Artificial Ventilations

traumaluv2011

traumaluv2011

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I was wondering what other EMTs prefer to use. I was reading up on the airway chapter and I saw an interesting comparison between the two. I would think the best method is to use a BVM based on the ability to use oxygen if available. However, say someone with a basic jump bag came upon an apneic patient as a first responder and they had both a pocket mask with one way valve or a BVM to choose from.

My book said that manual artificial respiration gives about 16% oxygen per ventilation while a BVM gives 21%. But the manual would give you more tidal volume. So is it better to have more oxygen or have more air going through the lungs?

I would think more oxygen would seem like the better option.
 
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If I had to choose between a mask or a BVM, it's ALWAYS a BVM.

I'm guessing you're new. Wait 'til you're ventilating a puking person.

BVM always wins. :)


Sent from my iPhone.
 
BVM no question.

However, if you're not used to using one and have no experience managing an airway you are more likely to be able to use a pocket mask more effectively, especially if you're alone. Much as they look intuative - mask over mouth & squeeze bag - they actually take a fair bit of practice (on a variety of people) before you can be confident about being able to open the airway adequately, get a good seal and ventilate an appropriate volume at an appropriate rate.

As for your question about oxygen versus volume. Vt is nice to have but it doesn't increase oxygenation in itself, for that you really need a higher fraction of inspired oxygen (i.e 0.21 instead of 0.16) or that oxygen needs to spend longer in the lungs (either positive end expiratory pressure or a lower inhalation to exhalation ratio).
 
Also, increased volume tends to increase the risk of not only gastric insufflation but also damage to the lungs by way of overinflation of the alveoli. As was said before, BVM over pocket mask any day.
 
no question. B V M.
 
BVM, provided you can competently use it and make a seal. Otherwise pocket mask.
 
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Yea, I'm pretty new to the field. Just got certified a month ago. Thank you for the answers. I will definitely go for a BVM if possible.
 
BVM, otherwise I may get dizzy. I also don't like my own vomit, much less someone elses.
 
Bag valve. Hands down. After a bit of practice and practical application in the field, you'll be able to use a BVM as, if not more, effectively than a face mask. I know I should jinx myself, but I've never had call to use my face mask. I've always been able to reach the BVM just as quickly.

Alpha, I know what you mean about vomit. Also, my instructor forever scared me about using a face mask when he told a story about a malfunctioning one way valve allowed a patient to puke into, and fill his mouth up with, vomit. I almost lost it listening to that story. :-S
 
On a slightly related issue, does anyone else use an ATV and mask? That way both hands are free for making a seal.
 
ArcticKat said:
On a slightly related issue, does anyone else use an ATV and mask? That way both hands are free for making a seal.
Click to expand...

If I'm digging out the vent, they're getting tubed. I try to mess around with a mask as little as possible.

And I'm curious about the OP's reasoning. If he/she is first on an arrest scene, hands only CPR is the best bet. No need to break out the pocket mask. If they're on a truck, there should be a BVM and some airway adjuncts handy.


Sent from my iPhone.
 
n7lxi said:
If I'm digging out the vent, they're getting tubed. I try to mess around with a mask as little as possible.

And I'm curious about the OP's reasoning. If he/she is first on an arrest scene, hands only CPR is the best bet. No need to break out the pocket mask. If they're on a truck, there should be a BVM and some airway adjuncts handy.


Sent from my iPhone.
Click to expand...

The vent probably delivers far better ventilations though. Consistent, pressure limited, slow and as above, you can use two hands to seal the mask.
 
n7lxi said:
If I'm digging out the vent, they're getting tubed. I try to mess around with a mask as little as possible.
Click to expand...

I'm referencing BLS providers.
 
It's not really a "vent". I believe he's just referring to one of the old oxygen powered PPV devices.
 
Nope, pretty sure it's a vent...

http://www.otwo.com/pdf/CAREvent ALS CPAP 2008.pdf

Using an ATV is not in the BLS scope, even with a mask, a BLS provider can administer CPAP though. It makes little sense to me that a BLS provider can provide crap poor ventilations using a BVM but can't use the ATV to administer better quality ventilations with less complications.

I'm putting together a protocol amendment to include the BLS ATV/mask. wondering if anyone else does it.
 
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Oh, OK. Sorry, you said ATV and I was thinking of something else.
 
The only way a basic can do CPAP here is with a disposable, non adjustable Downs Flow device. There is a pilot program ongoing to assess it's efficacy when used by BLS providers, prior to ALS arrival. Seems like a no brainer to me. Early CPAP for CHF is vital, and giving that skill to BLS only makes sense.

However, using a parapack vent or similar for BLS airway management in place of a BVM is overkill. If a BLS provider can't effectively manage an airway with a BVM, something in the original education or con ed is missing. I've seen EMTs struggle with maintaining a seal, not being able to jaw thrust an airway when bagging and having all kinds of other basic airway issues. Giving them more stuff to set up and play with detracts from the basic idea, “open the airway and squeeze in a breath 10 to 12 times a minute.” Let's have our EMS Con Ed educators focus more on the skills that EMTs really need, like good airway management, rather than giving them more toys and stuff to play with.
 
So here's my thought. Using the BVM during CPR on Annie is relatively easy. Crank her head back, get a plastic on plastic seal and squeeze in as much air as possible to get a visible chest rise.

Using a BVM WELL, on REAL PATIENTS on the other hand, as we all realize, is a difficult, not easily mastered skill. If you take away when to squeeze the bag, how hard and deep to squeeze the bag and the actual squeeze itself you are now better able to focus on proper airway positioning and good mask seal, helping to prevent leakage and gastric insuflation. In addition the vent will deliver a consistent, controled 10 bpm as opposed to getting excited and squeezing the heck out of the bag.

We should know how to use a BVM. But we dont' use Ambu bags onn everyone anymore for a reason. I personally think it's a great idea.
 
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