# blow by 02



## DV_EMT (Dec 11, 2009)

so i've been watching a few health shows lately and I've been seeing a lot of the EMT's using a BVM on an A/Ox3 infants... is this the proper method of delivering O2? why not use a NRB with the blow by method? is there a benefit to using the BVM? Do they hold a tight seal? any info from other EMT's would be appreciated (as i have not yet been sent for any infant calls).


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## VentMedic (Dec 11, 2009)

DV_EMT said:


> so i've been watching a few health shows lately and I've been seeing a lot of the EMT's using a BVM on an A/Ox3 infants... is this the proper method of delivering O2? why not use a NRB with the blow by method? is there a benefit to using the BVM? Do they hold a tight seal? any info from other EMT's would be appreciated (as i have not yet been sent for any infant calls).


 
Unless it is a flow inflating bag, which in the field in the U.S..not, they are suffocating the infant unless they have taken over actively assisting respirations. A self inflating BVM does not provide any free flow O2 and the valve takes in excess of 20 cmH2O of pressure to open if one has a very tight seal. Even cupping your hand with O2 tubing between your fingers and placed lightly over the child's face would be much safer.


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## nomofica (Dec 11, 2009)

Somebody has been watching Trauma.

I'd be using a ped NRB as well.


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## VentMedic (Dec 11, 2009)

nomofica said:


> I'd be using a ped NRB as well.


 
But only if you are actively ventilating a child. That could be difficult on an alert child.   The pedi BVM also does not provide free flow O2.

One that is spontaneously breathing just needs supplemental O2 by mask or NC.


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## Lifeguards For Life (Dec 11, 2009)

on the topic of blowby 02,

at 15lpm, holding the 02 source 2 inches from the face gives an O2 concentration of 40%. one inch gives roughly 60 percent and 1/2 inch will deliver approximately 80% O2 concentration.

Something I recently learned, that was not taught to us in basic


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## nomofica (Dec 11, 2009)

VentMedic said:


> But only if you are actively ventilating a child. That could be difficult on an alert child.   The pedi BVM also does not provide free flow O2.
> 
> One that is spontaneously breathing just needs supplemental O2 by mask or NC.



To be honest, I'd probably still be using a pedi NRB on an alert infant w/ good resps. I've never witnessed a child put up with an NC being shoved up their nostrils, especially when they're not used to having O2 being administered to them. I tend to put a ped on an NRB w/ ~ 10 LPM for supplementary O2 if the pt obviously does not like an NC. Never been called out on it. Keeps the kid a little less fidgety.

Nobody likes an extremely dry nasopharynx. Especially peds. And nobody likes when a baby is crying. Nobody.h34r:


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## JPINFV (Dec 11, 2009)

Just curious, does anyone have any experience with the alternative delivery methods like the Kidosbear Pediatric Oxygen Bear?


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## VentMedic (Dec 11, 2009)

nomofica said:


> To be honest, I'd probably still be using a pedi NRB on an alert infant w/ good resps. I've never witnessed a child put up with an NC being shoved up their nostrils, especially when they're not used to having O2 being administered to them.
> 
> Nobody likes an extremely dry nasopharynx. Especially peds. And nobody likes when a baby is crying. Nobody.h34r:


 
The NC is the only way we give O2 to children in the hospital who do not require much support.  Even at 1 - 2 liters they get a very high concentration of oxygen due to their low minute volumes to where it sometimes has to be ran off a blender for a precise concentration less than an FiO2 of 1.0.    Infants must also feed, usually by bottl,e which makes a mask very difficult to work around.  As well, few children want their face placed in plastic such as a mask which is why there is a huge market for child friendly gadgets such as the Teddy Bear that provides O2 while the child is held close to it.   I have  of course resorted to the paper cup and O2 tubing.


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## nomofica (Dec 11, 2009)

VentMedic said:


> The NC is the only way we give O2 to children in the hospital who do not require much support.  Even at 1 - 2 liters they get a very high concentration of oxygen due to their low minute volumes to where it sometimes has to be ran off a blender for a precise concentration less than an FiO2 of 1.0.    Infants must also feed, usually by bottl,e which makes a mask very difficult to work around.  As well, few children want their face placed in plastic such as a mask which is why there is a huge market for child friendly gadgets such as the Teddy Bear that provides O2 while the child is held close to it.   I have  of course resorted to the paper cup and O2 tubing.



Eh, just from my experience the kids I've dealt with much preferred the NRB over the NC. We don't actually have the child-friendly O2 toys, so I have no knowledge of how practical they are/aren't.


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## medicdan (Dec 12, 2009)

I have transported kids with the "OxyPhone" nebulizer short distances before, and it seems to work wonders. 




http://www.oxyphone.com/home.html


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## Lifeguards For Life (Dec 12, 2009)

emt.dan said:


> I have transported kids with the "OxyPhone" nebulizer short distances before, and it seems to work wonders.
> 
> 
> 
> ...



thats awesome! way more cool than the o2 bears


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## Dominion (Dec 12, 2009)

We have Ped NC and NRB and infant NRB, the one call I've had where an infant needed O2 I couldn't get the mask to work well.  I ended up doing close blow by with a ped mask.


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## DV_EMT (Dec 12, 2009)

nomofica said:


> Somebody has been watching Trauma.



Actually... it wasn't trauma supprisingly... it was the TV show, "Your Kid ate What?" Its actually pretty good... its on discovery health. But when they showed the EMT and Medic using a BVM... i was a little confused at they're method... hence the question.


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## redcrossemt (Dec 12, 2009)

DV_EMT said:


> Actually... it wasn't trauma supprisingly... it was the TV show, "Your Kid ate What?" Its actually pretty good... its on discovery health. But when they showed the EMT and Medic using a BVM... i was a little confused at they're method... hence the question.



If I'm correct, you can use an anesthesia bag to provide 100% oxygen, but a self-inflating BVM like those we all carry will not work unless providing PPV.


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