BVM for trauma pt in shock?

[Jn1232th]

So let's say 30 y.o. male involved in a motorcycle TC. Gets thrown from his bike and lands 20 ft from incident.His airway is open. He has cool , clammy skin. Weak and rapid pulse. And respiratory rate is 34. Would you bag this patient? Or would it best to use a non rebreather. I heard conflicting answers from different people so far.

 

[cprted]

As with all things, it depends.

How much volume is he moving? Is he ventilating his lungs? Are his resps deep and regular or are they shallow and irregular?

A BVM is a ventilation tool. If he is ventilating appropriately, then you should be fine with the supplemental oxygen delivery device of your choice. If those resps are gasping resps and he really isn't moving much air, you'll need to bag him (and then consider injuries that are causing this presentation ... thoracic trauma, increasing ICP, etc).

 

[ERDoc]

If the pt is breathing adequately then no oxygen is needed. If he is not breathing adequately then yes, bag him.

 

[ThadeusJ]

Personally I would check SpO2 for oxygenation status (because its fast and easy and can help with peripheral perfusion status), and assess his chest for signs of possible pneumo (busted ribs, air entry throughout not just certain spots). Facial trauma in case things get go sour and your open airway is no longer the case. If you have EtCO2 via nasal cannula option, that would indicate whether bagging should be considered.

NRB is to deliver oxygen when required. BVM is to vent off accumulated CO2 if required as well as delivering positive pressure ventilation to recruit collapsed airways while delivering oxygen (please be aware that you can use a BVM quite effectively without any oxygen input). ETT is for protecting the airway when the patient cannot do so themselves and/or bronchial toilet is required. There's a lot of grey area between these but those are the basic applications.

 

[Qulevrius]

So let's say 30 y.o. male involved in a motorcycle TC. Gets thrown from his bike and lands 20 ft from incident.His airway is open. He has cool , clammy skin. Weak and rapid pulse. And respiratory rate is 34. Would you bag this patient? Or would it best to use a non rebreather. I heard conflicting answers from different people so far.

BVM = minimal/absent respiratory effort, you're literally breathing for the patient. NRB = high flow O2 for maintaining adequate perfusion. If your patient has a patent airway but is tachypneac due to *reasons* (the way you describe the patient, he's going into shock - what's his breathing quality, is it shallow ?), I'd slap a NRB @ 15 LPM on him/her, request ALS intercept if longer than 10 min away from nearest STEMI/trauma center (depends on MOI), otherwise divert towards the nearest ER.

 

[wilderness911]

Side note, but having dealt with a number of these patients before I have found that in many cases simple repositioning of the airway is sufficient to allow for functional respiration, at which point you can throw on a NRB and work them up from there. Slightly different patient than what you are describing where the patient presents with tachypnea due to trauma or rising ICP, but in my experience most single vehicle motorcycle accident patients end up sliding 15-20' face down before coming to a stop...as a result, their chins are jammed so far into their chests that they are occluding their airways. Flipping them over and repositioning the airway has almost always been sufficient to get things back on track. When it hasn't, they have required intubation.