Advancing BVM Education

NysEms2117

NysEms2117

ex-Parole officer/EMT
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As an EMT-B I have come to realize proper BVM use, is one of the most important things I can learn. I can generally get a good seal, due to my mammoth hands, and know my proper vent intervals ect. However, I've heard of things like "Sellick’s maneuver" being tossed around by other people, and i just have to wonder, does it really work? I'm also wondering any tips or tools of the trade anybody has for dealing with a "difficult BVM pt", other then(for those that know where i work) get your partner to intubate. I find obese patients to be particularly hard to vent properly, along with toothless patients, and heavy bearded men.

~Andrew
 
Sellick's maneuver is actually smashing the esophagus flat to prevent regurgitation and gastric insufflation. Usually doesn't work and it's not routinely used any longer by BLS providers. AHA instructors are told to mention "we don't do that anymore..."
 
NysEms2117 said:
As an EMT-B I have come to realize proper BVM use, is one of the most important things I can learn. I can generally get a good seal, due to my mammoth hands, and know my proper vent intervals ect. However, I've heard of things like "Sellick’s maneuver" being tossed around by other people, and i just have to wonder, does it really work? I'm also wondering any tips or tools of the trade anybody has for dealing with a "difficult BVM pt", other then(for those that know where i work) get your partner to intubate. I find obese patients to be particularly hard to vent properly, along with toothless patients, and heavy bearded men.

~Andrew
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It just takes practice. Do it every chance you get and each time you do it, think about your technique. Not pulling the jaw far enough forward is probably the most common mistake I see. That, or ventilating too forcefully. Use adjuncts, and do 2-person ventilation any time you are having even a little difficulty.
 
Also, too many providers seem intent on providing BVM ventilations as a single provider skill, even though it can be extremely difficult to get and maintain a good seal while also having decent positioning on some patients on for some providers who have small hands. It is not a failing to do a two provider skill using two providers.
 
2 person BVM is superior to 1 person for sure. Have a FF or LEO help you maintain a seal perhaps.

A nice tip for beards is lube (or, if you carry it, plastic wrap - and poke a hole in it).

For BLS airways, @Brandon O recommended doubling up on NPAs and throwing in an OPA - advice that I really like.

In general, I don't get to BVM as much as I'd like to be fully competent. I can't help but wonder if I could beg my way into some time with an anesthesiologist or CRNA to get the extra practice.
 
EpiEMS said:
2 person BVM is superior to 1 person for sure. Have a FF or LEO help you maintain a seal perhaps.

A nice tip for beards is lube (or, if you carry it, plastic wrap - and poke a hole in it).
.
Click to expand...

Tegraderms works really well to plasticize the beard and improve mask seal.
 
EpiEMS said:
For BLS airways, @Brandon O recommended doubling up on NPAs and throwing in an OPA - advice that I really like.
Click to expand...
We call it a "superplug" and then cut the bridge off the nasal cannula and shove the two thin hoses down the NPAs and tape it the patients cheek.
 
@Bullets, I like the NC up the NPA idea! Meshes nicely with the notion of passive oxygenation during intubation attempts that I've heard about (never done it -- next tube I see, I'll pop on an NC).
 
Maintaining a good seal is very hard to do. The only way to actually get good at it is to do it a lot on real patients. The manikins that everyone train on do a horrible job at showing how hard it actually is.

Try to hold the mask with 2 hands and remember to pull the patients face into the mask and not to push the mask on the patients face. The sellicks maneuver is not really recommended anymore although in my OR shifts they had me do it.

If you are able to get your hands on a Street Level Airway Management book it gives good directions on how to align the airway and extra little tips and tricks.
 
@Remi would what bullets said be productive? or would you think that it's too much to do for not enough result?
 
NysEms2117 said:
@Remi would what bullets said be productive? or would you think that it's too much to do for not enough result?
Click to expand...
You don't always need multiple adjuncts, but when you do, you do. It's the right thing to do if you need them.

I'm not at all a fan of the lube-the-beard trick, but some people swear by it. Any port in a storm.
 
Remi said:
You don't always need multiple adjuncts, but when you do, you do. It's the right thing to do if you need them.

I'm not at all a fan of the lube-the-beard trick, but some people swear by it. Any port in a storm.
Click to expand...

I was more aiming at the cannula npa thing :P


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Never heard of the NC/NPA thing. Would be funny to see the nurses faces though on that one.
 
NysEms2117 said:
I was more aiming at the cannula npa thing :p


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Click to expand...
Sure you can do that, or just place the cannula over the NPA.

If you are going to cut the cannula, it might be easier to just use extension tubing instead.
 
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