hi everyone this is lahiru i'm from abc's of anesthesia and this is anae one of the medical
students now we're going to go through bagmas ventilation and the great thing about this is that
there really isn't that much to know about bagmas ventilation to know everything that i do know as
a consultant anesthetist so if you know these steps theoretically you know everything that
i want to know about how to get oxygenation and ventilation into a patient now what we're going
to go through is the principles firstly with bag mask ventilation is that really what you need is a
good seal of the face mask and what you're trying to achieve with that is positive pressure if i
can get a pr the pressure correctly it's going to be able to put oxygen and ventilation through the
mask holding that pressure through the airway down into lungs to inflate the lungs so that's pretty
much my goal and all of these techniques will be to enhance that goal now the broader scope of this
is if i want to oxygenate someone i go from less invasive to more invasive technique so i've got my
bag mask ventilation i've got an lma ventilation intubation with the endotracheal tube and i guess
the most invasive would be cutting the neck to do a cricothyroidome or some kind of surgical airway
so first of all these two are actually the things that will help me create a really good seal
appropriate sizing of my mask and creating a good seal so what that means is that i want this
mask to fit exactly perfectly around the face and the perfect landmarks here are the bridge of the
nose that point there and this chin dimple here if you put the mask like that you can see that
there's you know key clues in the anatomy to how it should fit now if the mask is too big you might
see it kind of going over the edge of the chin or not properly covering the mouth and i want you to
know that regardless of the size these are your endpoints that you need to create a really good
ceiling face mask the next thing is actually creating a better seal so let's say i've still
got a leak there's many ways you can get a better seal depending on the problem like for example
here's got to be so that's going to make it more difficult to create a seal you might even want
to shave the beard or you might want to put some tegadems around that to help help with the seal
one of the other things is sometimes when you're bag masking someone just remember you've got two
hands and also the hands of your mates so imagine you're having a bit of trouble sealing i might get
both my hands there in the right grip and that would help me achieve my seal and say i'm still
getting a leak maybe the face is drooping in the way maybe the patient has dentures in and the
dentures are out so the face is falling away or maybe there's some kind of mass inside or outside
the face again i could be holding the mast like this i'll get someone else to hold the bridge
of the nose another person to you know hold the mask to avoid a leak and these are all the things
you can do to really maximize the pressure and the seal that you can achieve with this mask
finally there's only a couple of other things you need to know that's maneuvers and adjuncts
these maneuvers and adjuncts just enhance the pathway the passage is optimized with these
devices so the maneuvers are pretty easy jaw thrust head tilt and chin lift now i'll show in
a future video essentially we're trying to open up that airway by creating good position a jaw
thrust through the angle of the jaw here in fact i might just demonstrate on you if the now if an a
was lying down a head tilt is just that and a chin lift is just that so essentially i'm trying to put
my fingers at the bottom of his chin and just lift forward that way now the jaw thrust can be a bit
more uncomfortable like if i was doing it from the front i'm just finding the angle of the jaw here
and then just thrusting forward that's a really great way of pushing the tongue off the back of
the throat the back of the pharynx opening up the airway but it's also really great because it kind
of gives a bit of pain so if you have a patient who's narcotised and just not responding that
well that will not only open the airway but that little bit of pain might stimulate your patient
to breathe as well and again i'll show this on future videos where we've got the proper mannequin
the final thing we'll do we'll actually go and show you some oropharyngeal airways and how to
size them here is an oropharyngeal airway called a gadell's airway and this is a nasopharyngeal
airway call it npa as well so i've got here an opa or npa godel or nasopharyngeal airway
now these are pretty simple devices essentially i've got two apertures into the throat i've got
the i've got here the mouth and also the nose and essentially you want them to get behind the tongue
down to just below the tongue just above the larynx above the airway and so the way
to size it makes a lot of sense so with the nasopharyngeal airway i go from the nostrils
there down to the angle of the jaw and that's about the right size again i don't have to be
perfect with sizing i just gotta give it a go something that's approximately right and if it
works that's great and if it doesn't work i need to modify and either get a bigger or smaller one
same with the goodell i'm sizing it from the side of the angle of the mouth to the angle of
the jaw there's many ways to size this but that's just one of the ones that works for me and again
i just need it close enough to make sure that i'm roughly achieving around the back curvature
so great that's bag bagmas ventilation that's everything i know about bagmas ventilation and
we'll go through all the practical stuff in another video uh good thank you very much
you