# Pocket mask vs BVM



## Rin (Mar 23, 2014)

Is there any place that actually habitually does the recommended mouth-to-mask to assist ventilations instead of the BVM?  'Cause I gotta say, there's no mask or face shield big enough to get me to put my face that close to a patient.  Folks that got started in the bad ol' days of mouth-to-mouth were hardcore.


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## Handsome Robb (Mar 23, 2014)

No. We're healthcare professionals...we've got the appropriate tools why not use them?

Do they even teach mouth to mask anymore?

I am not risking my health for a complete stranger...I'll take calculated risks but that is not one of them, especially when ventilation is falling out of favor in cardiac arrests.


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## mycrofft (Mar 23, 2014)

ARC still teaches and distributes (covered by fee) "rescue mask" for their CPRO classes. Same class also covers BVM. Not airways.


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## Rin (Mar 23, 2014)

Mouth-to-mask (w/ supplemental O2) is in all the books as the preferred method because it delivers the highest concentration of oxygen.


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## mycrofft (Mar 23, 2014)

BVM with 25 lpm can achieve nearly 100% oxygen, while Rescue mask require's rescuer's breath, therefore inserting gasses besides oxygen. 

Pocket mask makes a good ad hoc BVM mask though.


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## Handsome Robb (Mar 23, 2014)

Rin said:


> Mouth-to-mask (w/ supplemental O2) is in all the books as the preferred method because it delivers the highest concentration of oxygen.




It is not the preferred method.


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## DrParasite (Mar 23, 2014)

Robb said:


> It is not the preferred method.


it is the prefered one person airway delivery.  In fact, for the AHA CPR for healthcare providers, you start airways with a pocket mask, and only switch to BVM once a second person arrives.


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## MonkeyArrow (Mar 23, 2014)

DrParasite said:


> it is the prefered one person airway delivery.  In fact, for the AHA CPR for healthcare providers, you start airways with a pocket mask, and only switch to BVM once a second person arrives.



Really? When I took my AHA CPR for Healthcare Providers course, I don't think we ever even touched a pocket mask. It was always BVM, one person and two person ventilations.


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## RebelAngel (Mar 23, 2014)

I would if I had to. No way I'm doing the less effective one person bvm. I don't want that on my shoulders when mouth to mask is recommended over one person bvm. In other instances it would be bvm with supplemental O2. 

I actually carry a pocket mask in my purse and a pocket mask and adult bvm in my bag.


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## DesertMedic66 (Mar 23, 2014)

DrParasite said:


> it is the prefered one person airway delivery.  In fact, for the AHA CPR for healthcare providers, you start airways with a pocket mask, and only switch to BVM once a second person arrives.



This.


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## NomadicMedic (Mar 23, 2014)

RebelAngel said:


> I would if I had to. No way I'm doing the less effective one person bvm. I don't want that on my shoulders when mouth to mask is recommended over one person bvm.







Don't take this the wrong way, but you're clearly very new. Work a few messy arrests, and you'll learn the very last thing you want to do is get your face right next to the chum fountain. 

You'd be far better off doing compression only CPR for a few minutes anyway. Stopping to ventilate a code isn't a great idea.


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## Handsome Robb (Mar 23, 2014)

Thank you DE.

Since we're on the more effective path...don't ventilate and just do compressions...since that's what's proven to work along with defibrillation.

Compressions and early defibrillation.

I don't really see ventilations in there...


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## DesertMedic66 (Mar 23, 2014)

Robb said:


> Thank you DE.
> 
> Since we're on the more effective path...don't ventilate and just do compressions...since that's what's proven to work along with defibrillation.
> 
> ...



I clearly see it 

//troll


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## NomadicMedic (Mar 23, 2014)

Okay. Be nice.


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## Handsome Robb (Mar 23, 2014)

:nosoupfortroll:


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## Handsome Robb (Mar 23, 2014)

MonkeyArrow said:


> Really? When I took my AHA CPR for Healthcare Providers course, I don't think we ever even touched a pocket mask. It was always BVM, one person and two person ventilations.




This.

They don't teach pocket mask in AHA HCP BLS. Not that I remember and I've taken it a few times...


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## Brandon O (Mar 23, 2014)

Robb said:


> This.
> 
> They don't teach pocket mask in AHA HCP BLS. Not that I remember and I've taken it a few times...



They ought to be. It's in the video.


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## Handsome Robb (Mar 23, 2014)

Brandon O said:


> They ought to be. It's in the video.



Maybe I just don't remember it. 

Doesn't matter, still not going to get me to use one.


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## Brandon O (Mar 23, 2014)

Robb said:


> Maybe I just don't remember it.
> 
> Doesn't matter, still not going to get me to use one.



It's the kind of thing instructors like to fast-forward through.

I recognize that it doesn't reflect actual practice very well, but I think it's valuable to keep reminding people that one-person BVM kinda sucks and you shouldn't be doing it. (Obviously the preferred alternative would be two-person, not mouth to anything, although I do think providers should be aware of the options.)


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## Handsome Robb (Mar 23, 2014)

Brandon O said:


> It's the kind of thing instructors like to fast-forward through.
> 
> 
> 
> I recognize that it doesn't reflect actual practice very well, but I think it's valuable to keep reminding people that one-person BVM kinda sucks and you shouldn't be doing it. (Obviously the preferred alternative would be two-person, not mouth to anything, although I do think providers should be aware of the options.)




I do agree with being aware of options. Where I work it'd be pretty rare to not have enough hands around to have a two person BVM going.

When I've had to start bagging in the back with no FF on board (or on scene and fire isn't there yet) I take a BVM mask, my silly little demand valve "ventilator" and attach the circuit to the mask and set it then hold the mask with two hands while the vent cycles at the set RR/TV. 

Also our CPAP masks are compatible with these circuits as well and I've had good luck with that with conscious patients that needed PPV and weren't nauseous or actively vomiting. Then I don't even have to hold anything.


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## DesertMedic66 (Mar 23, 2014)

Robb said:


> This.
> 
> They don't teach pocket mask in AHA HCP BLS. Not that I remember and I've taken it a few times...



We still teach it and have to test students out on it.


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## Tigger (Mar 23, 2014)

I can't get anyone to two person BVM with me here. It's absurd. "We don't have enough hands!" Really? There's two firefighters standing there looking for something to do...solved.


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## RebelAngel (Mar 23, 2014)

We're very small. Typically it's one EMT and the ambulance driver on runs. 



Robb said:


> I do agree with being aware of options. *Where I work it'd be pretty rare to not have enough hands around to have a two person BVM going.*
> 
> When I've had to start bagging in the back with no FF on board (or on scene and fire isn't there yet) I take a BVM mask, my silly little demand valve "ventilator" and attach the circuit to the mask and set it then hold the mask with two hands while the vent cycles at the set RR/TV.
> 
> Also our CPAP masks are compatible with these circuits as well and I've had good luck with that with conscious patients that needed PPV and weren't nauseous or actively vomiting. Then I don't even have to hold anything.


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## RebelAngel (Mar 23, 2014)

DesertEMT66 said:


> We still teach it and have to test students out on it.



We learned both mouth to mask and BVMs.


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## Tigger (Mar 23, 2014)

RebelAngel said:


> We're very small. Typically it's one EMT and the ambulance driver on runs.



I'd hope the driver has a CPR card though. And even if they don't, it doesn't take a course to squeeze the bag when told.


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## Carlos Danger (Mar 23, 2014)

RebelAngel said:


> We're very small. Typically it's one EMT and the ambulance driver on runs.



All the more reason to try to become proficient with single-person mask ventilation.

It's not an easy skill to learn, and sometimes it's nearly impossible to do. But if you try to get good at it, there will be times that it comes in handy.


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## mycrofft (Mar 23, 2014)

I think the crux of statements praising the pocket mask are based upon it being very difficult for many people to do a BVM by themselves, so they can use a pocket mask individually. Rinn, I didn't mean to sound demeaning.

Inflations or rescue breathing in a code, especially at the very first, are important in the algorithm besides making sure the blood we're compressing around is still red not blue, because in an unwitnessed man down with loss of consciousness and apparent pulselessness/apnea, there is no other way to ascertain that there is not a supratracheal airway embarrassment.

"Codes" originating from airway embarrassment are much more "salvageable" than codes originating from lethal MI, or series of MIs. However, pumping away and ignoring that cocktail weeny wedged by the epiglottis just evened out the playing field to about 0%.


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## mycrofft (Mar 23, 2014)

PS: I demonstrate to my CPRO students how tricky it is to do a one-man BVM, then go on to show how to do it and use the video as a basis for what can be done better (e.g., GRAB that mask with your _hand_, not your _fingers_ as shown, and get it right up by the connector to the valve, making a seal any way you can without losing the airway).


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## Brandon O (Mar 23, 2014)

mycrofft said:


> "Codes" originating from airway embarrassment are much more "salvageable" than codes originating from lethal MI, or series of MIs. However, pumping away and ignoring that cocktail weeny wedged by the epiglottis just evened out the playing field to about 0%.



I think you may be overestimating the number of unwitnessed arrests that are due to cocktail weenies.


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## mycrofft (Mar 23, 2014)

Anyone eating cocktail weenies without witnesses might be a bachelor borderline alcoholic. 

He might be an EMT. 

But, I am repeating myself.  *
-------------------------------------------
Many more codes IN ADULTS will be due to MI or stroke than airway embarrassment, but even the first attempt to ventilate will hopefully assess whether the airway is patent or not. I show my students a two-foot diameter pie chart with a skinny little slice out of it. The slice represents the non-MI/non-CVA true codes, which is airway embarrassments, electrocutions, etc (and largely kids), and the best candidates for a save.


*Apology to Mark Twain's joke about US senators and liars.


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## DrParasite (Mar 23, 2014)

Robb said:


> This.
> 
> They don't teach pocket mask in AHA HCP BLS. Not that I remember and I've taken it a few times...


Throwing the BS flag on this.

Feel free to check out the AHA CPR guidelines here http://www.evms.edu/media/evms_publ...r_life_support/AHA_SKILL_CHECK_SHEETS_ALL.pdf under step 4, after minimizing interruptions.

I'm not saying I would be ever using one in the field, but it is taught in class, and you should be proficient in it if you have a valid AHA HCP card.

btw we don't get the FD on cardiac arrests.  usually a 2 person BLS crew and a 2 person ALS crew.


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## mycrofft (Mar 23, 2014)

*Opened the link...*

I thought ARC paperwork was like income tax!

I see BVM for BLS but not rescue mask. Am I missing it?

I do not like make-believe scenarios. I think they are insulting to adults unless they are good at and like "make believe". I prefer to make them demonstrate skills while I furnish correction PRN.


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## Handsome Robb (Mar 23, 2014)

DrParasite said:


> Throwing the BS flag on this.
> 
> Feel free to check out the AHA CPR guidelines here http://www.evms.edu/media/evms_publ...r_life_support/AHA_SKILL_CHECK_SHEETS_ALL.pdf under step 4, after minimizing interruptions.
> 
> ...



Well I can provide a copy of my card. Like I said I very well could've toned it out and missed it. Very possible. Who knows. 

I know how to use a pocket mask. Had to demonstrate it plenty of times in my lifeguarding career. Demonstrating it once on a mannequin doesn't equal proficiency.


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## mycrofft (Mar 24, 2014)

DEmedic said:


> ... Work a few messy arrests, and you'll learn the very last thing you want to do is get your face right next to the chum fountain.



DEMedic…some things can't be unheard. Or unread. Man oh man oh man….:wacko:


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## ThadeusJ (Mar 25, 2014)

Pocket masks were designed to be used by the lay person and now that they recommend compressions only for one person CPR, they should still be carried in the event that two people are there and want to do something for the patient.  

For the skilled medic, BVM's are far superior for their ability to 1) provide 100% oxygen, 2) provide and gauge the quality of ventilations, 3) allow the user to view the scenario better (you can't really see the scene when you're face to face with your patient).  Although good pocket masks have filters, BVM's place you at arm's length and the good ones allow you to place a filter on the exhalation port (although I have found that most services don't even carry filters).

Pocket masks may be advocated due to their lower cost, but in my opinion they have no place in a professional service (maybe in your car for the way home, but not on an ambulance).


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## Household6 (Mar 25, 2014)

This is Limmer, Emergency Care 12th Edition.. I remember that I highlighted it, because I didn't think it was right.. But it did come up on the test. I keep a pocket mask with an O2 port in my First Responder bag.. I haven't used it yet.


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## mycrofft (Mar 25, 2014)

Household6 said:


> This is Limmer, Emergency Care 12th Edition.. I remember that I highlighted it, because I didn't think it was right.. But it did come up on the test. I keep a pocket mask with an O2 port in my First Responder bag.. I haven't used it yet.



Check that mask periodically. Those with O2 nipples can become too stiff to open up


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## ThadeusJ (Mar 28, 2014)

Regarding the quote from a textbook, I have to caution that we shouldn't take things from texts unless they are referenced. Anyone can write a text and use "experts" to fill in the blanks.  As we know, the death knell for quality is doing something because "we've always done it this way and it seems to work".

I attend a lot of conferences and have come across several paramedic texts that are just plain wrong. In one, I saw an oxygen setup that was quite dangerous and went looking for it as an example here.  Well, today on one of my Respiratory Therapy Facebook groups, this was found in a hospital (The exact same setup seen in the text I was referring to).  I have to share this with the group as example of what you see in a text ain't necessarily correct:


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## Av8or007 (Mar 29, 2014)

Is that a large volume nebulizer connected to small bore o2 tubing?...

If so, scary.


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## chaz90 (Mar 29, 2014)

ThadeusJ said:


> In one, I saw an oxygen setup that was quite dangerous and went looking for it as an example here.  Well, today on one of my Respiratory Therapy Facebook groups, this was found in a hospital (The exact same setup seen in the text I was referring to).  I have to share this with the group as example of what you see in a text ain't necessarily correct:



Okay, I'll admit to my ignorance. I know absolutely nothing about how this should be set up. What is it (large volume nebulizer/humidifier?), what's wrong with it as is, and how should it be set up?


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## Av8or007 (Mar 29, 2014)

I'm not exactly sure what it is either, but aerosol therapy from a neb or large vol neb usually needs larger bore tubing from neb to pt.

If not, im assuming aerosol/fluids could collect in the o2 tubing going to the pt and impede gas flow.


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## mycrofft (Mar 29, 2014)

ThadeusJ gets my vote for "T-Shirt of the Week":

 As we know, the death knell for quality is doing something because "we've always done it this way and it seems to work".​
But remember: sometimes that's all you've got.:sad:


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## ThadeusJ (Mar 29, 2014)

Sorry all, stepped away for a bit...yes, this setup is an armful of respiratory pieces that can fit together...so here's what they did to provide humidification for nasal cannula (starting at the oxygen outlet):  hook up a high humidity nebulizer made to attach to wide bore tubing, which goes to a mask or trach mask for maximal humidity (these humidifiers have venturis on them as well to adjust FiO2)...then they attached another venturi (used on venturi masks) so now this venturi is actually attached "backwards" in the system...THEN they attached the nasal cannula to the nipple...given the use of the venturi used as a connector, I doubt much oxygen made it to the patient.

I have actually seen this very setup in a paramedic text (possibly written by the ICU nurse who set this setup up).   This picture was posted by a RT colleague in some hospital in the US.  

The message I wanted to convey is "just because its in a text, it ain't necesarily correct".


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## spnjsquad (Apr 1, 2014)

BVM is the way to go. You don't know how long it's been since you paitent touched a toothbrush haha.


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## rockyfortune (Apr 4, 2014)

I just finished up emt school on march 27th and i can say all they talk about is pocket masks...they make you do a skill station cpr/aed with a pocket mask...they stress that its hard to get a good seal with a one person bvm--but bvm for an apneic patient skill station you are a one man show...doesn't make sense to me but that's how it is taught.


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