 100 percent oxygen.

G. Pocket mask—this is the simplest positive pressure oxygen delivery device. It allows

a rescuer to deliver rescue breaths without having to do mouth-to-mouth

resuscitation.

VENTILATION

Ventilation involves the actual act of inspiring and expiring air/gases by the lungs. A patient

may have an open airway but cannot ventilate themselves. The mainstay of treatment for a

lack of ventilation is the bag-valve-mask (BVM). The BVM can provide rescue breathing to a

patient indefinitely. If not performed correctly, however, it can make hypoxia worse and can

result in the death of the patient. Refer to figure 4 to see how a BVM is applied.

Figure 4: The application of a bag-valve mask

The first step is to recognize that the patient needs ventilation. If the RR is less than 8 breaths per minute or when the tidal volume falls below 300 ml/breath, assisted ventilation is

necessary. The cause may be discovered and reversed; however, artificial ventilation must be initiated before attempting to reverse the cause of the apnea/hypopnea.

Position the patient, set up the airway, and maintain the proper airway position. The patient

needs to be supine and the gurney elevated to about the level of the rescuer’s abdomen. The

rescuer should be standing at the level of the crown of the patient’s head. The jaw should be

thrust forward, pushing the chin upward. Tilting back of the head is appropriate for patients

without a suspected cervical spine injury.

An adjunct can be helpful in the form of a nasopharyngeal airway. An oral airway can be used if

the patient has no gag reflex. This will insure a patent airway. Measure the nasal airway from

the tip of the nose to the ear lobe. Choose a mask that fits over the mouth and nose with a

complete seal and no leakage. The mask should be sealed to the patient’s face. The rescuer’s

thumb should be at the nose end and the fingers should surround the chin end of the mask. See

figure 5 in your manual for proper placement of the BVM.

Figure 5: BVM placement of the hands

The goal is to provide tidal volume of 800 cc in adults and a target RR of 10 ventilations per

minute. A rescuer should listen for breath sounds and should observe the rising of the chest

during ventilations. High flow oxygen should be given and a pulse oximeter should be used to

measure the oxygen concentration in the blood.

The provider should lift the chin up to the BVM instead of pushing the mask down on the face.

Pushing the mask will push the tongue into the back of the throat, leading to an obstructed

upper airway. The seal should be effective. For this reason, many propose a two-rescuer use of

the BVM. One person maintains the seal and the other person ventilates the patient. Use the

correct tidal volume (about 800 cc) and don’t over or under-ventilate the patient. Over-

inflation may cause the stomach to insufflate, leading to vomiting and aspiration.

To properly provide BVM ventilation, the provider needs a BVM with a non-rebreathing valve

and an oxygen reservoir (allowing a spontaneously breathing patient to draw oxygen from the

bag and reservoir) and a clear mask (allowing the provider to identify any regurgitation) that