# What is your preferred ventilation method?



## paramedichopeful (Aug 19, 2009)

I am just curious as to which ventilation method you prefer to use on your patients, BVM wise. My intstructor gave us 3 ways of ventilating the patient if we must do it by ourselves. We can use one hand to hold the seal on the mask and the patient's face and squeeze the bag with the other. Another way was to use one hand to squeeze the bag while holding the mask-face seal using a headlock-looking maneuver. The 3rd option was to use both hands to hold the seal and put the bag between your body and your arm, squeezing the bag in up against your body with your arm and thus creating exceptional tidal volumes. I just want to know what you guys prefer. I personally like the body-squeeze method best. It leaves both hands free to make a good enough seal and still allow you to get enough of a compression on the bag. I've only done it on the training dummy in class, but I'm wondering if there's any difference in how well the methods work on a real patient. Any advice?^_^


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## Burlyskink (Aug 19, 2009)

Well, speaking from my experience in class thus far, I prefer having one hand holding the mask with the CE method. While also using my hand holding the bag to squeeze and help apply pressure to the seal.


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## paramedichopeful (Aug 19, 2009)

Burlyskink said:


> Well, speaking from my experience in class thus far, I prefer having one hand holding the mask with the CE method. While also using my hand holding the bag to squeeze and help apply pressure to the seal.


What exactly is the CE method? We didn't cover that in class.


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## Burlyskink (Aug 19, 2009)

paramedichopeful said:


> What exactly is the CE method? We didn't cover that in class.


You create a C with your thumb and your pointer finger that seals the mask, and you create an E with the rest of you fingers on the jaw to maintain the head-tilt-chin lift.

Edit - Here you go, I found an Image.







Edit Again - oops, I mixed it up a little, turns out it is called the EC method not the CE... sorry about that


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## paramedichopeful (Aug 19, 2009)

Burlyskink said:


> You create a C with your thumb and your pointer finger that seals the mask, and you create an E with the rest of you fingers on the jaw to maintain the head-tilt-chin lift.
> 
> Edit - Here you go, I found an Image.
> 
> ...


Thanks for posting the pic- made it a lot easier to understand. Thanks for gettin me lined out.


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## Sasha (Aug 19, 2009)

I prefer the patient to breathe on their own, and if that's not possible I prefer an ETT and BVM with a resqpod.


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## Burlyskink (Aug 19, 2009)

paramedichopeful said:


> Thanks for posting the pic- made it a lot easier to understand. Thanks for gettin me lined out.



No problem glad to help.

on topic: and obviously, my favorite  two man cpr(really 3 man, but meh) would be to have someone just seal/hold the mask with both hands using the EC position and have one person squeezing the bag. With the third person doing compressions periodically switching.



Sasha said:


> I prefer the patient to breathe on their own, and if that's not possible I prefer an ETT and BVM with a resqpod.



 Haha, I think we all prefer the patient to breath on their own.. but it doesn't always happen : (


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## paramedichopeful (Aug 19, 2009)

since I'm not the smartest cookie in the jar, can I ask what a "resqpod" is?


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## Dominion (Aug 19, 2009)

paramedichopeful said:


> since I'm not the smartest cookie in the jar, can I ask what a "resqpod" is?



http://www.advancedcirculatory.com/resqpod/product_overview.htm

"The ResQPOD prevents unnecessary air from entering the chest during CPR. As the chest wall recoils, the vacuum (negative pressure) in the thorax is greater. This enhanced vacuum pulls more blood back to the heart, doubling blood flow during CPR. Studies have shown that this mechanism increases cardiac output, blood pressure and survival rates. Patient ventilation and exhalation are not restricted in any way."

Edit: and a visual demo. http://www.advancedcirculatory.com/ResQMan/ResQPod512.wmv


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## Shishkabob (Aug 19, 2009)

I use one hand as to try to avoid hyperventilation.  Squeezing with both hands, especially with big hands, can lead to too much air being put in.


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## Sasha (Aug 19, 2009)

Dominion said:


> http://www.advancedcirculatory.com/resqpod/product_overview.htm
> 
> "The ResQPOD prevents unnecessary air from entering the chest during CPR. As the chest wall recoils, the vacuum (negative pressure) in the thorax is greater. This enhanced vacuum pulls more blood back to the heart, doubling blood flow during CPR. Studies have shown that this mechanism increases cardiac output, blood pressure and survival rates. Patient ventilation and exhalation are not restricted in any way."



It also has this little timer light that flashes when it's time to ventilate to prevent over ventilation or under ventilation. That's why I like it.


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## Dominion (Aug 19, 2009)

Sasha said:


> It also has this little timer light that flashes when it's time to ventilate to prevent over ventilation or under ventilation.



Yep, I like that feature.  It helps new firefighters or EMT's to know when to squeeze the bag.  Better than letting them go crazy with it.  When the local service got the pods they invited the reps of Resqpod to do an impromptu demo with it during one of their inservice days.  They had a seasoned medic with a good reputation come up and vent.  They did this for about 2 mins and let her do her thing.  She stayed on target.  Then they did another 2 mins but started asking her questions like "Whats the dosage for X", "Name the major bones and organs in the body," etc.  Before long she was squeezing along at a high rate.  They did the same thing with a new EMT.  Then they both came up and stood side by side and were given the pod.  Then asked different questions in the same format.  This time they were able to stay on target while watching the light blink and having the questions asked.


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## paramedichopeful (Aug 19, 2009)

Linuss said:


> I use one hand as to try to avoid hyperventilation.  Squeezing with both hands, especially with big hands, can lead to too much air being put in.


oh thanks guys. i watched the video and it all makes sense now.


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## ResTech (Aug 19, 2009)

If I'm ventilating a patient I use the c-clamp technique. If extra personnel are available, I prefer to have one person maintain the mask seal while I control the ventilatory rate and tidal volume delivered. 

It is also recommended that while ventilating a patient with a BVM, that someone maintain cricoid pressure throughout the entire ventilation process until the airway is secured to prevent gastric distention. One, if helps a lot to prevent vomiting and aspiration, and two, it helps to prevent the gastric distention from impeding on the intrathoracic volume which impedes ventilation.... in other words keeps from pushing the diaphragm upward towards the chest which decreases tidal volume.


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## HotelCo (Aug 19, 2009)

Important thing to remember about the resqpod is.. If the Pt has a pulse.. don't use it! It's only meant to be used during CPR.


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## Brandon O (Aug 19, 2009)

paramedichopeful said:


> The 3rd option was to use both hands to hold the seal and put the bag between your body and your arm, squeezing the bag in up against your body with your arm and thus creating exceptional tidal volumes.



Exceptional tidal volumes are not desirable unless you are ventilating the Cyclops. Stop when the chest rises.


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## Smash (Aug 20, 2009)

paramedichopeful said:


> thus creating exceptional tidal volumes.



What are 'execptional' tidal volumes?  Large?  Small?  Of particularly fine quality?  Lustrous or sparkly?


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## el Murpharino (Aug 20, 2009)

Sasha said:


> It also has this little timer light that flashes when it's time to ventilate to prevent over ventilation or under ventilation. That's why I like it.



I like ETCO2 and keeping it within 35-45 mmHg. I'm not familiar at all with a resQpod, so I can't speak for its efficiency or ease of use.


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## Seaglass (Aug 20, 2009)

Sasha said:


> It also has this little timer light that flashes when it's time to ventilate to prevent over ventilation or under ventilation. That's why I like it.



Same. I prefer to squeeze the bag one-handed, and hold the mask with a CE with the other hand.


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## paramedichopeful (Aug 20, 2009)

Smash said:


> What are 'execptional' tidal volumes?  Large?  Small?  Of particularly fine quality?  Lustrous or sparkly?



high volumes, but not high enough to cause distention or other problems


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## Dominion (Aug 20, 2009)

el Murpharino said:


> I like ETCO2 and keeping it within 35-45 mmHg. I'm not familiar at all with a resQpod, so I can't speak for its efficiency or ease of use.



Medics here tell the new guys about ETCO2 and how to keep it going.  But the ResQpod is nice on BLS trucks while waiting for medics or if the medic for whatever reason hasn't setup or isn't setting up ETCO2.


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## tlkennedy5 (Aug 21, 2009)

FROPVD (Flow Regulated Oxygen Powered Ventilation Device) for you students

basically...I push the button...you breath... 

HOWEVER...

if I don't have that on me....I prefer a well placed, verified, and secured endotracheal tube...lol


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## Smash (Aug 21, 2009)

paramedichopeful said:


> high volumes, but not high enough to cause distention or other problems



Ok, so what are high volumes?  How many ml/kg?  Why do you need high volumes anyway?  What sorts of pressure?  Aside from gastric insufflation what other problems are you avoiding and how?


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## Akulahawk (Aug 21, 2009)

tlkennedy5 said:


> FROPVD (Flow Regulated Oxygen Powered Ventilation Device) for you students
> 
> basically...I push the button...you breath...
> 
> ...


Sounds like the old Demand Valve with a 40cm H2O pop-off device. 
For BVM use: I prefer the CE method - one holding the mask and the other squeezing the bag. Otherwise, I also like the well placed, verified, secured ETT...


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## VentMedic (Aug 21, 2009)

tlkennedy5 said:


> FROPVD (Flow Regulated Oxygen Powered Ventilation Device) *for you students*
> 
> basically...I push the button...you breath...


 
These should only be in the hands of well trained personnel.  The Elder Demand Valve brought many complications to patients in the 80s but not because of it not being  a good device but because too many just thought you stuck it on the patient, pushed a button and that was all there was to it.

Even at a 40 cmH2O pop-off, you can still do some serious damage with improper use and rate.


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## MSDeltaFlt (Aug 21, 2009)

VentMedic said:


> These should only be in the hands of well trained personnel. The Elder Demand Valve brought many complications to patients in the 80s but not because of it not being a good device but because too many just thought you stuck it on the patient, pushed a button and that was all there was to it.
> 
> Even at a 40 cmH2O pop-off, you can still do some serious damage with improper use and rate.


 
Amen, Vent. Amen. If you don't know how you can "jack the pt up", then you probably shouldn't bother with this or any device like it. 

If the pt needs to be ventilated and you don't have the option of using a vent, the standard BVM with the "CE" hold (or "OK" hold as I was taught) will do just fine. It does take skill and hand strength/coordination to do it properly. You also get the "feel" of how well the pt can be or gets ventilated which is crucial.


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## tlkennedy5 (Aug 21, 2009)

I was kidding btw...I don't even know anyone that still uses a demand valve...though I'm sure someone does...I said it mainly for kicks


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## Akulahawk (Aug 21, 2009)

tlkennedy5 said:


> I was kidding btw...I don't even know anyone that still uses a demand valve...though I'm sure someone does...I said it mainly for kicks


Well, it does have one use... just hook it up to an E cylinder and go diving... just be careful that you don't exceed 1.3 ATM while breathing 100% O2...


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## VentMedic (Aug 22, 2009)

tlkennedy5 said:


> I was kidding btw...I don't even know anyone that still uses a demand valve...though I'm sure someone does...I said it mainly for kicks


 
No, they are quite common especially for FFs instead of a NRBM. As well they are used in some hospital cardiopulmonary labs for shunt studies. 

http://www.med-worldwide.com/prod/life-support-products-elder-cpr-demand-valve-71779


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## usafmedic45 (Aug 22, 2009)

> I was kidding btw...I don't even know anyone that still uses a demand valve...though I'm sure someone does...I said it mainly for kicks



They are also taught in diver-oriented first aid and rescue diver courses despite the risks that Vent previously mentioned that result when one puts such a device into incompetent hands.


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## JB_EMT (Aug 23, 2009)

I also prefer the CE method.


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## RescueYou (Aug 29, 2009)

Of course, 3 person CPR is great, but it's not too common. I personally choose to use the EC method for the mask and squeezing the bag between my arm and body in case my other hand is needed.


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