Which is better?

[Achilles]

I asked this question in the 100% directionless thread about a month ago and got like four answers. My question is, is BVM better or is Mouth to mask better? I realize you ccan deliver 100% o2 with a BVM but you can feel the chest rises in mouth to mask.
Regards,
Andrew

 

[STXmedic]

I argued with my instructor on exactly this when I went through medic. He claimed that mouth to mask was better because you could feel compliance better. I forget my argument (other than BVM is just as effective at oxygen delivery), but he eventually conceded to giving me the point on the test

If you're looking for a test answer; Whatever the book says is right.

If you're looking for practical application; Whatever works. But you won't catch me with my face right up to the patient's when I'm giving positive-pressure ventilations.

 

[usalsfyre]

Flow inflating bag FTW...

Realistically, there's a reason you don't see too many pocket mask on crash carts. A BVM can do everything also can and more.

 

[TransportJockey]

Mouth to mask is useless if you're on a proper ambulance. Hell, with the new CPR guidelines, a mask is rather pointless anyways when they are teaching layperson CPR as hands only

 

[JPINFV]

Flow inflating bag FTW...

Realistically, there's a reason you don't see too many pocket mask on crash carts. A BVM can do everything also can and more.

Virtually unlimited human resources from all around the hospital. ICU code blue at my current hospital? On call team IM team, maybe family med team (if it's a family med patient), and ICU team all come running, plus additional nurses and an RT.

The only time I can see a pocket mask being the best option is when one person is managing the airway and breathing. This allows two hands to keep head tilt/chin lift while also maintaining a good seal.

 

[Sandog]

Mouth to mask is useless if you're on a proper ambulance. Hell, with the new CPR guidelines, a mask is rather pointless anyways when they are teaching layperson CPR as hands only

Actually, AHA heartsaver is still teaching with giving breaths.
http://www.niacc.edu/ahatc/pdf/heartsaver_cpr_aed.pdf

 

[TransportJockey]

Actually, AHA heartsaver is still teaching with giving breaths.
http://www.niacc.edu/ahatc/pdf/heartsaver_cpr_aed.pdf

Hmmm odd, I've done several heartsaver standbys (teaching lay people to do hands only CPR) and it was literally only compressions. Oh well, not like I'm gonna do breaths on someone off duty anyway. They're lucky if I call 911 for them

 

[Tigger]

The only time I can see a pocket mask being the best option is when one person is managing the airway and breathing. This allows two hands to keep head tilt/chin lift while also maintaining a good seal.

While I agree, I have my doubts that a mask is going to keep significant vomit off me. If the option is pocket mask or nothing, I think I might lean towards just concentrating on compressions.

If you have two rescuers, the person doing compressions can squeeze the bag as well.

 

[Tigger]

Hmmm odd, I've done several heartsaver standbys (teaching lay people to do hands only CPR) and it was literally only compressions. Oh well, not like I'm gonna do breaths on someone off duty anyway. They're lucky if I call 911 for them

The AHA literature I've read states that if the lay rescuer is "trained and able" that they should continue to provide rescue breaths with the 30:2 ratio. However if they are not trained as such they should just skip the breaths all together. Look, Listen, Feel was removed from the program entirely.

I do not find this to be all that clear.

 

[Sandog]

From your link.

There has been no change in the recommendation for a
compression-to-ventilation ratio of 30:2 for single rescuers of
adults, children, and infants (excluding newly born infants). The
2010 AHA Guidelines for CPR and ECC continue to recommend
that rescue breaths be given in approximately 1 second.

Seems clear to me. I just completed the AHA instructor course, and we were taught to continue teaching breaths.

There is a non-heartsaver category which might not emphasize breaths. I will have to look into it.

 

[Tigger]

From your link.

There has been no change in the recommendation for a
compression-to-ventilation ratio of 30:2 for single rescuers of
adults, children, and infants (excluding newly born infants). The
2010 AHA Guidelines for CPR and ECC continue to recommend
that rescue breaths be given in approximately 1 second.

Seems clear to me. I just completed the AHA instructor course, and we were taught to continue teaching breaths.

There is a non-heartsaver category which might not emphasize breaths. I will have to look into it.

To clarify, I don't understand what the difference between a trained and untrained person is. If you are taught CPR, are you not trained in it? I guess not...

 

[Sandog]

To clarify, I don't understand what the difference between a trained and untrained person is. If you are taught CPR, are you not trained in it? I guess not...

Agreed, that is confusing.

 

[Sandog]

AHA has a hands only course, for family and friends. With this course you are taught hands only but you also do not get a CPR card.
http://www.heart.org/HEARTORG/CPRAn.../Family-Friendsreg-CPR_UCM_303576_Article.jsp

So I guess that is the distinction of trained vs. non trained. I guess we call it, sorta trained.

 

[Merck]

Oh well, not like I'm gonna do breaths on someone off duty anyway. They're lucky if I call 911 for them

Admirable.....

 

[Tigger]

AHA has a hands only course, for family and friends. With this course you are taught hands only but you also do not get a CPR card.
http://www.heart.org/HEARTORG/CPRAn.../Family-Friendsreg-CPR_UCM_303576_Article.jsp

So I guess that is the distinction of trained vs. non trained. I guess we call it, sorta trained.

Fair enough I suppose. No card=no training. Just well I guess we need another word for going to a class and learning something. Education seems a bit too much.

 

[TransportJockey]

Admirable.....

I carry nothing, not even any PPE when I am off duty. I don't stop at car wrecks unless it's a wreck in the wilderness when I'm offroading. Around here there are more than enough ricky rescues that stop at everything and bystanders who whip out their phones and call 911. I will NOT open myself to that liability of performing anything medical related while not being paid and covered by my agency.

 

[NYMedic828]

If I am passing a legitimate wreck before anyone shows up or a person collapses next to me I couldn't just turn a blind eye.

I'm absolutely no Ricky rescue but I have morals and just walking away isn't ethical.

Will I be giving mouth to mouth? No... Compressions until SOMEONE arrives, absolutely.

 

[leoemt]

The "book" will tell you the the pocket mask is preferred over a BVM. Real world though I would be reaching for a BVM. There is no way I am putting my face that close to a patient who is going to vomit at any minute.

 

[WolfmanHarris]

What book is recommending pocket mask for anything in EMS? If I'm sole responding to an arrest I'm doing compressions only until I have extra hands. Once I have hands for CPR I'm managing the airway with BVM and OPA at a minimum; advanced airways as required and time allows. You won't find a pocket mask on an Ambulance or RRU around here and I don't remember using them at any level above first aid.

 

[mycrofft]

Pocket mask is a good spare BVM mask, same lumen. Just don't use the little white filter housing.

"No mouth" CPR is aimed at getting laypersons (not untrained persons) to attempt bystander resuscitation when fear of contagion and fear of malpractice (doing CPR without breaths when breaths are taught as mandatory) would otherwise deny the victim aid.

BVM is better with two persons or if you lack ability to repeatedly inflate the patient. Pocket mask is better of you are alone and able to repeatedly inflate the patient. Either can give you an enhanced oxygen percent, but that is being questioned as being useful or not in cardiac resuscitation situations.