Bagging with BVM while stretcher is in motion

rhan101277

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This may seem like a silly question, but I haven't had to do this. To have a proper seal you need to use to hands and doing so leave's no control over your end of the stretcher. It can be maneuvered by one person, but it isn't smart considering various terrain, conditions etc.

My question is, How do you manage this?
 

reaper

Working Bum
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Hopefully have three people, so you can concentrate on the airway.

If that is not possible. Then lean on the stretcher and use your body to guide it, while both hands are controlling the BVM.
 

exodus

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guy up front controls stretcher and motion and guy on back j ust keeps it straight.
 

rhan101277

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Ok, thanks. I have never BVM'd before on a real person so I was just asking. I want to do it right and not look stupid in front of the trauma team.

I mean I know how to BVM properly, I just didn't want to look like a fool rolling in there with the stretcher all everywhere up and down the hall.:rolleyes:
 

medicdan

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Ideally, of course, you have an advanced airway in place (well secured, I hope), so you only need one hand, and only every few seconds... This of course comes from the Basic...
 

TransportJockey

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When I've had to do it I've had either a Combi or King in place. When I was doing internships for medic usually it'd be an ETT
 

TripsTer

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Dang, I would hope that when you're on-scene, you got the FD to help you with manpower and when rolling the stretcher into the ER you have nurses there to help you too with bagging.

But then again, you could be in a rural setting.

It's a pretty bad day if you're on a respiratory arrest and you only have your partner. Thank god I work in the city...
 
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zmedic

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If the patient is well oxygenated you could think of the movement as almost an intubation attempt. A well oxygenated adult can usually tolerate about 3-4 minutes without ventilations during intubation, so if you are having less than ideal bagging during the 30 second walk to the rig probably not the end of the world. But ideally you'd have at least three people on scene, two could push the stretcher and another could just be doing bagging. Or one just does face seal and another squeezes the bag with one hand and pushes the stretcher with the other.

But if you are far enough out in the sticks that you are going to be dealing with respiratory arrests with just two people the service should think about getting the combitube or King airway.
 

8jimi8

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we have rolled into our ER working a full code, called in when we had a 10 min eta and the nurses looked at us and asked why we were there.
unlikely.

Even if you caught someone by surprise I HIGHLY DOUBT that the comment was "what are you doing here?" ... it is understandable if it was a LITERAL questions such at "what are you doing here (what's going on with this patient?)"

i will disregard your little anecdote unless you are going to step up and give alot more details about going to an ER and them not assisting you in a code...

seriously, after the nurse said "what are you doing here," what happened? Did you and your partner take them to a new hospital? Did you have ROSC/R and the patient jumped off the stretcher and went on his merry way?

I'm so disinterested in and so tired of the myths that incite division among PROFESSIONAL HEALTH CARE PROVIDERS. anyway, i'm sorry for the thread hijack.


*** to attempt relevance to the thread ***

I don't know about 4 minutes of being off oxygen between ETI attempts, from the skill sheet you have 30 seconds between assisted ventilations. I have seen MDs take more than 30 seconds, i'm not saying that everyone realistically hits the < 30 second mark, but that is what we are taught. If your patient can't tolerate being moved without bagging them every 5-6 seconds, the outcome is already grim.

My suggestion is that you make a plan with your partner such as :

1. Ok we are going to get him on the stretcher and then let me get a good 2 breaths in over 10 seconds and then we roll.
2. Once we get to the front door, stop the stretcher so I can bag her again
3. repeat until you get to the ambulance, which would hopefully only be like 2 10 seconds stops.

you can't stop treatment indefinitely for transport and vice versa
 

Linuss

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I've seen nurses utterly fail at the BVM in CPR class, so don't feel dumb. Everyone starts somewhere :)
 

ah2388

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yea..just remember that various providers spend varying amounts of time on different skills. What may seem second nature to you may not be to them...
 

lightsandsirens5

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It's a pretty bad day if you're on a respiratory arrest and you only have your partner. Thank god I work in the city...
How about a full arrest and only you and your partner? Done that multiple times. Not fun! But in such a rural setting, the best you can hope for is a deputy to show up so he can drive the amb and you and you partner can be in back.

~~~~~~

Also, Reaper nailed it. The person in front (ie. at the feet) can pretty much drive and stear the whole gurney by themselves. On sharp turns, the person at the head can help steer with their elbows or something.
 

trevor1189

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Realistically, BVM is a simple concept. In practice It is rather hard to do, getting the right seal and position is crucial and a lot of people don't do it correctly. Especially hard to do if you are trying to move a Pt and bag at the same time.


Realistically, you really shouldn't be taking a apneic Pt. into the ER with BVM only, some advanced airway should be secured unless the Pt. just crashed as you are pulling in. Also if this is the case, you can probably get the Pt. into the ER in less than 30 seconds, which most likely will not make much difference in outcome.
 

trevor1189

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I've seen nurses utterly fail at the BVM in CPR class, so don't feel dumb. Everyone starts somewhere :)
Yeah there are incompetent people all over the place in every profession, nurses, doctors, emts, paramedics, you name it. Its rather scary.
 

Linuss

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Realistically, you really shouldn't be taking a apneic Pt. into the ER with BVM only, some advanced airway should be secured unless the Pt. just crashed as you are pulling in.
If they can be maintained with basic adjuncts than there is no need for an advanced airway.

If an NPA / OPA is enough, than that's fine.
 

TripsTer

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Apparently I offended some, my apologies, I did not mean to insult anyone, just thought I could give a little elbow shove but I now see the sensitivity threshold and do not plan on crossing it again.

Working in the city, me on a BLS unit can expect manpower from an engine or ladder company in approximately 5 minutes if they're not there already (which they usually are).

Back when I worked EMS in the 'burbs, volunteer engine companies usually took about 10-15 minutes to arrive.

I can only imagine working in a rural area, props to you guys that do.
 

8jimi8

CFRN
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I have to admit that I was the one who took offense.

Truthfully, nurses receive very little airway control training. They show you the ambubag, but you really don't really hear much about the EC clamp, nor do they really talk about suction, opa/npa, or lung compliance, unless you learn from a nurse with ICU or ER experience.

I specifically came to EMS to get more training and information about airway control. And I am wholeheartedly an advocate of camaraderie between Health Care Professionals.

I definitely agree that the mods are quite sensitive here. I guess that makes it more about the information that you post, than how witty we can tease each other. That works for me too!
 

CAOX3

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I would agree three people is ideal. Everyone may not have that benefit, then you have to do the best you can.
 
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