Adult Bag Valve Mask use on child?

[Legacy_Camaro]

I lifeguard at a local pool here in Salt Lake, and our pool manager has been teaching the lifeguard newbies that they can use the adult bag valve mask on a child/infant if they are really really careful.

I'm also EMT-I and I'm almost positive that a lifeguard newbie who has never done CPR before in their life could use an adult BVM on a child/infant without it ending in total disaster.

I'm pretty sure that protocol in most places says that if your going to use a BVM, you have to use the appropriate size for the patient.

I can't find anything on the internet for or against it however, I could use some help.

 

[firecoins]

you can use an adult but you should not defalte the whole bag. You need alot less air than the air an adult BVM provides. Honestly, amateurs should have the right size.

 

[MMiz]

First, welcome to EMTLife!

You should not be using an adult BVM on a child/infant. Just because it's possible doesn't make it right or legal. I sure wouldn't want to be the provider on the end of a lawsuit for using an adult BVM on a child or infant.

Again, one can use adult AED pads on a child, and once I read in a medical journal about some doctor in a remote location using a car battery as a defibrillator. Spend the extra $20 and get separate adult/child/infant BVMs. I can't think of a single argument against separate BVMs.

I hope that helps!

 

[Aidey]

I lifeguard at a local pool here in Salt Lake, and our pool manager has been teaching the lifeguard newbies that they can use the adult bag valve mask on a child/infant if they are really really careful.

I'm also EMT-I and I'm almost positive that a lifeguard newbie who has never done CPR before in their life could use an adult BVM on a child/infant without it ending in total disaster.

Are we talking the mask or the bag? Because no, you really can't use the mask on a smaller person because it won't seal. You can use the bag on a smaller person. Remember, you are looking for chest rise. How big the bag is doesn't matter as long as you are only inflating to chest rise.

 

[akflightmedic]

Agree with spend the extra $20 to have appropriate size BVM on hand.

Should that not occur anytime soon and you find yourself trying to use an adult BVM on a child, remember only inflate until you see chest rise and do not squeeze forcefully.

Also, you will not get a good seal or any seal most likely, so turn the mask upside down. It fits better and will work better and that little last resort tip is only if the numbskull does not buy the right equipment.

Otherwise, me personally, I would carry my own pocket mask and use that as opposed to using wrong equipment. Certainly would stand up better when you are explaining yourself to the lawyers in court.

 

[Veneficus]

and once I read in a medical journal about some doctor in a remote location using a car battery as a defibrillator.

3 or 4 years ago one of my classmates actually took the time to convert 200joules to amps and volts. I admit I don't remember the exact numbers but I remember it being somewhere around 100 amps and 50,000 volts.

 

[truetiger]

There's absolutely nothing wrong with using an adult bvm with a child mask if you have to, that doesn't make any excuse for not having one. Just ventilate to get adequate chest rise and be careful not to fully depress the bag, easy enough.

 

[LucidResq]

Otherwise, me personally, I would carry my own pocket mask and use that as opposed to using wrong equipment. Certainly would stand up better when you are explaining yourself to the lawyers in court.

+1

I would imagine easier to limit the volume of air you're pushing than with an adult BVM as well...

 

[EMSLaw]

Otherwise, me personally, I would carry my own pocket mask and use that as opposed to using wrong equipment. Certainly would stand up better when you are explaining yourself to the lawyers in court.

Remember that in the unlikely event that a case against you made it to trial (something like only 1% of civil cases do. The vast majority are disposed of by settlement, or pre-trial motion, or some other means), you aren't explaining yourself to the lawyers. You're explaining yourself to the jury.

So, if the adult BVM is the only thing you have available, and you're faced with an apneic child, the explanation would be that you did the best with what you had, presumably.

Also, as I recall, the trick of turning the adult mask upside-down to use it on a child is mentioned in the standard EMT-B books, so it could be argued quite successfully that, while not ideal, it is a part of the standard of practice and a skill well within the scope of an EMT. It's certainly preferable to letting someone die of suffocation.

Incidentally, since the risk of litigation seems to come up a lot... Consider the following. The National Practitioner Data Bank's 2006 Annual Report reveals that from 1990-2006, 158 malpractice reports were made against 157 EMTs (or "Emergency Medical Practitioners"). The number of malpractice claims against EMTs of all levels, from basic to paramedic are vanishingly small. While the NPDB isn't a definitive source, consider the always-risk-averse insurance industry - malpractice insurance for an EMT or Paramedic costs somewhere around $150.00 a year. Malpractice insurance for an MD might exceed a thousand times that number, in some high-risk specialties.

This isn't a suggestion that you go out and do what you want, and please don't take it that way. But also don't allow the fear of litigation to rule your practice, either.

Sorry, I'll step off my soap box now.

 

[mycrofft]

EMS law, that's awesome.

Dang, facts, how can we operate with those?

Anyway...if it's life or death and likely to work, try it. You can seal the whole face ito the mask if it will allow proper inflation, but you have to look at the pt, something we do less and less of nowadays in between looking at monitors, writing paperwork, and texting our friends.

 

[EMSLaw]

Some further information...

According to the latest nationwide study, which is admittedly 16 years old, the incidence of litigation against EMS practioners is small:

Total of 76 cases over 5 years:
• Just over 40% of the cases were
dismissed
• Five cases with plaintiffs' awards or
settlements greater than $1 million

Source: Prehosp Disaster Med. 1994 Oct-Dec;9(4):214-20; discussion 221.

This from a very good slideshow on EMS liability by Ryan Stark, Esq. of Page, Wolfberg & Wirth in Pennsylvania.* It's available here, and I would recommend it to anyone interested in the liability issues in EMS. The case studies are interesting, but illustrate the sort of egregious conduct that leads to malpractice lawsuits against EMTs and Medics.

I'd be happy to discuss these issues with anyone who is interested. Otherwise, I'm moving the soap box back into storage.

*-Hrm... I wonder if they're hiring. Do you think they have a physical agility test as part of the process?

 

[8jimi8]

Agree with spend the extra $20 to have appropriate size BVM on hand.

Should that not occur anytime soon and you find yourself trying to use an adult BVM on a child, remember only inflate until you see chest rise and do not squeeze forcefully.

Also, you will not get a good seal or any seal most likely, so turn the mask upside down. It fits better and will work better and that little last resort tip is only if the numbskull does not buy the right equipment.

Otherwise, me personally, I would carry my own pocket mask and use that as opposed to using wrong equipment. Certainly would stand up better when you are explaining yourself to the lawyers in court.

Seriously, get a pocket mask with an oxygen inlet port. Maybe you could go above your manager's head and ask the owner. You can use your textbook to show him that there are different and correct sizes that need to be used.

I'm sure there is some type of regulations that would actually require a pool to carry rescue equipment of appropriate sizes for the clients that they serve. Honestly. I don't understand how this could continue to be an issue after your bring the subject up.

Even if your pool can't BUY this equipment, i'm sure you could go doorbell ringing to your different EMS / FIRE services and beg some of their stuff off of them. Or go to your local red cross / cpr instruction sites and ask for a donation. Go to a church and explain your need. There are plenty of ways to get the resources that you need.

 

[LucidResq]

Not that a BVM would've saved this kid's life, or that a properly-sized BVM wasn't used, or that he even needed a peds BVM....

but nonetheless, a close-ish-to-home reminder that yes! Lifeguards do need to resuscitate children occasionally!

 

[clibb]

First, welcome to EMTLife!

You should not be using an adult BVM on a child/infant. Just because it's possible doesn't make it right or legal. I sure wouldn't want to be the provider on the end of a lawsuit for using an adult BVM on a child or infant.

Again, one can use adult AED pads on a child, and once I read in a medical journal about some doctor in a remote location using a car battery as a defibrillator. Spend the extra $20 and get separate adult/child/infant BVMs. I can't think of a single argument against separate BVMs.

I hope that helps!

It's legal here and we were taught that we could use it. NOT that we were supposed to, but if we had no other option.
Correct me if I'm wrong...
An adult's lungs are 800cc. An infants is 150 cc. As the child grows, the bigger the lungs get. So you aren't really sure how much air you're supposed to give the child as a newbie. They could be hyperventilating or damaging the lungs with the amount of pressure they are applying to the BVM. Also, using an adult BVM on a Pediatric patient sucks. It's extremely hard to get the right fit for the child without covering the whole entire face and you're not supposed to cover the eyes.
Like suggested above, you should spend a little extra money and get a Pediatric BVM.

 

[Aidey]

I So you aren't really sure how much air you're supposed to give the child as a newbie.

Until the chest rises seems like a pretty straight forward benchmark to me. It's the same for lay people all the way up those doing ACLS.

Maybe I'm biased because I used to work in remote situations where our gear options were limited. We carried an adult size bag, with the different mask sizes. It saved us from carrying the 2 extra sizes of bags.

 

[MRE]

3 or 4 years ago one of my classmates actually took the time to convert 200joules to amps and volts. I admit I don't remember the exact numbers but I remember it being somewhere around 100 amps and 50,000 volts.

Thats going to be a little bit on the high side. 100 amps at 50,000 volts is 5 million watts, or 50,000 100 watt light bulbs. Even for a small amount of time, this is a huge amount of power.

A joule is a measurement of total energy delivered, so you need to know how long the delivery time is to determine the voltage and current required.

Using some numbers from Zoll's website, one of their AEDs develops an average current of a little over 15 amps through an impedance of 100 ohms. From this you can calculate the average voltage to be 1500 volts and a delivery time of about 9mS for a 200 joule shock. These are averages, so peak values will be somewhat higher, but probably only 20-25 amps and 2000-2500V or so.

I did calculate how long it would take to deliver 200 joules at 50,000 volts and 100 amps (which requires an impedance of 500 ohms and is much higher than what you should see) and came up with 0.00004 seconds or 40 micro seconds. However Zoll has numbers indicating shocks are usually around 10mS which is in line with my first figure above.

 

[MRE]

After that long and off topic post above, I figured I would hit on the real purpose of the thread.

There may be times that a pedi BVM and mask are not available, especially in rural areas where an ambulance is delayed and responders go right to the scene in personal vehicles. In these situations, they may have an adult BVM, and in my opinion should use it. Watch for chest rise and adjust the larger mask to fit the patient's face. That is what is taught in CPR for the professional rescuer and for the healthcare provider.

If you are on an ambulance you should have pedi supplies and should use them.

 

[foxfire]

As a lifeguard, I would not be in favor of carrying a pedi mask and adult mask in my fanny pack along with all the other junk I have to carry.
I carry a adult mask and if ever need to use it for a child, will just turn it around and use it that way till other guard arrives with proper size, or EMS arrives. I am not going to wait around for the proper size to start RBs.
If I did need to bag them, I would just watch for proper chest rise.
Do the newbie guards learn how to start a o2 tank? Or do you even have that?
Personally, I would have a hard time mentally using a BVM without o2 supply.

 

[MRE]

Personally, I would have a hard time mentally using a BVM without o2 supply.

You probably realize this, but just in case; the advantages of using a BVM without oxygen over a pocket mask are that you are delivering fresh air to the patient and not air you have exhaled already (less oxygen).

Plus you don't have to have your face down in theirs which allows you to better see what is going on, and you are further away if they vomit.

 

[redcrossemt]

once I read in a medical journal about some doctor in a remote location using a car battery as a defibrillator.

Touch both sides of a car battery, I promise it won't defib you...