Now let's cover the particulars of the bag valve mask. And I think it's important for
us to talk about several aspects while not deliberating too long about why we would use
a bag valve mask, what it is for, and some pitfalls that we can accidentally get into
if we're not aware of what to do with it or how to use it properly. So I'm just gonna
kinda ago through them as systematically as I can and explain how we use it, why we use
it and with what adjuncts we use it with. Okay. So there's a couple of different sizes
that we should make note of. As you can see, there's clearly a difference between these
two bag valve masks. One is for infant. The other is for child and adult. They deliver
different amounts of air into the lungs and they have a different size mask, usually that
incorporates with the size of the bag valve or the actual area of the bag itself. So that's
important. We don't want to use this on a child or an adult. And we don't want to necessarily
have to use this on an infant, but we can if that's all we have. Think about it though.
We can deliver a lot more air with a big bag like this, and so we must only give the infant
enough air to see chest rise and fall. Something to keep in mind when we're dealing with that,
but ideally you get the right size tool for the right size job. Now moving right along,
some aspects to think about here. You can see that this bag valve has a reservoir attached
to it. Many times they do right out of the bag from the manufacturer. This reservoir
allows us to fill it with 100% oxygen so that when we deliver the rescue breath to the patient,
we're delivering a higher concentration of oxygen into the body of the patient so that
it can compensate for any of their other things that are going on. Now if we hook up the oxygen
tubing to the oxygen inlet and we do not see the reservoir bag inflating at an appropriate
rate; a little trick of the trade, I like to put my thumb over the outlet here which
seals this bag system off and only allows the reservoir to fill at that point. The 02
should be on high flow so that we fill that up, and we can continue to keep it inflated
while we're delivering our rescue breaths to the patient. However, you may be in a system
or in an environment that does not have high flow 02 regulators. In that case, I would
suggest pulling off the reservoir and using it as a room air only bag valve device. So
that's what this would look like here. Now when it comes to sealing the mask over the
face of the patient, there's a couple of points I'd like to make. Look at the shape of this
mask. You see that you have this apex that goes over the nose of the patient with a bell
on the other end that's wider, and this should seal around the chin and face of the patient
under their bottom lip. So it would look like this. We're gonna bring the apex part over
the bridge of the nose while the bell portion fits over their mouth and seals around the
bottom side of their chin. We're also going to use a specific method called the CE method
of holding the mask and sealing the mask. Now we're going to put the C with the stem
of the actual bag valve right there. This index and thumb finger is what helps me balance
the pressures on the right side of the face of the patient. It's not the E that balances
the other side. It's the palm of my hand that's gonna help get the pressure on the other side
of the mask. The E portion of my fingers is literally just to grab the mandible or jawline
of the patient's chin and jaw and actually draw their jaw up into the mask, drawing their
face up into the mask. We can sometimes see mistakes where people think they're supposed
to push the mask down over the face of the patient and that's how we get a good seal.
When in reality, that's not true. We're actually making the seal with our fingers and our palm
of our hand while we grab the jawline and pull it up into the mask. We're pulling up
into the mask and then getting a good seal and delivering a good rescue breath with the
bag valve mask. However, there can be facial features. There can be external, internal,
and then there can be traumatic facial features that cause problems with sealing the mask.
If we run into this situation and we have a second rescuer, as I do here, that's already
doing chest compression or other activities, we could always incorporate then into this
effort. Jody, I'm having a hard time getting a good seal here. Could you see if you could
seal that mask, and I'll concentrate on the actual squeeze of the bag. So he's able to
use two hands now to seal the mask appropriately. And then when he says, okay, I've got it,
I'm gonna attempt to squeeze the bag. And I had probably better see a chest rise and
fall. And if I do not see a chest rise and fall, that air did not go in. No matter how
bad I want it to, no chest rise, no chest fall, we did not give the patient a breath.
Now on a side note from there. If there's no way that we can possibly seal this mask
to the face of this patient, there's other adjuncts available. It starts getting into
advanced life support and advanced airways, but I think it's worth mentioning because
many of you use them. We have the superglottic airways that are designed to fit with the
actual stem of the bag valve without the mask that could help deliver a secured airway with
a rescue breath. We have the more traditional endotracheal tubes that are also designed
with the actual stem of the bag valve mask. And this too can assist us when, for whatever
reason, the actual mask is not fitting and not sealing. I'm gonna say this; if you can't
get a rescue breath successfully in with a bag valve mask, don't use it. Put it aside.
Get a regular rescue mask and try to give a rescue breath that way. If that works better
for you, it's gonna be better for you to deliver a mouth to mask rescue breath than it is for
us to spend a ton of time trying to get a successful rescue breath in and failing. The
patient is gonna become anoxic, which means they're gonna run out of oxygen, and we're
gonna be doing more harm than good. And so I think it's just vitally important that if
you believe you're supposed to use one of these and your protocol state to use it, it's
a tool that you just have to practice with. I believe everybody can get proficient with
it, but not if you don't practice. And practice makes perfect. So if you fit into that category
where you're supposed to use one of these, or you see the benefits of using a bag valve
mask, I suggest you get your mannequin out, get your bag valve mask out, and start practicing
so that you can become a well-versed rescuer in the airway management arena.