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New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation and Bag-Mask Ventilation

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

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  1. New Orleans EMS Airway Lecture Series: Lecture 2Oxygenation and Bag-Mask Ventilation Jeffrey M. Elder, M.D. Deputy Medical Director

  2. You Must Become and Expert!

  3. 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

  4. Patients that Desaturate • Extremes of Age – young and old • Co-Morbid patients – CHF, COPD, DM, Chronic illness • Pregnancy • Morbid Obesity

  5. Desaturation after paralysis

  6. Successful BMV • Depends on 3 things • A patent airway • Adequate mask seal • Too large a mask better than too small • Proper ventilation

  7. 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%

  8. 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

  9. 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

  10. 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

  11. Ventilation • High Airway pressure from: • Short inspiratory time • Large tidal volumes • Incomplete airway opening • Increased airway resistance • Decreased compliance

  12. 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

  13. Opening the Airway

  14. Opening the Airway

  15. 1 Hand Mask Hold

  16. 2 Handed Technique

  17. Airway Adjuncts

  18. Peter DeBlieux, M.D. LSU Emergency Medicine • Manual of Emergency Airway Management, 3rd Edition. Walls, R. and Murphy, M. 2008.

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