SlideShare une entreprise Scribd logo
1  sur  35
BAG and MASK VENTILATION
(BMV)
Sakun Rasaily, Staff Nurse
Pediatric –I
B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
PRESENTATION OUTLINE
• INTRODUCTION OF BMV
• EQUIPMENT & PARTS
• TYPES / ADVANTAGES/ DISADVANTAGES OF BAG
• INDICATIONS
• PROCEDURE
• TECHNIQUE
• CONTRAINDICATIONS
• COMPLICATIONS
• NURSING MANAGEMENT.
INTRODUCTION
BAG and MASK VENTILATION:
• This is the most important airway skill.
• A basic airway management technique that allows for
oxygenation and ventilation of patients until a more
definitive airway can be established.
• Also used in cases where endotracheal intubation or
other definitive control of the airway is not possible.
Contd...
• In the pediatric population, BMV may be the
best option for prehospital airway support.
BMV ventilation is also appropriate for elective
ventilation in the operation theatre when
intubation is not required, but it is now often
substituted by the laryngeal mask airway
EQUIPMENT & PARTS OF BMV
PARTS OF BMV
The BMV consists of
1. The bag : a flexible air chamber , attached to a face mask via
a shutter valve which is squeezed to expel air to the patient.
2. Mask: a flexible mask to seal over the patients face,
3. Filter and valve : a filter & valve prevent backflow into the
bag itself (prevents patient deprivation and bag
contamination)
4. Oxygen Reservoir:
5. Pressure Gauge
6. Oxygen Connecting tube
Contd…..
• Provide a volume of 6-7 mL/kg per breath (approximately
500 mL for an average adult).
• For a patient with a perfusing rhythm, ventilate at a rate of 10-
12 breaths per minute.
• Adult size: 2 litres, Paediatric size:500 ml
TYPES OF BAG USED
1.Flow inflating bag (Anaesthesia Bag)
• Fills only when oxygen from a
compressed source flows into it
• Depend on a compressed gas source
• Must have a tight face-mask
seal to inflate
• Use a flow-control valve to
regulate pressure-inflation
2.Self inflating bag (AMBU Bag)
• Fill spontaneously after they
are squeezed, pulling oxygen or
air into the bag
• Remain inflated at all times
• Can deliver positive-pressure
ventilation without a compressed
gas source.
• Require attachment of an oxygen reservoir to deliver 100%
oxygen
Advantages and disadvantages of types of bags
Advantages Disadvantages
Flow Inflating
Bag
•Delivers 100% oxygen at all times
•Easy to determine the adequacy
of seal
•Stiffness of lungs can be felt
•Can deliver PEEP or CPAP
•Requires a tight seal to remain
inflated
•Requires a gas source to
inflate
•No safety pop-off valve
•Requires more experience
Self Inflating
Bag
•Does not need a gas source to
inflate
•Pressure release valve/ Pop – off
valve set at 30 – 40 cm H20
•Easier to use
•Will inflate even without
adequate seal
•Requires a reservoir to deliver
100% oxygen
•Can not be used to deliver
100% free flow oxygen
THE THREE PILLARS OF AIRWAY
MANAGEMENT
:1Patency of Upper Airway : ( airflow integrity )
2Protection against aspiration
3Assurance of oxygenation and ventilation
INDICATION
• Respiratory failure
Failure of ventilation
Failure of oxygenation
• Failed intubation
• Elective ventilation in the operating room
PROCUDURE
• One hand to
• maintain face seal
• position head
• maintain patency
• Other hand for ventilation
BMV TECHNIQUE
• “Sniffing”position if C-spine OK
• Thumb + index finger to maintain face seal
• Middle finger under mandibular symphysis
• Ring and little finger under the angle of mandible
Bag and mask ventilation
Yes
No
Check for inadequate seal; reapply face mask
Chest Rise
No
Chest RiseYes
Check for blocked airway.
Reposition head, remove secretions, mouth slightly open
Chest RiseYes
No
Consider insufficient pressure. Increase pressure; consider intubation
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
No Yes
•Continue positive pressure ventilation
•Consider intubation
•Consider OG tube insertion
•Need of post-resuscitation care
•Gradually discontinue
positive pressure ventilation
•Provide tactile stimulation
•Provide free flow oxygen
•Need of post-resuscitation care
WHY SNIFFING POSITION?
• Sniffing position allows for greater occipito-atlanto-
axial angulation.
• No exact definition has been established.
• However, 35 degrees neck flexion and 15 degrees
head extension is generally considered worldwide.
• Sniffing position prevents falling of tongue thus
preventing obstruction of the upper airway.
BMV DURING CPR
• During cardiopulmonary resuscitation (CPR), give 2 breaths
after each series of 30 chest compressions until an advanced
airway is placed. Then ventilate at a rate of 8-10 breaths per
minute.
• Give each breath over 1 second.
• If the patient has intrinsic respiratory drive, assist the
patient’s breaths. In a patient with tachypnea, assist every
few breaths.
• Ventilate with low pressure and low volume to decrease
gastric distension.
CRICOID PRESSURE
• Cricoid pressure consistencycy should be maintained not in all but in
emergency cases while appling BVM .
• It is the backward Pressure on cricoid cartilage with a force of 30-40
newtons
• This pressure is meant to compress the esophagus and reduce the risk
of aspiration.
• However, it does not completely protect against regurgitation,
especially in cases of prolonged ventilation or poor technique.
• Care must be taken to avoid excessive pressure, which can result in
compression of the trachea.
BMV VENTILATION: ASSESSMENT OF ADEQUACY
• Observe the chest rise and fall
• Good bilateral air entry
• Improving color
• Lack of air entering the stomach
• Feeling the bag
• Pulse oximetry (oxygen saturation)
CONTRAINDICATIONS
• In the case of complete upper airway obstruction.
• BVM ventilation is relatively contraindicated after paralysis
and induction (because of the increased risk of aspiration).
• Caution is advised in patients with severe facial trauma and
eye injuries.
• In addition, foreign material (e.g. gastric contents) in the
airway may lead to aspiration pneumonitis. In these
circumstances, alternative approaches, including endotracheal
intubation, may be necessary.
PREDICTORS OF A DIFFICULT
AIRWAY : BMV
• Upper airway obstruction
• Edentulous patients
• Beard
• H/O Snoring
• Obese
• Elderly >70 years
• Facial burns, dressings, scarring
• Poor lung mechanics
• resistance or compliance
DIFFICULT AIRWAY ADAGE
• The first response to failure of bag-mask ventilation is always
“better” bag-mask ventilation
• optimize airway position, triple airway maneuvre (head tilt,
chin lift, jaw thrust)
• place Oropharyngeal and Nasopharyngeal airways
• two-handed technique
• try lifting head off pillow to open airway
• Generate as much positive pressure as possible
without inflating the stomach
Contd...
If bag and mask still fails:
1. Intubate
2. If Cant ventilate, cant intubate
*Larngeal mask airway
*Cricothyroidotomy
*Needle Cricothyroidotomy and Transtracheal Jet
Ventilation
COMPLICATIONS OF BMV
Related to over-inflating or over-pressurizing the
patient, which can cause:
• Hypoventilation/ Hyperventilation
• Inflated air in the stomach (called gastric insufflation)
• Lung injury from over-stretching (called volutrauma)
• Lung injury from over-pressurization (called barotrauma)
• Lung aspiration
• Air Embolism
NURSING MANAGEMENT:
1. Promote respiratory function.
2. Monitor for complications
3. Prevent infections.
4. Provide adequate nutrition.
5. Monitor GI bleeding.
PROMOTE RESPIRATORY FUNCTION
1. Auscultate lungs frequently to assess for abnormal sounds.
2. Suction as needed.V/S recording and reporting.
3. Turn and reposition every 2 hours.
4. Secure ETT properly.
5. Monitor ABG value and pulse oximetry.
Suction of an Artificial Airway
1. To maintain a patent airway
2. To improve gas exchange.
3. To obtain tracheal aspirate specimen.
4. To prevent effect of retained secretions.
( Its important to OXYGENATE before and
after suctioning)
MONITOR FOR COMPLICATIONS
1. Assess for possible early complications
Rapid electrolyte changes.
Severe alkalosis.
Hypotension secondary to change in
Cardiac output.
2. Monitor for signs of respiratory distress:
Restlessness
Apprehension
Irritability and increase HR.
CONTD………
3. Assess for signs and symptoms of barotrauma(rupture of
the lungs)
Increasing dyspnea
Agitation
Decrease or absent breath sounds.
Tracheal deviation away from affected side.
Decreasing PaO2 level .
1. Assess for cardiovascular depression:
Hypotension
Tachy. and Bradycardia
Dysrhythmias.
• PREVENT INFECTION
1. Maintain sterile technique when suctioning.
2. Monitor color, amount and consistency of sputum.
• PROVIDE ADEQUATE NUTRITION
1. Begin tube feeding as soon as it is evident the patient will remain on the
ventilator for a long time.
2. Weigh daily.
3. Monitor I&O .
MONITOR FOR GI BLEEDING
1. Monitor bowel sounds.
2. Monitor gastric PH and hematest gastric secretions every shift.
• INTRODUCTION OF BVM
• EQUIPMENT & PARTS OF BVM
• TYPES / ADVANTAGES/ DISADVANTAGES OF BAG
• INDICATIONS
• PROCEDURE
• TECHNIQUE
• CONTRAINDICATIONS
• COMPLICATIONS
• NURSING MANAGEMENT.
ANY Questions PLZ!!!
REFERENCES
• http://emedicine.medscape.com/article/80184-overview
• www.proceduresconsult.com/.../bag-mask-ventilation-
EM-082-procedures
• https://en.wikipedia.org/wiki/Bag_valve_mask
• https://meds.queensu.ca/central/assets/modules/basic-
airway-management/bagmask_ventilation.html
• www.ncbi.nlm.nih.gov/pubmed/14717873
• www.slideshare.net
Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamala

Contenu connexe

Tendances

Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
Bougie, trachlite , laryngeal tube , combitube , i gel ,truviewBougie, trachlite , laryngeal tube , combitube , i gel ,truview
Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
Dhritiman Chakrabarti
 

Tendances (20)

Oxygen delivery devices
Oxygen delivery devicesOxygen delivery devices
Oxygen delivery devices
 
LAYNGEAL MASK AIRWAY
LAYNGEAL MASK AIRWAYLAYNGEAL MASK AIRWAY
LAYNGEAL MASK AIRWAY
 
Laryngoscope
LaryngoscopeLaryngoscope
Laryngoscope
 
Endotracheal intubation
Endotracheal intubationEndotracheal intubation
Endotracheal intubation
 
CVP Monitoring_Dr. Subrata Kumar_BSMMU_2014
CVP Monitoring_Dr. Subrata Kumar_BSMMU_2014CVP Monitoring_Dr. Subrata Kumar_BSMMU_2014
CVP Monitoring_Dr. Subrata Kumar_BSMMU_2014
 
Epidural anesthesia
Epidural anesthesiaEpidural anesthesia
Epidural anesthesia
 
Oropharyngeal Airway.pptx
Oropharyngeal Airway.pptxOropharyngeal Airway.pptx
Oropharyngeal Airway.pptx
 
Laryngeal mask-airway
Laryngeal mask-airwayLaryngeal mask-airway
Laryngeal mask-airway
 
Central venous catheterization
Central venous catheterizationCentral venous catheterization
Central venous catheterization
 
Acls advanced cardiac life support
Acls   advanced cardiac life supportAcls   advanced cardiac life support
Acls advanced cardiac life support
 
Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
Bougie, trachlite , laryngeal tube , combitube , i gel ,truviewBougie, trachlite , laryngeal tube , combitube , i gel ,truview
Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
 
Central line
Central line Central line
Central line
 
Intubation ppt
Intubation pptIntubation ppt
Intubation ppt
 
Mechanical ventilation
Mechanical ventilationMechanical ventilation
Mechanical ventilation
 
Venturi Mask for Oxygen Delivery Administration
Venturi Mask for Oxygen Delivery AdministrationVenturi Mask for Oxygen Delivery Administration
Venturi Mask for Oxygen Delivery Administration
 
Intercostal drainage
Intercostal drainageIntercostal drainage
Intercostal drainage
 
Bpap (bi level positive airway pressure)
Bpap (bi level positive airway pressure)Bpap (bi level positive airway pressure)
Bpap (bi level positive airway pressure)
 
Cvp
CvpCvp
Cvp
 
Oxygen delivery systems
Oxygen delivery systemsOxygen delivery systems
Oxygen delivery systems
 
Ventilator
VentilatorVentilator
Ventilator
 

En vedette

6080986 nasogastric-tube-insertion
6080986 nasogastric-tube-insertion6080986 nasogastric-tube-insertion
6080986 nasogastric-tube-insertion
Ngaire Taylor
 

En vedette (20)

Nasogastric Tube Feeding
Nasogastric Tube FeedingNasogastric Tube Feeding
Nasogastric Tube Feeding
 
Rt insertion
Rt insertionRt insertion
Rt insertion
 
Safe Suctioning
Safe SuctioningSafe Suctioning
Safe Suctioning
 
Oxygen therapy. methods of oxygenation
Oxygen therapy. methods of oxygenationOxygen therapy. methods of oxygenation
Oxygen therapy. methods of oxygenation
 
6080986 nasogastric-tube-insertion
6080986 nasogastric-tube-insertion6080986 nasogastric-tube-insertion
6080986 nasogastric-tube-insertion
 
Suction
SuctionSuction
Suction
 
Medical laryngoscope
Medical laryngoscopeMedical laryngoscope
Medical laryngoscope
 
One lung ventilation
One lung ventilationOne lung ventilation
One lung ventilation
 
Airway management part I
Airway management part IAirway management part I
Airway management part I
 
Nasogastric tube insertion
Nasogastric tube insertionNasogastric tube insertion
Nasogastric tube insertion
 
Final urinary bladder catheterisation
Final urinary bladder catheterisationFinal urinary bladder catheterisation
Final urinary bladder catheterisation
 
URINARY CATHETER SKILLS AND CARE: DR SWAPNIL TOPLE, DNB UROLOGY
URINARY CATHETER SKILLS AND CARE: DR SWAPNIL TOPLE, DNB UROLOGYURINARY CATHETER SKILLS AND CARE: DR SWAPNIL TOPLE, DNB UROLOGY
URINARY CATHETER SKILLS AND CARE: DR SWAPNIL TOPLE, DNB UROLOGY
 
Enteral Feeding Tubes for Drug Administration
Enteral Feeding Tubes for Drug AdministrationEnteral Feeding Tubes for Drug Administration
Enteral Feeding Tubes for Drug Administration
 
Ng tubes policy and guidelines ICU Adult
Ng tubes policy and guidelines ICU AdultNg tubes policy and guidelines ICU Adult
Ng tubes policy and guidelines ICU Adult
 
Nursing care for nasogastric tube patients
Nursing care for nasogastric tube patientsNursing care for nasogastric tube patients
Nursing care for nasogastric tube patients
 
Endo tracheal Suctioning
Endo tracheal SuctioningEndo tracheal Suctioning
Endo tracheal Suctioning
 
Preoperative assessment for cardio thoracic surgery
Preoperative assessment for cardio thoracic surgeryPreoperative assessment for cardio thoracic surgery
Preoperative assessment for cardio thoracic surgery
 
Video &amp; fibreoptic laryngoscope
Video &amp; fibreoptic laryngoscopeVideo &amp; fibreoptic laryngoscope
Video &amp; fibreoptic laryngoscope
 
Anaesthetic problems of open chest and pathophysiology of one lung ventilation
Anaesthetic problems of open chest and pathophysiology of one lung ventilation Anaesthetic problems of open chest and pathophysiology of one lung ventilation
Anaesthetic problems of open chest and pathophysiology of one lung ventilation
 
Oxygen delivery devices
Oxygen delivery devicesOxygen delivery devices
Oxygen delivery devices
 

Similaire à Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamala

Bag and mask.pptx Pediatric Bag and mask.pptx Pediatric
Bag and mask.pptx Pediatric Bag and mask.pptx PediatricBag and mask.pptx Pediatric Bag and mask.pptx Pediatric
Bag and mask.pptx Pediatric Bag and mask.pptx Pediatric
drmohammedashiqch
 
Mechanical ventilation
Mechanical ventilationMechanical ventilation
Mechanical ventilation
Roy Shilanjan
 
Asthma Update - Spirometry.pptx
Asthma Update - Spirometry.pptxAsthma Update - Spirometry.pptx
Asthma Update - Spirometry.pptx
FauziShahida
 
weaning complete note.pptx
weaning complete note.pptxweaning complete note.pptx
weaning complete note.pptx
RitaMagar1
 
Chest tube managment clinical practice.pptx
Chest tube managment clinical practice.pptxChest tube managment clinical practice.pptx
Chest tube managment clinical practice.pptx
michelle505237
 

Similaire à Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamala (20)

AIRWAY CLEARANCE TECHNIQUES
AIRWAY CLEARANCE TECHNIQUESAIRWAY CLEARANCE TECHNIQUES
AIRWAY CLEARANCE TECHNIQUES
 
Bag and mask.pptx Pediatric Bag and mask.pptx Pediatric
Bag and mask.pptx Pediatric Bag and mask.pptx PediatricBag and mask.pptx Pediatric Bag and mask.pptx Pediatric
Bag and mask.pptx Pediatric Bag and mask.pptx Pediatric
 
2 Airway Management.pptx
2 Airway Management.pptx2 Airway Management.pptx
2 Airway Management.pptx
 
Mechanical ventilation
Mechanical ventilationMechanical ventilation
Mechanical ventilation
 
Ventilator in Critical Care
Ventilator in Critical CareVentilator in Critical Care
Ventilator in Critical Care
 
Asthma Update - Spirometry.pptx
Asthma Update - Spirometry.pptxAsthma Update - Spirometry.pptx
Asthma Update - Spirometry.pptx
 
Physiotherapy in surgery in abdominal and thoracic surgery
Physiotherapy in surgery in abdominal and thoracic surgeryPhysiotherapy in surgery in abdominal and thoracic surgery
Physiotherapy in surgery in abdominal and thoracic surgery
 
Basic airway management
Basic airway managementBasic airway management
Basic airway management
 
Weaning from mechanical ventilation
Weaning from mechanical ventilationWeaning from mechanical ventilation
Weaning from mechanical ventilation
 
mechanical ventilation
mechanical ventilationmechanical ventilation
mechanical ventilation
 
ventilator mode.pdf
ventilator mode.pdfventilator mode.pdf
ventilator mode.pdf
 
Ventilator mode
Ventilator modeVentilator mode
Ventilator mode
 
Non invasive ventilation 24th oct 2014 final
Non invasive ventilation 24th oct 2014  finalNon invasive ventilation 24th oct 2014  final
Non invasive ventilation 24th oct 2014 final
 
weaning complete note.pptx
weaning complete note.pptxweaning complete note.pptx
weaning complete note.pptx
 
ventilator troubleshooting sel study made by my self
ventilator troubleshooting sel study made by my selfventilator troubleshooting sel study made by my self
ventilator troubleshooting sel study made by my self
 
Airway Management.pptx
Airway Management.pptxAirway Management.pptx
Airway Management.pptx
 
Presentation.power point presentation for
Presentation.power point presentation forPresentation.power point presentation for
Presentation.power point presentation for
 
Chest tube managment clinical practice.pptx
Chest tube managment clinical practice.pptxChest tube managment clinical practice.pptx
Chest tube managment clinical practice.pptx
 
Chest Tube In-Service
Chest Tube In-ServiceChest Tube In-Service
Chest Tube In-Service
 
Water seal drainage ppt.pptx
Water seal drainage ppt.pptxWater seal drainage ppt.pptx
Water seal drainage ppt.pptx
 

Dernier

Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
adilkhan87451
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
chetankumar9855
 
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
adilkhan87451
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
9953056974 Low Rate Call Girls In Saket, Delhi NCR
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
mahaiklolahd
 

Dernier (20)

Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
 
Andheri East ^ (Genuine) Escort Service Mumbai ₹7.5k Pick Up & Drop With Cash...
Andheri East ^ (Genuine) Escort Service Mumbai ₹7.5k Pick Up & Drop With Cash...Andheri East ^ (Genuine) Escort Service Mumbai ₹7.5k Pick Up & Drop With Cash...
Andheri East ^ (Genuine) Escort Service Mumbai ₹7.5k Pick Up & Drop With Cash...
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
 
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
 
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
 
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service Avai...
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
 
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
 

Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamala

  • 1. BAG and MASK VENTILATION (BMV) Sakun Rasaily, Staff Nurse Pediatric –I B.P. Koirala Institute of Health Science Dharan, Sunsari (Nepal)
  • 2. PRESENTATION OUTLINE • INTRODUCTION OF BMV • EQUIPMENT & PARTS • TYPES / ADVANTAGES/ DISADVANTAGES OF BAG • INDICATIONS • PROCEDURE • TECHNIQUE • CONTRAINDICATIONS • COMPLICATIONS • NURSING MANAGEMENT.
  • 3. INTRODUCTION BAG and MASK VENTILATION: • This is the most important airway skill. • A basic airway management technique that allows for oxygenation and ventilation of patients until a more definitive airway can be established. • Also used in cases where endotracheal intubation or other definitive control of the airway is not possible.
  • 4. Contd... • In the pediatric population, BMV may be the best option for prehospital airway support. BMV ventilation is also appropriate for elective ventilation in the operation theatre when intubation is not required, but it is now often substituted by the laryngeal mask airway
  • 6. PARTS OF BMV The BMV consists of 1. The bag : a flexible air chamber , attached to a face mask via a shutter valve which is squeezed to expel air to the patient. 2. Mask: a flexible mask to seal over the patients face, 3. Filter and valve : a filter & valve prevent backflow into the bag itself (prevents patient deprivation and bag contamination) 4. Oxygen Reservoir: 5. Pressure Gauge 6. Oxygen Connecting tube
  • 7. Contd….. • Provide a volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult). • For a patient with a perfusing rhythm, ventilate at a rate of 10- 12 breaths per minute. • Adult size: 2 litres, Paediatric size:500 ml
  • 8. TYPES OF BAG USED 1.Flow inflating bag (Anaesthesia Bag) • Fills only when oxygen from a compressed source flows into it • Depend on a compressed gas source • Must have a tight face-mask seal to inflate • Use a flow-control valve to regulate pressure-inflation
  • 9. 2.Self inflating bag (AMBU Bag) • Fill spontaneously after they are squeezed, pulling oxygen or air into the bag • Remain inflated at all times • Can deliver positive-pressure ventilation without a compressed gas source. • Require attachment of an oxygen reservoir to deliver 100% oxygen
  • 10. Advantages and disadvantages of types of bags Advantages Disadvantages Flow Inflating Bag •Delivers 100% oxygen at all times •Easy to determine the adequacy of seal •Stiffness of lungs can be felt •Can deliver PEEP or CPAP •Requires a tight seal to remain inflated •Requires a gas source to inflate •No safety pop-off valve •Requires more experience Self Inflating Bag •Does not need a gas source to inflate •Pressure release valve/ Pop – off valve set at 30 – 40 cm H20 •Easier to use •Will inflate even without adequate seal •Requires a reservoir to deliver 100% oxygen •Can not be used to deliver 100% free flow oxygen
  • 11. THE THREE PILLARS OF AIRWAY MANAGEMENT :1Patency of Upper Airway : ( airflow integrity ) 2Protection against aspiration 3Assurance of oxygenation and ventilation
  • 12. INDICATION • Respiratory failure Failure of ventilation Failure of oxygenation • Failed intubation • Elective ventilation in the operating room
  • 13. PROCUDURE • One hand to • maintain face seal • position head • maintain patency • Other hand for ventilation
  • 14. BMV TECHNIQUE • “Sniffing”position if C-spine OK • Thumb + index finger to maintain face seal • Middle finger under mandibular symphysis • Ring and little finger under the angle of mandible
  • 15. Bag and mask ventilation Yes No Check for inadequate seal; reapply face mask Chest Rise No Chest RiseYes Check for blocked airway. Reposition head, remove secretions, mouth slightly open Chest RiseYes No Consider insufficient pressure. Increase pressure; consider intubation
  • 16. 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 No Yes •Continue positive pressure ventilation •Consider intubation •Consider OG tube insertion •Need of post-resuscitation care •Gradually discontinue positive pressure ventilation •Provide tactile stimulation •Provide free flow oxygen •Need of post-resuscitation care
  • 17. WHY SNIFFING POSITION? • Sniffing position allows for greater occipito-atlanto- axial angulation. • No exact definition has been established. • However, 35 degrees neck flexion and 15 degrees head extension is generally considered worldwide. • Sniffing position prevents falling of tongue thus preventing obstruction of the upper airway.
  • 18. BMV DURING CPR • During cardiopulmonary resuscitation (CPR), give 2 breaths after each series of 30 chest compressions until an advanced airway is placed. Then ventilate at a rate of 8-10 breaths per minute. • Give each breath over 1 second. • If the patient has intrinsic respiratory drive, assist the patient’s breaths. In a patient with tachypnea, assist every few breaths. • Ventilate with low pressure and low volume to decrease gastric distension.
  • 19. CRICOID PRESSURE • Cricoid pressure consistencycy should be maintained not in all but in emergency cases while appling BVM . • It is the backward Pressure on cricoid cartilage with a force of 30-40 newtons • This pressure is meant to compress the esophagus and reduce the risk of aspiration. • However, it does not completely protect against regurgitation, especially in cases of prolonged ventilation or poor technique. • Care must be taken to avoid excessive pressure, which can result in compression of the trachea.
  • 20. BMV VENTILATION: ASSESSMENT OF ADEQUACY • Observe the chest rise and fall • Good bilateral air entry • Improving color • Lack of air entering the stomach • Feeling the bag • Pulse oximetry (oxygen saturation)
  • 21. CONTRAINDICATIONS • In the case of complete upper airway obstruction. • BVM ventilation is relatively contraindicated after paralysis and induction (because of the increased risk of aspiration). • Caution is advised in patients with severe facial trauma and eye injuries. • In addition, foreign material (e.g. gastric contents) in the airway may lead to aspiration pneumonitis. In these circumstances, alternative approaches, including endotracheal intubation, may be necessary.
  • 22. PREDICTORS OF A DIFFICULT AIRWAY : BMV • Upper airway obstruction • Edentulous patients • Beard • H/O Snoring • Obese • Elderly >70 years • Facial burns, dressings, scarring • Poor lung mechanics • resistance or compliance
  • 23. DIFFICULT AIRWAY ADAGE • The first response to failure of bag-mask ventilation is always “better” bag-mask ventilation • optimize airway position, triple airway maneuvre (head tilt, chin lift, jaw thrust) • place Oropharyngeal and Nasopharyngeal airways • two-handed technique • try lifting head off pillow to open airway • Generate as much positive pressure as possible without inflating the stomach
  • 24. Contd... If bag and mask still fails: 1. Intubate 2. If Cant ventilate, cant intubate *Larngeal mask airway *Cricothyroidotomy *Needle Cricothyroidotomy and Transtracheal Jet Ventilation
  • 25. COMPLICATIONS OF BMV Related to over-inflating or over-pressurizing the patient, which can cause: • Hypoventilation/ Hyperventilation • Inflated air in the stomach (called gastric insufflation) • Lung injury from over-stretching (called volutrauma) • Lung injury from over-pressurization (called barotrauma) • Lung aspiration • Air Embolism
  • 26. NURSING MANAGEMENT: 1. Promote respiratory function. 2. Monitor for complications 3. Prevent infections. 4. Provide adequate nutrition. 5. Monitor GI bleeding.
  • 27. PROMOTE RESPIRATORY FUNCTION 1. Auscultate lungs frequently to assess for abnormal sounds. 2. Suction as needed.V/S recording and reporting. 3. Turn and reposition every 2 hours. 4. Secure ETT properly. 5. Monitor ABG value and pulse oximetry.
  • 28. Suction of an Artificial Airway 1. To maintain a patent airway 2. To improve gas exchange. 3. To obtain tracheal aspirate specimen. 4. To prevent effect of retained secretions. ( Its important to OXYGENATE before and after suctioning)
  • 29. MONITOR FOR COMPLICATIONS 1. Assess for possible early complications Rapid electrolyte changes. Severe alkalosis. Hypotension secondary to change in Cardiac output. 2. Monitor for signs of respiratory distress: Restlessness Apprehension Irritability and increase HR.
  • 30. CONTD……… 3. Assess for signs and symptoms of barotrauma(rupture of the lungs) Increasing dyspnea Agitation Decrease or absent breath sounds. Tracheal deviation away from affected side. Decreasing PaO2 level . 1. Assess for cardiovascular depression: Hypotension Tachy. and Bradycardia Dysrhythmias.
  • 31. • PREVENT INFECTION 1. Maintain sterile technique when suctioning. 2. Monitor color, amount and consistency of sputum. • PROVIDE ADEQUATE NUTRITION 1. Begin tube feeding as soon as it is evident the patient will remain on the ventilator for a long time. 2. Weigh daily. 3. Monitor I&O . MONITOR FOR GI BLEEDING 1. Monitor bowel sounds. 2. Monitor gastric PH and hematest gastric secretions every shift.
  • 32. • INTRODUCTION OF BVM • EQUIPMENT & PARTS OF BVM • TYPES / ADVANTAGES/ DISADVANTAGES OF BAG • INDICATIONS • PROCEDURE • TECHNIQUE • CONTRAINDICATIONS • COMPLICATIONS • NURSING MANAGEMENT.
  • 34. REFERENCES • http://emedicine.medscape.com/article/80184-overview • www.proceduresconsult.com/.../bag-mask-ventilation- EM-082-procedures • https://en.wikipedia.org/wiki/Bag_valve_mask • https://meds.queensu.ca/central/assets/modules/basic- airway-management/bagmask_ventilation.html • www.ncbi.nlm.nih.gov/pubmed/14717873 • www.slideshare.net