# BVM on breathing pt



## Explorer127 (Mar 28, 2008)

ok....so can you bag a pt. with respirations less than 12... lets say u have pt with a rr of 8 or 10...would u bag them? how would you go about doing this? btw...the pt is conscious.. what if the pt is not conscious?


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## MedicPrincess (Mar 28, 2008)

You absolutley can bag a pt that is still breathing, consicous or not.  With a RR of 8 or 10 I would try postion first, although not for very long....depending on quality/depth of those 8-10.

Bag with them.  That is when they take a breath, you squeeze the bag to give'em a little more.  If they are conscious, make sure you are talking to them, telling them what your going to do next.


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## emtwacker710 (Mar 28, 2008)

MedicPrincess said:


> You absolutley can bag a pt that is still breathing, consicous or not.  With a RR of 8 or 10 I would try postion first, although not for very long....depending on quality/depth of those 8-10.
> 
> Bag with them.  That is when they take a breath, you squeeze the bag to give'em a little more.  If they are conscious, make sure you are talking to them, telling them what your going to do next.



I would do the same thing, I remember from my EMT class, you can assist ventilations with a BVM, I've actually done it twice so far on 2 respiratory distress calls..


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## skyemt (Mar 28, 2008)

you may or may not want to do this...

remember, you don't treat numbers, you treat patients...

are there folks who are very comfortable breathing 8-10 times a minute? absolutely!! you will not bag these patients...

are there patients breathing 12 times a minute, shallow, that can't finish full sentences? you might need to bag them.  are they 10 up from 8? or 10 down from 18? have you taken their rate once? well you can't tell trend that way...

you mentioned, rate, but what about tidal volume? 14RR and shallow vs 10 and full... which is worse?? have you even considered tidal volume? or just rate?

yes, i know it was a simple question, but EMS done well is not simple. there are many factors to consider other than, "hmm my chart says 8-10 bag them"...

just my .02.


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## emtwacker710 (Mar 28, 2008)

I know what your saying, I always keep the numbers in mind but I also look for other stuff too, like how the pt. is feeling, responding to questions, I'll ask the family members, "is this normal for him?" or "is this his normal color?" because you don't see these people everyday you don't know what is normal and not normal, I actually know a kid 2 years younger than me, I can't remember what it is but he actually has a bluish/grey tint to his extremities...keep that in mind..


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## BruceD (Mar 28, 2008)

emtwacker710 said:


> ... I actually know a kid 2 years younger than me, I can't remember what it is but he actually has a bluish/grey tint to his extremities...keep that in mind..



Might be Methemoglobinemia, but I believe it's relatively rare.


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## MSDeltaFlt (Mar 28, 2008)

I personally do not look at the numbers (RR) to determine if I'm going to bag a pt or not.  I look at GCS, quality of respirations, and then the SpO2's.

Case in point; I had a transfer of a retired physician who was on BiPAP of 10/5 and 80% FiO2.  I couldn't take the BiPAP with me even if it could fit in the aircraft.  The pt was also C/A/O X 4 and verbally appropriate with a GCS = 15 stating that he did not want to be intubated if we could help it.

The AMBU with 10 PEEP got us to the aircraft, but the noninvasive facemask ventilation on the vent really did the trick.

So, yes, you can bag a conscious pt.


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## VentMedic (Mar 28, 2008)

MSDeltaFlt said:


> The AMBU with 10 PEEP got us to the aircraft, *but the noninvasive facemask ventilation on the vent really did the trick.*



But the vent you were using was probably pt triggered sensitivity?  You also have an RRT background.  That gives you a little edge with the BVM and vents when it comes to accomondating or "adjusting" for pt synchrony. 

For those not familiar with ventilators and/or BiPAP (trade name for 2 levels), each breath initiated can be mechanically assisted.  The machine senses the patient's respiratory effort.  

That same sensitivity should be recognized when attempting to ventilate a conscious or unconscious pt with some respiratory effort.  If not, expect some complications like ineffective volume delivery and vomiting.


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## Explorer127 (Mar 28, 2008)

wouldn't the pt resist it though? like im thinking if someone were to bag me now, it would feel kind of weird... am i wrong? and would u compress the bag between breaths, or while the pt breathes? lets say u dont have a bvm...what would happen if u used a face mask instead?


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## SwissEMT (Mar 28, 2008)

I'm just going to rant a little, so excuse the comma splices.

Sometimes I cry a little, I mean, I keep it on the inside obviously, but when I read posts like this and I'm here working the hardest I can to become the best medical professional I can, I can't help but just get depressed. 
I feel like I'm swimming against the current, like I'm on the edge of the niagara falls and everyone is just falling off the waterfall of stupidity. 
I try to swim so hard, by reading more, by studying more, by asking the doctors about all the questions to develop my mindset. I usually feel like I'm managing to hold on, but sometimes I read or hear things that really test my grip.
Everytime I see a post like this, or I'm at the hospital and hear providers ask similarly painful questions, it's as if a tumbling body slams into me, almost pushing me off the edge of the waterfall.
I mean, is it that bad? Am I one of the few souls out there who actually reads my books and have some sort of common-sensical approach to medicine? Do people ever use instinct anymore? I'm just an EMT-B, not a FCEPNREMTCC-EMTP or whatever. Hell, I'm probably younger than a lot of you. 
Know what? I feel like this guy





I know you'll all probably yell at me or give me negative points (or whatever the internet equivalent is), stating that this is a personal attack against this poster, but it isn't. I really don't mean to attack or make fun of anybody. I just sometimes really feel like I'm fighting a losing battle against the river of stupid people.


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## Explorer127 (Mar 28, 2008)

ok...first of all, im just an emt-explorer doing first responder training, and u say u think ur younger? are you younger than 14? i didn't think so. how about you actually answer the question?


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## basic (Mar 28, 2008)

You have to remember that every one has different experience levels though.  It's better that people with these questions ask them and learn than to not ask and pretend that they know.  Don't you agree?

You've got to understand that it is easy to pass the NR and that people can become EMTs in less than 6 months.  In a perfect world all EMTs would be able to know and do everything right.  But in reality most people try to get by with all they need to move up and on.

I think that the experience and learning that goes on in the field plays a huge roll in truly becoming an EMT.  No matter how many times I reread my books, until my hands get to do it, I can't do anything else to remember it more than I already do.


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## basic (Mar 28, 2008)

omarsobh said:


> ok...first of all, im just an emt-explorer doing first responder training, and u say u think ur younger? are you younger than 14? i didn't think so. how about you actually answer the question?



Glad to see you online and trying to figure this stuff out


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## Explorer127 (Mar 28, 2008)

hey, thanks. so wouldn't a conscious pt. resist the bvm?


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## ffemt8978 (Mar 28, 2008)

Play nice, people.


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## Explorer127 (Mar 28, 2008)

ahahahahahaha


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## VentMedic (Mar 28, 2008)

We had another thread recently with the same questions.  There is some very good advice in that thread from several forum members.  I definitely recommend reading it. 

http://www.emtlife.com/showthread.php?t=5594&highlight=bagging

You do have a very valid question and that is why even ACLS is putting more emphasis on the BVM than immediate intubation. Intubation should not be a skill taught in a few minutes of playing around at a manikin station as what happened in many ACLS classes.  Teaching intubation can also be a waste if someone has no idea how to use a BVM or BVT on an untubated or intubated patient whether conscious or unconscious.  Even the BVT requires a special touch to keep in synch with a breathing patient.   Unfortunately even Paramedics want to get to the "more exciting" skills and some fail to master the BVM and sometimes not even the BVT.  

Not everybody has the same expertise as with many skills regardless of their credentials.   Some doctors and RNs as well as a few RRTs suck at using the BVM because they may never have fully been trained in its use as well as getting experience using it.  Even the RT profession had its share of problems with "quick mart" training centers in the 1980s.  Members of these professions as well as EMTs and Paramedics may also work in jobs where they may rarely if ever use a BVM.


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## Topher38 (Mar 28, 2008)

omarsobh said:


> hey, thanks. so wouldn't a conscious pt. resist the bvm?




Not always, I mean I can only imagine that it is very wierd to have someone trying to breath for you but if you explain to them what you are going to do and coach them to try and control thier breathing.


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## MSDeltaFlt (Mar 28, 2008)

I feel as if I need to apologize for not clarifying my original post.  My response to the original question was to give an example of how far you could actually go with ventilating a conscious pt providing you actually have the proper knowledge, training, AND experiece as Vent said.  Vent and Rid have probably done this (the vent thing) at least once in their careers if I'm not mistaken.

Sometimes I have a tendency to chase rabbits.

Swiss, I apologize if I confused you.  It truly was unintentional.  If I do this again, please call me on it.  I do not want to be counter productive to someone's learning.

With respect.


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## SwissEMT (Mar 28, 2008)

I don't think I'm smarter than everyone else, matter fact, I consider myself pretty stupid. I simply think that EMS in general is going down the drain because incoming EMTs aren't reading their books and aren't using their brains and want everything on a platter. 
Ask yourself this: Are guidelines and texts in the book going to encompass enough circumstances to be able to make decisions for you? No. You'll find yourself having to use your sense of judgement. 
It's exactly that which is the answer to your question. *It depends.* If a guy is breathing at 33/minute, should you bag him? You don't need a pulseOx, or wave-form capnography to give you an answer. Know what the best indicator is for when to do an intervention? Using your sense of judgement. If you're genuinely worried about the patient's respiratory status, bag him. 
It's silly to ask questions about small variations in circumstances or being ridiculously vague. 
The most common answer you'll hear is "IT DEPENDS" and that's what people mean when they say "don't trust the numbers"

Now though my first post may have come off as mean, I'm sure there are many others out there who will share the same opinion. We're all working and are surrounded by idiots. They're giving us a bad name. They're the ones showing up on the news. They're the national average. And it's pretty taxing to be working your *** off to become a great provider when you'll just end up being veiled by mediocrity.
See? I'm not such a huge ******* afterall. Now go buy some books and read your *** off and become the best provider you can. Lights and sirens won't save lives, your brain will.

MSDelta, I wasn't pointing fingers at you at all. Don't worry about it. I did think it was funny that you were using Fi02, PEEP, ETCO2 in a reply to a poster with basic medical training.


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## MSDeltaFlt (Mar 28, 2008)

No harm.  No foul.


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## VentMedic (Mar 28, 2008)

Common sense with understanding what is normal and not normal is a great compliment to a good assessment.   Unfortunately EMS has spent more time worrying about "certs" than education or the real "basics" for understanding  each skill or protocol. 



SwissEMT said:


> MSDelta, I wasn't pointing fingers at you at all. Don't worry about it. I did think it was funny that you were using Fi02, PEEP, ETCO2 in a reply to a poster with basic medical training.



Actually, anyone working with any type of oxygen equipment should know what FiO2 is.  The BVM can be varied from an FiO2 of 0.40 to 1.0 by the reservoir bag or tube. 

PEEP is also now available as a built in feature that can be changed on many BVMs.  Unfortunately, very few are given much education about PEEP and its appropriate use also at either EMT or Paramedic level.  

The BVM is also misunderstood and used as a "free - flow" O2 delivery device.  Many don't realize that the patient will not receive flow unless a very tight seal is made and the patient can generate almost -20 cmH2O pressure to open the valve.   There are free flow bags using Jackson-Reese type circuits which one may see in hospitals used by Anesthesiologists and RRTs. 

Many are also unfamiliar with the amount of volume in ml that a bag can deliver or how the pop-off is used.  Some bags also include a safety valve for air entrainment.

Very few take the time to read the package insert for their BVM. Most assume a BVM is a BVM and all are the same.

ETCO2 may be necessary to become familiar with at least at a very introductory level if you are working an ALS truck with a Paramedic.  It can be a useful tool just like the pulse ox but also should not replace commonsense and physical assessment.


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## skyemt (Mar 28, 2008)

VentMedic said:


> PEEP is also now available as a built in feature that can be changed on many BVMs.  Unfortunately, very few are given much education about PEEP and its appropriate use also at either EMT or Paramedic level.



Vent, would you mind going into the PEEP and its appropriate use a bit more...

thanks


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## VentMedic (Mar 28, 2008)

PEEP:  Positive End Expiratory Pressure
Definition: Maintains pressure phase above ambient pressure during the expiratory phase of ventilation and helps prevent the collapse of the small airways and alveoli.

On the BVM it is an expiratory flow retard valve at a preset value by an additional valve to attach or a fixed adjustable valve.  

This link gives an overview of PEEP which is used on almost all ventilator patients.  It also describes CPAP.  


http://virtual.mjc.edu/lylet/242/PEEP.htm

The link is from an RT education site which has other notes that might be of interest with many more links.
http://virtual.mjc.edu/lylet/242/

CPAP is Continuous Positive Airway Pressure so it is present at both inspiration and expiration. 

In the presence of low BP, questionable pneumo, or airtrapping and hyperinflation, PEEP is not recommended with the BVM.   It can help with CHF, Pulmonary Edema and various V/Q mismatches from PNA and other causes of ARDS.   Again, caution when there are cardiac output or low BP issues.  Usually if oxygenation is a problem 5 cmH2O may help somewhat without too many side effects.    

If a patient is on PEEP on a ventilator, the PEEP valve on the BVT is usually set to match the PEEP on the ventilator.  5 cmH2O is usually a maintenance level and it is not always necessary to match.  

COPD patients attempt their own form of "PEEP" with pursed lip breathing to increase oxygenation.

Babies also attempt to increase their oxygenation when distressed by "grunting" which creates a flow retard through the glottis.


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## skyemt (Mar 29, 2008)

VentMedic said:


> PEEP:  Positive End Expiratory Pressure
> Definition: Maintains pressure phase above ambient pressure during the expiratory phase of ventilation and helps prevent the collapse of the small airways and alveoli.
> 
> On the BVM it is an expiratory flow retard valve at a preset value by an additional valve to attach or a fixed adjustable valve.
> ...



thank you Vent!

question about the low cardiac output scenarios... i am assuming that PEEP will raise intrathoracic pressures somewhat, resulting  in a further decrease in preload... is this what you are referring to? why it is not indicated in low cardiac output situations?


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## VentMedic (Mar 29, 2008)

skyemt said:


> thank you Vent!
> 
> question about the low cardiac output scenarios... i am assuming that PEEP will raise intrathoracic pressures somewhat, resulting  in a further decrease in preload... is this what you are referring to? why it is not indicated in low cardiac output situations?



*Clinical review: Positive end-expiratory pressure and cardiac output*
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16356246


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## certguy (Mar 29, 2008)

To quote an old addage ; " THE ONLY STUPID QUESTION IS THE ONE NOT ASKED . " This site is a great learning resource for everyone associated with EMS . Keep in mind we have students on the site who may not have covered this topic yet or they still feel shaky on it . Learning's a lifelong process and it certainly doesn't stop when you get your cert . It's better to ask any questions you have here than not have the knowledge when it's needed . Instead of getting frustrated at folks asking questions , help them out . EMT's and Medics aren't made from cookie cutters , and they all learn at different rates . Some pick it up easier than others .


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## tydek07 (Mar 29, 2008)

Hello,
   It depends on what your pt looks like and if their body is doing fine with breathing 8-10/min. For very healthy people, that may be a norm. for them. We have all heard treat you pt, not your equipment. Well same thing can be applied, Treat your pt, not their vitals. Everyone has different "norm vitals", so you cannot go just by the numbers. 
    So to answer your question, yes you can bag an alert patient if the need is there, but if they are alert, probably not going to have to help them along. If the person is breathing, but with AMS, work with their breathing. When they take a breath, give them a breath, then give them a couple breaths inbetween their own breaths. Just try and get the rythym down.
   So like always, depends on the situation, isn't that how every ems questions is answered, haha.
   Have a good day,


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## Meursault (Mar 29, 2008)

VentMedic said:


> Actually, anyone working with any type of oxygen equipment should know what FiO2 is.  The BVM can be varied from an FiO2 of 0.40 to 1.0 by the reservoir bag or tube.



The first time I saw FiO2 mentioned, it took me a second to make the connection, because my EMT text and various state materials use percentage of O2 without a label. Apparently we're too stupid to divide.

Interesting link, too.


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## TKO (Mar 29, 2008)

I just had a call the other night with a pt in heart failure that couldn't breathe.  Got there and standing, he could breathe with accessory muscle use.  Sat him down and he quickly degraded.  Sats were like 80% and his lungs were swimming in fluid that when he coughed up, was pink-tinged...and there was lots of it.

He was conscious and I bagged him for 20 minutes to the hospital while he complained at a rate of 3 words per breath while pleading to stand up in the bus, but it kept him alive.  I had a SP02 monitor on him to monitor his pulse because I thought for sure he was going to tank before we got to the big H.  Then I bagged for 20 minutes in the hospital while they pushed NTG and lasix.

As earlier stated, we treat the pt and not the monitor.  You bag because the pt isn't getting adequate oxygen intake on their own and you just do your best to get the Cx pt to agree with it....and be sure you bag when they inspire; don't force it.


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## BossyCow (Mar 31, 2008)

As part of a class, we assisted each other's breathing with a BVM. It's a very educational experience and is also a wonderful team building excercise. 

I have found with many asthma pts the assistance with a BVM not only doesn't cause anxiety, but can relieve it. As an Asthma pt myself, I know that the anxiety I feel during an asthma attack is usually a side effice of the effort it is taking to breathe. When the BVM is used, the effort I have to use to breathe is lessened and consequently so is my anxiety.


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## skyemt (Mar 31, 2008)

BossyCow said:


> As part of a class, we assisted each other's breathing with a BVM. It's a very educational experience and is also a wonderful team building excercise.
> 
> I have found with many asthma pts the assistance with a BVM not only doesn't cause anxiety, but can relieve it. As an Asthma pt myself, I know that the anxiety I feel during an asthma attack is usually a side effice of the effort it is taking to breathe. When the BVM is used, the effort I have to use to breathe is lessened and consequently so is my anxiety.



how is the asthma patient positioned as your are doing that?


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## BossyCow (Mar 31, 2008)

On the stretcher, in a seated position. 

I've both done it and had it done to me. Since its only an assist with their breathing, you don't need to be as particular about a full seal on the face. You are just giving a bit of pressure to augment their breathing.

In class, we put blankets down on the floor and do it lying down.


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## skyemt (Mar 31, 2008)

BossyCow said:


> On the stretcher, in a seated position.
> 
> I've both done it and had it done to me. Since its only an assist with their breathing, you don't need to be as particular about a full seal on the face. You are just giving a bit of pressure to augment their breathing.
> 
> In class, we put blankets down on the floor and do it lying down.



ok... i was going to say.... take an asthmatic with a bad attack... no way there going to let you lay them down...


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## Doughboy (Mar 31, 2008)

VentMedic said:


> Actually, anyone working with any type of oxygen equipment should know what FiO2 is.  The BVM can be varied from an FiO2 of 0.40 to 1.0 by the reservoir bag or tube.



Maybe in a perfect world, but I'd settle for EMTs who know the indications and contraindications of the medications they have, know where to find the mask part of the BVM after taking the bag part out of the bag, or understand the importance of a good assessment first.

In the end, knowing how to fiddle with the FiO2 of your BVM or having read the insert card that comes with it doesn't mean jack if you can't recognize that your patient's respirations are inadequate, and the pt needs to be bagged.  


As far as bagging an asthma pt... I'm not going to touch that one.


Omarsobh:  As a first responder, bagging a conscious, breathing patient is going to be outside of your scope of practice, or outside of the skills you are trained to perform.  If you are responding in an official capacity (I.E. FD, PD, Lifeguard, etc... I'm inclined to believe you're not because of your age, but who knows...) then you are legally obligated to only practice within the scope of your training, and can be held accountable if you exceed your training and the patient has a negative outcome.  In any case, this is not something you should be doing with the training you have.

I'm not trying to be a ****, and I know this isn't the answer to your question, but it's something to look out for. 

As far as whether or not a patient will become agitated if you try to bag them while they are conscious (for low resps)... in my experience, if a patient has enough energy to be combative, they are probably not hypoxic enough to merit bagging!


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## ffemt8978 (Mar 31, 2008)

Doughboy said:


> Omarsobh:  As a first responder, bagging a conscious, breathing patient is going to be outside of your scope of practice, or outside of the skills you are trained to perform.  If you are responding in an official capacity (I.E. FD, PD, Lifeguard, etc... I'm inclined to believe you're not because of your age, but who knows...) then you are legally obligated to only practice within the scope of your training, and can be held accountable if you exceed your training and the patient has a negative outcome.  In any case, this is not something you should be doing with the training you have.
> 
> I'm not trying to be a ****, and I know this isn't the answer to your question, but it's something to look out for.
> 
> As far as whether or not a patient will become agitated if you try to bag them while they are conscious (for low resps)... in my experience, if a patient has enough energy to be combative, they are probably not hypoxic enough to merit bagging!



What makes you think that bagging a conscious, breathing patient is outside of his scope of practice as a first resopnder, or that they are not taught the skills necessary?  This is a fundamental objective for FR's in Washington state.  Scope of practice varies from area to area, so please remember that before you make all encompassing statements.


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## VentMedic (Mar 31, 2008)

> Originally Posted by VentMedic
> Actually, anyone working with any type of oxygen equipment should know what FiO2 is. The BVM can be varied from an FiO2 of 0.40 to 1.0 by the reservoir bag or tube.





Doughboy said:


> Maybe in a perfect world, but I'd settle for EMTs who know the indications and contraindications of the medications they have, know where to find the mask part of the BVM after taking the bag part out of the bag, or understand the importance of a good assessment first.
> 
> In the end, knowing how to fiddle with the FiO2 of your BVM or having read the insert card that comes with it doesn't mean jack if you can't recognize that your patient's respirations are inadequate, and the pt needs to be bagged.



Fiddle with the FiO2 of the BVM?   I think you have just given your own example of not being familiar with the equipment.

I do apologize for not making the FiO2 statement clearer for some. I have seen EMT(P)s arriving without the reservoir and have had them state that they always remove it because it just gets in the way.  If the reservoir is not attached on the BVM, with O2 running at 15L, the most FiO2 you can expect from the BVM is 0.40 due to air entrainment.   

Neonatal and Pediatric teams may remove the tail or reservoir bag for some patients where giving too much oxygen may be an issue.  Usually these SPECIALTY TEAMS use a blender to provide more precise concentrations of oxygen. 

As far as the insert card, most assume the BVM is a simple piece of equipment and never really understand how to make the most of it or how to check if the BVM is defective.

If you do not know your equipment and how to use it effectively including the BVM, the patient is not going to get the full benefit once respiratory failure is recognized. 




Doughboy said:


> As far as whether or not a patient will become agitated if you try to bag them while they are conscious (for low resps)... in my experience, if a patient has enough energy to be combative, they are probably not hypoxic enough to merit bagging!



Hypoxic refers to oxygenation.  A patient can still have adequate oxygenation but lack in ventilation.  That is where the assistance comes in.  

True if the patient is fighting you it would be a mute point to restrain provided they have enough ventilatory drive to breathe on their own or they are capable of protecting their airway.  Of course for ALS situations where this may involve head injury or for flight, sedation and an ETT may be the way to go for those circumstances. 

Not every patient scenario will be text book.  There is no reason one can not ask questions before they come across something they did not encounter in class or clinical.



Doughboy said:


> As far as bagging an asthma pt... I'm not going to touch that one.



That has been discussed in the link to the other thread earlier and as BossyCow stated, positioning and gaining the patient's confidence is key. 




Doughboy said:


> I'm inclined to believe you're not because of your age, but who knows...) .



I do not believe the EMS profession has achieved an elitist status to where we devour our young who have valid questions  They are the next generation of professional Paramedics.


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## Doughboy (Mar 31, 2008)

ffemt8978 said:


> What makes you think that bagging a conscious, breathing patient is outside of his scope of practice as a first resopnder, or that they are not taught the skills necessary?  This is a fundamental objective for FR's in Washington state.  Scope of practice varies from area to area, so please remember that before you make all encompassing statements.



Well, after looking up the WA state FR protocols (they have protocols?!) you appear to be correct.  That's the most progressive set of FR standards I've ever seen.  Excuse my generalization.  

Is our poster from WA?  I don't know.

In my experience as an AHA instructor, first responder training usually translates to first aid, CPR with AED, and maybe oxygen admin or epi-pen training.  This training is not adequate to be bagging a conscious, breathing patient, or most importantly, to decide whether or not to bag a conscious, breathing patient.

It's really interesting to me that WA doesn't have albuterol nebs for EMT-Bs, for example, but has such a complete set of protocols for FRs and a statewide FR curriculum.


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## Doughboy (Mar 31, 2008)

VentMedic said:


> I do not believe the EMS profession has achieved an elitist status to where we devour our young who have valid questions  They are the next generation of professional Paramedics.



Wooah, sorry if that came off sounding that way.  As someone who took my basic class at 17 and had to wait to achieve licensure, I assure you it's not a question of elitism.  What I meant was that I doubted a 14 y/o would have to worry about not being covered by good samaritan laws because he was responding to an incident while on duty in some capacity, but was more likely to be a bystander who assisted at a scene.

All valid points on FiO2, but I maintain that I'd rather see EMT classes effectively teach how to make a good seal on a BVM and provide adequate ventilation and spend more time on recognition of serious emergencies than the nuances of their equipment, which most often varies from unit to unit, anyway.  

In other words:



VentMedic said:


> If you do not know your equipment and how to use it effectively including the BVM, the patient is not going to get the full benefit once respiratory failure is recognized.




True, but I would argue that the damages resulting from failure to recognize respiratory failure, especially for EMT-Bs and FRs, far outweigh the negative consequences of not knowing the semantics of FiO2, tidal volume, PEEP, ETCO2, etc.


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## BossyCow (Mar 31, 2008)

Yes I am from WA state and not a FR but an EMT-B. I am also a CPR/FA instructor, Wilderness EMT instructor and Medical Officer for my small rural fire department. 

And as far as neb treatments, we can assist a pt with neb treatments if they have the prescription already. If not, with the permission of our MPD, we have been able to provide it for those who have no script, but only on a case by case basis. 

In WA state there is a huge variation between the type of area any given department is serving. While the state regulations are a basis, each individual region makes their own protocols with the cooperation of the MPD's from the receiving facilities in that region. 

FR is a dying breed in these parts. The amount of time and training is almost the same as what is required for EMT-B so few departments are willing to invest in a FR class when for about the same amount of time and money they can have an EMT-B. At least on my side of the I-5 corridor, there are few FR left.


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## skyemt (Mar 31, 2008)

Doughboy said:


> True, but I would argue that the damages resulting from failure to recognize respiratory failure, especially for EMT-Bs and FRs, far outweigh the negative consequences of not knowing the semantics of FiO2, tidal volume, PEEP, ETCO2, etc.



semantics of FiO2??

i can assure you... as someone who has been studying this very topic for two days... you would change your opinion greatly if you were more knowledgable about the physiology of ventilation and respiration...

not a criticism, but a promise...


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## Explorer127 (Apr 1, 2008)

wow, im kinda surprised that people are still responding to this question, lol. i gotta say, that last post was pretty funny, lol. 

btw, the person who was asking before about whether where I am a First responder can use a bvm, the answer is yes. and i'm not from WA, but from connecticut. basically here, an MRT (some places call it a first responder) can do anything an EMT can do. however, you do need to be with a basic, at all times.(unless of course, you're on scene alone


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## ffemt8978 (Apr 1, 2008)

All right, people.  I've already had to remove a couple of posts here for a violation of our forum rules.  Please take a moment and review these rules and remember that we take the BE POLITE rule seriously.

You may disagree with what is posted, and may present valid arguments to support your beliefs but you may NOT post anything that is rude, inflammatory, derogatory, or insulting to any other forum member.


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## Doughboy (Apr 1, 2008)

omarsobh said:


> btw, the person who was asking before about whether where I am a First responder can use a bvm, the answer is yes. and i'm not from WA, but from connecticut. basically here, an MRT (some places call it a first responder) can do anything an EMT can do. however, you do need to be with a basic, at all times.(unless of course, you're on scene alone



Omar, I wasn't asking if you could or could not use a BVM, but whether or not you could use it on a conscious patient.  Making a blanket statement about your scope of practice, i.e. that you can do anything an EMT can do, is pretty hazardous.  Have you been trained to do everything an EMT has been trained to do?  I'm really asking because I'm unfamiliar with your state's protocols, and the CONN OEMS' web page is borderline incomprehensible, but have you been trained to administer medication, for example?  If not, and an EMT let you do this, they'd be putting their license at risk by letting you do it.  I'm not trying to rag on your certification level at all, I just don't know.


Sky, I'll try to address this in a way that doesn't get my post deleted:

Please don't presume to know anything about my education.

It is extensive.

Just because I don't believe EMT-Bs and FRs need to know the what FiO2 means in order do their jobs does not mean that a) I don't know what it means, or, more importantly b) that they don't need to understand the  concepts underlying respiration and ventilation.  

In the future, please consider basing your argument on what you know, not what you think other people don't know.


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## certguy (Apr 1, 2008)

Doughboy , 

   Since when is assisting a conscious pt's respirations such a hard skill ? You match thier breaths and as Bossy said , this also lowers thier anxiety . As an asthma pt. myself , believe me , I can relate to that . If you haven't experienced it yourself it's like 2 bodybuilders wrapping a chain around your chest and pulling at both ends  while you're trying to breathe through a stir straw . It's scary , and it sucks . The goal of an FR is to provide care till EMS can get there . The sooner you provide better oxygenation and ease the anxiety , the better . These guys may not have as much training as the rest of EMS , but they can and do save lives . Give them a break , you may be one of thier pts. some day .


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## VentMedic (Apr 1, 2008)

Doughboy said:


> Just because I don't believe EMT-Bs and FRs need to know the what FiO2 means in order do their jobs does not mean that a) I don't know what it means, or, more importantly b) that they don't need to understand the  concepts underlying respiration and ventilation.
> 
> In the future, please consider basing your argument on what you know, not what you think other people don't know.



So you don't believe an EMT should know if they are giving 100% or 21% oxygen?   I really have to disagree with you there.  Oxygen is considered a medication and there should be some understanding about the concentrations you are administering.     

Assessing oxygenation by color and mentation as well as ventilation by rate, depth and quality should also be understood to know when and how much oxygen should be administered.   That is where tidal volume or if you prefer "how much air with each breath" or "watch the chest go up and down" comes into the assessment.  I do agree with MSDeltaflt about giving O2 in most cases but how much can be assessed physically and listening to the patient.  They should also know when and why they refer to their protocols or use clinical judgement for some circumstances. 

I believe FR and EMTs should be well trained to use the BVM when appropriate.  This should include the equipment, hows and whys.

I also don't believe their education should stop with that one certificate.  That should only be a foundation for continuing their education with more questions and seeking answers.  Many of these professionals are very intelligent and deserve to be treated with respect as they advance their knowledge.  Sometimes, though, it takes a little conversation that does go over their head alittle to spark more questions in their quest for knowledge.   It would be too easy if "that is all there is".


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## Doughboy (Apr 1, 2008)

certguy said:


> Doughboy ,
> 
> Since when is assisting a conscious pt's respirations such a hard skill ?



Since... always?  Not trying to be a smart-***, but I don't think it's easy to do.  I've done it to tubed patients and trached patients, where there is more feedback from the pt's respirations than using a straight BVM, and I still think it's hard.  Add in road noise and bumps, and it becomes even more difficult.  


Vent:
.:sigh:.
I do think EMTs should know what ballpark % of O2 they are administering, as I have seen it taught in most EMT programs.  What I said was that I'd hate to see time in EMT classes dedicated memorizing what FiO2, PaO2, ETCO2, etc. mean [semantics], when it could be dedicated to learning the actual concepts of care in a meaningful way that will affect patient care.

I agree with you 100% about ongoing education, but, realistically, is the average cop who receives FR training only because he or she is required to really going to go search pubmed for resuscitation statistics?  This is why we need to be careful about the things we choose to teach at specific levels.  Checking for pulses is no longer taught in AHA heartsaver CPR.  I don't have to tell you why, because it sounds like you know your stuff, but clearly the trend is not towards complicating first responder training (which, in my mind, is not meant for medical professionals).


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## VentMedic (Apr 1, 2008)

Doughboy said:


> Vent:
> .:sigh:.
> I do think EMTs should know what ballpark % of O2 they are administering, as I have seen it taught in most EMT programs.  What I said was that I'd hate to see time in EMT classes dedicated memorizing what FiO2, PaO2, ETCO2, etc. mean [semantics], when it could be dedicated to learning the actual concepts of care in a meaningful way that will affect patient care.



I am DEFINITELY not about memorizing formulas that will be forgotten.  Did you even read why I mentioned the difference for the BVM at 40% and 100% before you started in with your criticism?   The BVM is what the thread is about.  I seriously don't think you would be interested in what information I could offer about the NC or NRBM.   However, there are others that might want to know a little more about that also.   

I also did not mention PaO2 or ETCO2 except when asked about it or in response to another member.  PEEP, however, should be discussed if the BVM has a built in PEEP valve because some have a tendency to crank it down to 10  or 20 cmH20 even in a code situation to "get more oxygen".  

The beauty of a forum is you don't have to read posts that don't interest you.  It also allows you to ask questions that those in your immediate vicinity can not answer.   There are also forums for cops and FFs if the medical conversation here is too intense for them.  This forum has a variety of members from FR to Paramedic to RNs to RRTs and various combinations of all credentials. Most are seeking more medical information.  The OP's questions have been answered and  a link to another thread was added for more information at a basic level.   The thread continued as it should if there are more questions.  It shouldn't just stop with one or two posted answers. 

This BVM question may be of interest to many levels, not just a FR.  I teach med students, doctors both MDs and PhDs, as well as RNs the basics of the BVM all the time.  This is not a unique question. 

Dumbing done information is not always the best approach.  Expecting very little from providers has left EMS in the dark ages when compared to other  health care professions.  

I really don't know why you are so hung up on "FiO2" being used.  I can use oxygen in percentage since I see that is what you use in your posts if that makes you happier.


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## skyemt (Apr 1, 2008)

Doughboy said:


> Omar, I wasn't asking if you could or could not use a BVM, but whether or not you could use it on a conscious patient.  Making a blanket statement about your scope of practice, i.e. that you can do anything an EMT can do, is pretty hazardous.  Have you been trained to do everything an EMT has been trained to do?  I'm really asking because I'm unfamiliar with your state's protocols, and the CONN OEMS' web page is borderline incomprehensible, but have you been trained to administer medication, for example?  If not, and an EMT let you do this, they'd be putting their license at risk by letting you do it.  I'm not trying to rag on your certification level at all, I just don't know.
> 
> 
> Sky, I'll try to address this in a way that doesn't get my post deleted:
> ...



i respond to what i read... if you don't agree, then ignore it!

i do have a question for you, that i believe will clear up where i am coming from...

let's say there is a basic, who has as you say recognized the need to use the BVM... he has a good seal, knows the rate... however, you notice that the reservoir bag has not been used... DO YOU HAVE AN ISSUE WITH THIS??

i will await your answer.


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## Explorer127 (Apr 1, 2008)

woah, this is wayyy more controversal than i thought it was gonna be... i just wanted to know a little about using a bvm on a conscious pt.

lol

btw, the question's been answered. 

except for one part....can u use a face mask if u don't have bvm with u?

i know someone's gonna sayy something about the oxygen percentage stuff.. i know a facemask only gives 16%, and a bvm can give either 21% or 99-100%....but if a facemask is all u have wouldn't it be better than nothing?


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## VentMedic (Apr 1, 2008)

omarsobh said:


> btw, the question's been answered.
> 
> except for one part....can u use a face mask if u don't have bvm with u?



What type of face mask?

One made for CPR rescue breathing, yes, if necessary but could be awkward depending on level of consciousness.  

For oxygen masks like a simple or NRBM, that depends on the rate and quality of breathing being done by the pt.


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## Explorer127 (Apr 1, 2008)

yea, i was talking about a cpr mask. thanks


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## EMTDON970 (Apr 14, 2008)

*Bvm*

I have "bagged" many conscious patients.


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