# Mastering the BVM



## bunkie (Sep 7, 2009)

I'm getting extremely frustrated with the BVM. I can't seem to get the seal on right. I am told my "technique is good" but if the PT isn't getting air, wtf is the point of my technique? The trouble is that a lot of our rescue annies are beat to sam hell and back and dont have airways to begin with. :wacko: So you can't really confirm on a lot of them that you are getting chest rise. That chest was crushed about 60 students ago.  I will admit I get obsessive about perfection, but I feel that in this instance, its probably a character flaw that isn't too bad to have. 

Do you have any tips for me to master the BVM? And is there any way to tell that I have it sealed right even if my RA is broken in ten places? :glare:


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## Shishkabob (Sep 7, 2009)

If it's just you bagging, do the CE clamp and hold tight.  If there is an extra set of hands on the scene, have them use BOTH hands to hold the mask, and you do the squeezing.

People with smaller hands tend to have trouble doing it by themselves, and that's just something you'll have to deal with... or get a hand transplant.  Just press down on their face.  As my old teacher said... "There shouldn't be any blood in your fingertips"


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## Lifeguards For Life (Sep 7, 2009)

bagging a real patient feels totally different than a real patient. make sure you maintain a patent airway, TIGHTLY seal the mask around you're pt. face with an EC clamp, and watch to see if the dummies chest rises. We have a few dummies at our school, where the tubing is kinked or ripped and you can not possibly get chest rise no matter how good you bag him? can other people get chest rise on you're dummy? if they can ask for help to figure out what you are doing different. BVM is suppsedly the hardest basic skill to maintain. good luck


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## Lifeguards For Life (Sep 7, 2009)

also if i am bagging a pt on the floor, i will maintain their neck in that neutral position by holding their head in between my legs, EC clamp with left hand, and squeeze the bag against my right leg with my right hand


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## BossyCow (Sep 7, 2009)

Lifeguards For Life said:


> also if i am bagging a pt on the floor, i will maintain their neck in that neutral position by holding their head in between my legs, EC clamp with left hand, and squeeze the bag against my right leg with my right hand



Also the bag can be compressed against the pt's forehead.


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## Lifeguards For Life (Sep 7, 2009)

BossyCow said:


> Also the bag can be compressed against the pt's forehead.



lol.why would you want to compress the bag against the pt. head? i have never seen that before, but good to know. i imagine there would be several contraindications to this method, but cool. now i gotta go post this in the "what did you learn today thread"


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## el Murpharino (Sep 7, 2009)

Lifeguards For Life said:


> bagging a real patient feels totally different than a real patient.



I have found this to be true as well....


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## VentMedic (Sep 7, 2009)

BossyCow said:


> Also the bag can be compressed against the pt's forehead.


 
I have used my own leg to compress against but not a patient's head.  One may not have had a chance to know what cranial surgeries, injuries or meds the patients are on to know what damage can be done.  I wouldn't want to promote any leaks into or out of the skull for either air or fluid.   We are even concerned with the pressure of the mask although it is a necessary procedure.


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## 46Young (Sep 7, 2009)

When bagging the dummy, spread the mask apart a little with your fingers, then let it fall back into place on the dummy's face. This should help maintain a good seal.

When I'm bagging a pt on the floor or from the captain's seat, I'll use my knee on the pt's forehead to keep the head tilt position.


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## 46Young (Sep 8, 2009)

When bagging the pt, if there is a set of idle hands, cricoid pressure (cric) ought to be used. This will minimize gastric inflation, and direct the air through the trachea, where it belongs.

 Give yourself cric and then try to swallow. It can't be done.


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## Seaglass (Sep 8, 2009)

Do you have small hands? I trained with a guy who can't get a seal with one hand, so he uses both on the mask. He tucks the bag under his arm and compresses it against his ribs with his elbow. No idea if that would work in real life, but it worked with the dummy.


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## bunkie (Sep 8, 2009)

Thanks guys! No, my hands aren't small, but my thumb has limited movement from an accident where I sliced through the tendon. It's still fresh, happened in March but I do a lot of physical therapy on it and it's getting a lot better.  I do the EC, I keep the "patient" between my knees while I bag, but I never thought to use my leg to help. We have skills lab tomorrow, anxious to give all the tips a shot and see what works best for me.


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## RescueYou (Sep 8, 2009)

Lifeguards For Life said:


> bagging a real patient feels totally different than a real patient.



Absolutely true. I personally push tightly down with a CE grip on the mask and just hope for the best. But in real life, you can normally see the chest rise. If not, you may want to check your oral/nasalpharyngeal and seal and double check anything else. Your partner can be of great assistance in reality.


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## mycrofft (Sep 9, 2009)

*Sense.*

Of course you don't squish a crushed forehead with the bvm.....although some desk EMT will want to argue that anoxia kills faster than the skull frag you shoved through the corpus callosum to the cerebellum...

BVM's pretty dicey without some sort of airway. Manual is good if that's all you have. And make it a rule of thumb to have suction ready if you start inflating.


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## SurgeWSE (Sep 9, 2009)

*Bagging*

Assuming your pt is apneic, use some form of extraglottic airway (Combitube, King, LMA) as quickly as possible.  There is plenty of research showing that ET tubes or extraglottic airways deliver oxygen much more reliably than BVM +adjunct.  Until we manage to retrain a vast number of providers, we will continue to see poor delivery with the BVM.

If an extraglottic airway is not an option, the suggestions about using two hands to form a seal and bagging with your forearm or elbow will certainly help.  Something else to which you should pay attention is maintaining a neutral or sniffing position.  Pressing down on the face with the mask is intuitive, but you'll force the airway closed.  When you form the "EC" grip, make sure you're using the "E" portion to pull UPWARD on the the jaw, and assuming no suspected cervical injury, the whole face.  At the same time, push the "C" DOWNWARD into the "E."


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## VentMedic (Sep 9, 2009)

SurgeWSE said:


> Assuming your pt is apneic, use some form of extraglottic airway (Combitube, King, LMA) as quickly as possible. There is plenty of research showing that ET tubes or extraglottic airways deliver oxygen much more reliably than BVM +adjunct. Until we manage to retrain a vast number of providers, we will continue to see poor delivery with the BVM.


 
For the apneic patient, the goal is to ventilate the patient with can be done with or without supplemental oxygen. Some confuse oxygenate and ventilate especially since CCR is now advocating just placing a NRBM on the patient that has coded. 

ETTs are more effective because they are subglottic devices but require skill and education to place. So yes, an ETT is more effective than a BVM if properly placed.

LMAs, King and Combitubes are supraglottic and while some believe they are no brainers to place, if these devices are poorly placed, they fail to ventilate the patient. When it comes to the damage that can occur with a Combitube, I would rather see some master the BVM. The King is better but still, one should know how to use the BVM correctly and definitely after it is attached to either a supra or subglottic device with is also a difficult skill for some to master.


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## bunkie (Sep 18, 2009)

Just an update. I've gotten the hang of the BVM. And aced my airway assessment module. Thanks everyone.


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## 46Young (Sep 18, 2009)

bunkie said:


> Just an update. I've gotten the hang of the BVM. And aced my airway assessment module. Thanks everyone.



Good stuff. What worked for you?


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## bunkie (Sep 18, 2009)

:blush: Not pushing so hard on the mask. Bringing the face into it rather then pushing it to the face. If that makes sense.


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## fiddlesticks (Sep 19, 2009)

well the only thing that really helps is doing it in real life we did it in the OR in my paramedic program. it helped me to  make a good seal. does your school do any OR time?


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## bunkie (Sep 19, 2009)

We're doing ED rotations, thats it. But we practice on each other in class on skills days.


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## fiddlesticks (Sep 19, 2009)

thats always a good way to help to, its too bad you can't get some OR time or even time with an RT. that was a good rotation for me as well.


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## bunkie (Sep 19, 2009)

fiddlesticks said:


> thats always a good way to help to, its too bad you can't get some OR time or even time with an RT. that was a good rotation for me as well.



At least the classmates can't complain. ^_^


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## fiddlesticks (Sep 19, 2009)

yeah thats true


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## Shishkabob (Sep 19, 2009)

bunkie said:


> At least the classmates can't complain. ^_^



Just don't go in to medic school with that mentality...

I hate poking people that can poke me back :wacko:


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## bunkie (Sep 19, 2009)

Linuss said:


> Just don't go in to medic school with that mentality...
> 
> I hate poking people that can poke me back :wacko:



:lol: There is little chance for revenge here.


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## VentMedic (Sep 19, 2009)

bunkie said:


> :lol: There is little chance for revenge here.


 
I can't believe you wrote that.


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## bunkie (Sep 19, 2009)

VentMedic said:


> I can't believe you wrote that.



The worst my classmates can do is leave me strapped to a board or beat me with the RA.


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## fiddlesticks (Sep 20, 2009)

Or they could start  a 14g iv on you that would suck


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