BVM mishap. Did I do something wrong?

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jshal

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I'm new, so when hiccups like this happen, I get kinda agitated and don't know wether it's my fault, or just something that happens from time to time.

This happened to me last week and idk why. I'm not quite sure how to make it never happen again. I was ventilating an OD pt via BVM. (Very slow respirations) it seemed like my seal was totally fine. I squeezed the bag and instead of ALL the air going down the trachea/throat, some got stuck in the patients cheeks, making their cheeks blow out and blow the some of the air back kinda. When it did, I changed my hand position and actually squeezed the bag a little harder, and then it was fine. I had to squeeze it harder than I'm comfortable doing. it was frustrating and scary when it occurred. The pt was not in full respiratory arrest, so maybe they happened to breath out at the exact moment I squeezed? (This was the first ventilation I gave them and we were synced yet ) Could that have been it?

Nothing came of it so I didn't reach out to anyone afterwards.

Advice?
 
It also could have been the position of the airway, but that seemed totally fine too. No OPA was used. (Rejected)
 
Sounds like the airway was partially obstructed. In the future, consider an NPA and watch your positioning. Make sure you're getting a good jaw lift when you're bagging. If at all possible, use a two person technique. Always think about pulling the patient's face up into the mask instead of pressing the mask down onto the face.
 
Watch head positioning and don't be afraid to use two people to ventilate. Without an advanced airway lots of patients are difficult to bag with a one handed seal. From there you run into a problem where to maintain seal you're sacrificing positioning or to maintain positioning you're losing too much volume to leakage.

In the spontaneously breathing bradypneic patient watch for their inherent respiratory rate and attempt to ventilate in time with it.

Other things to consider include watching their stomach carefully for gastric inflation, especially if you're having poor compliance and need to increase bag pressures. You may not be able to eliminate gastric inflation but you can take steps to limit it and be prepared to clear the airway.

Other than that, keep reflecting, reading and trying to improve. Avoid the pitfalls and only learning from more experienced providers who may have developed bad habits. Listen but evaluate for yourself and ask follow-up questions. The acceptable answer for "why did you do that?" is never "Because that's the way we've always done it." or "Bill told me to."
 
Mask ventilation is very often not easy. As a skill it is highly under-appreciated in EMS for both its importance and difficulty. It actually takes a lot of practice to get really good at.

So dont stress about it. Just use all the tips you've been taught and practice every chance you get.
 
Was there an airway obstruction? Did patient need suctioning? Since OPA was rejected, assuming no contraindications pop an NPA in next time. Lube that sucker up and patent the **** outta that airway. Make sure you're checking for gastric distention.
 
Also since I can't edit for some reason, try to match the patients Respitory rhythm and increase their total volume. Don't squeeze harder, good way to cause barotrauma.
 
RobertAlfanoNJEMT said:
Always insert in airway in an OD pt.. They lose control of their tongue and it blocks their airway..
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I actually very rarely use an OPA on my apneic opioid ODs. Most seem to have some level of gag reflex present, or will very soon after I begin treatment. Unless I'm unable to ventilate effectively with a BVM, they don't respond to Narcan, or their tongue is actively becoming an issue, I place an NPA alone and call it good. The last thing I want to do is induce vomiting in these people.
 
chaz90 said:
I actually very rarely use an OPA on my apneic opioid ODs. Most seem to have some level of gag reflex present, or will very soon after I begin treatment. Unless I'm unable to ventilate effectively with a BVM, they don't respond to Narcan, or their tongue is actively becoming an issue, I place an NPA alone and call it good. The last thing I want to do is induce vomiting in these people.
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When I said "an airway" I wasn't specifying OPA over NPA... I generally use an NPA as well
 
RobertAlfanoNJEMT said:
When I said "an airway" I wasn't specifying OPA over NPA... I generally use an NPA as well
Click to expand...

I hope you understand why one would think that you meant an OPA, Making a statement like "They lose control of their tongue and it blocks their airway" would make one think that you were attempting to control that tongue. Which, as I'm sure you're well aware, you do not do with a nasal trumpet.
 
DEmedic said:
I hope you understand why one would think that you meant an OPA, Making a statement like "They lose control of their tongue and it blocks their airway" would make one think that you were attempting to control that tongue. Which, as I'm sure you're well aware, you do not do with a nasal trumpet.
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Does an NPA not go behind the pts tongue?
 
They lose control of their tongue which blocks their airway, insert a nasal airway which snakes behind the tongue and allows them to breath.. So no I do not understand why you would make that assumption
 
Every OD doesn't need an airway. Passive airway obstruction is common, but certainly not universal. Treat your patients as they present.
 
Remi said:
Every OD doesn't need an airway. Passive airway obstruction is common, but certainly not universal. Treat your patients as they present.
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Does it hurt them to insert an NPA? No. And if I do it I know their airway is secure and I can focus on treating their other presenting life threats and ailments..
 
RobertAlfanoNJEMT said:
Does it hurt them to insert an NPA? No. And if I do it I know their airway is secure and I can focus on treating their other presenting life threats and ailments..
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Does it hurt? Probably not. Unless it does. Every intervention has risks, even simple BLS ones.

The point is that it just isn't necessary if they are moving air just fine without it. We shouldn't make a habit of doing things just because they probably won't hurt.
 
RobertAlfanoNJEMT said:
I didn't say anything about lifting the tongue... Just clearing the airway of the tongue.. You can admit that you misinterpreted me at any time
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The way you stated "they lose control of their tongue and it blocks the airway" is going to make the majority of people think you are referring to a OPA being the best airway option.

Also for my post I was just stating the difference between an OPA and NPA as far as what they do.

Edit: since when does placing a NPA mean the airway is secured?
 
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