Bag Valve Mask:
Of course you should already know what to do for the apneic lifeless appearing patient.
Assisted ventilations are just that: you will ASSIST the patient with their own respirations. They make an attempt to breathe, you are right there with them. Not against them. Not trying to over ride them. When their inspiratory effort kicks in you squeeze to give them the breath they would like to take on their own. You will also tell them that you are going to assist them whether they appear conscious or not.
There are 2 types of breathing that you should assist regardless of rate. Quality counts more.
1. Agonal Breathing - looks like an abreviated sigh gone wrong - pt may be unconscious or semi-conscious. The rate may be 6 or 16. This breathing pattern will need assistance due to poor quality.
2. Guppy Breathing (gasps going nowhere) - looks like a fish out of water, mouth opens nothing much happens. The rate may be 6 or 16. Assistance will be required.
When you decide to ASSIST:
Match their rate in the beginning regardless of how fast or how slow until their body relaxes or the fast RR starts to slow. For the fast rate, gradually increase the tidal volume (squeeze) until the breathing slows. For the very slow rate (less than 6), after several squeezes matching each breath, gently see what the response of the patient presents if you try to "initiate" another breath. If they fight, continue squeezing at their rate but with a more adequate tidal volume.
For the very conscious patient, keep them comfortable. The COPD patient who is in the "tripod" position and mentating on a NRBM; the body is in its full rescue mode. This patient will go down with a fight. Unless he fatiques and decompensates quickly, he will struggle to stay in control. If he fatiques, it'll probably be quick. Be ready. Reminding him about pursed lip breathing may help. He probably knows the procedure and just needs a little reminding. This patient's problem may be more ventilation than oxygenation. His respiratory rate may be 8 due to air-trapping. Keep that in mind if you have to assist his ventilations.
If you decide to assist someone on a NRBM, be ready. You may not have many breaths before they lose oxygenation. The same is true if you stop assisting to unload at the ER. Keep that NRBM handy to place during the unloading.
Remember a self inflating BVM provides no free flow O2 at the mask. If you place the mask on the patient's face, it may take up to -20 cmH2O to open the valve for a breath with a perfect seal. They may not be able to open it at all if the face mask is not sealed properly. Don't miss a beat with their respirations when assisting so they do not have to stuggle to open the valve.
This is important to know with the conscious and alert (or getting loopy) person such as the asthma, CHF or PNA pt with adequate but tiring breaths. Just a squeeze enough to open the valve until they are confident in your ability. If you are able to keep their head somewhat elevated, they may resist and/or vomit less. No pillow. Head flexed forward may give resistance or will ventilate the stomach.
Have suction available anytime you are using a BVM.
A lot will be a clinical judgement call. How far to the hospital? How much oxygen is he on? Rate and QUALITY of respirations? What is the patient is saying? Or, not saying?
