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BAG & MASK VENTILATION

BAG & MASK VENTILATION. Indications. Apneic or gasping following initial steps and tactile stimuloation HR<100/min in a spontaneously breathing baby Spontaneously breathing infant - cyanotic despite free flow oxygen. Contraindications. Diaphragmatic hernia

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BAG & MASK VENTILATION

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  1. BAG & MASK VENTILATION

  2. Indications • Apneic or gasping following initial steps and tactile stimuloation • HR<100/min in a spontaneously breathing baby • Spontaneously breathing infant - cyanotic despite free flow oxygen

  3. Contraindications • Diaphragmatic hernia • Non -vigorous baby born through meconium stained liquor

  4. Selecting bag & mask equipment • Size of bag (240-750 ml): To deliver a tidal volume of 6-8 ml/kg • Oxygen capability: Oxygen source, reservoir • Safety feature: Pop off valve, pressure gauge (optional) • Mask: Size 0 & 1 (Cover chin, mouth, nose), cushioned edges

  5. Forming seal • Positioning the infant • Position of resuscitator

  6. Forming & checking the seal • Positioning & holding the mask: Enclose chin, mouth & nose, ensure snug seal, avoid pressure over neck and eyes • Squeeze the bag with finger tips: Don’t squeeze empty the bag with whole hand • Observe chest movements: Noticeable rise and fall of chest, shallow and easy breathing

  7. Ventilation rate and pressure • Rate : 40-60 breaths/minute Squeeze-two-three-squeeze • Pressure : Increase in HR &/or Noticeable rise and fall of chest Initial breath: 30-40 cms H2O Later : 15-20 cms H2O

  8. Improvement • Increasing HR • Improving color • Spontaneous breathing

  9. No improvement / deterioration • Chest movement not adequate • Inadequate seal • Reapply mask • Blocked airway • Reposition • Clear secretions • Ventilate with open mouth • Insufficient pressure • Increasing pressure

  10. Deterioration • Check oxygen delivery system • Oxygen supply • Oxygen tubing

  11. Orogastric catheter • Indication • Need for bag and mask ventilation for over 2 minutes • Technique • Use 6-8 Fr size, measure the length, aspirate gastric contents, leave outer end open

  12. Preterm infants • Avoid excessive chest wall movements (large tidal volume) • Monitoring of pressure may help to provide consistent inflations and avoiding unnecessary high pressure • CPAP after resuscitation may be helpful

  13. Select bag and connect to oxygen source • capable of giving 100% oxygen • Select appropriate size mask • Test bag • Good pressure • Pressure release valve working • Pressure manometer 30-40 cm H2O Baby needs Bag and mask ventilation • Position yourself at head end or side of baby • Position baby’s head in sniffing position • Position bag and mask properly on baby • Check easy chest rise during first two-three breaths

  14. Bag and mask ventilation Chest Rise No Yes Check for inadequate seal; reapply face mask Yes Chest Rise No Check forblocked airway. Reposition head, remove secretions, mouth slightly open Yes Chest Rise No Consider insufficient pressure. Increase pressure; consider intubation

  15. Ventilate for 30 seconds Rate 40-60 bpm Increasing HR, visible rise and fall of chest Check heart rate with stethoscope or umbilical palpation for 6 seconds Less than 6 beats (< 60bpm) 6-10 beats (60-100bpm) More than 10 beats (>100 bpm) • Continue ventilation • Initiate chest compression • Consider intubation • Continue ventilation • Consider intubation • Check for • spontaneous • breathing Yes No • Gradually discontinue • positive pressure ventilation • Provide tactile stimulation • Provide free flow oxygen • Need of post-resuscitation care • Continue positive pressure ventilation • Consider intubation • Consider OG tube insertion • Need of post-resuscitation care

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