Your position while using a BVM?

[Aprz]

Is positioning yourself above the pt. head better than laterally, or important? For some reason, I am thinking it is acceptable to be lateral to the pt. head as long as you have a good seal, but to put it lightly, I was made aware that is wrong in my EMT-b class the other day, that you have to be above the pt. head (I don't mean standing over it or anything like that, I just mean whether you can be by their ears or not I guess is as simple as I can put it).

I attempted to browse/search the forums (difficult since I can't search just "bvm" / found Mastering the BVM), check my books, and Google, but I found nothing that emphasized on where you should be positioned by the head.

 

[Martyn]

I would say whatever position gives the best seal. Personally I prefer to be kneeling with the pt's head in between my knees or close to there. That way if you also have to hold C spine and you are on your own you can hold C with your knees while freeing up both hands for the BVM.

 

[High Speed Chaser]

I'm going to apprach this question from a Primary Survey Point of view (DRABCD) of my geographic location. A When checking an airway it's easier to do it from the head (triple airway manoeuvre or Laryngoscopy). Since your already at the head when checking A (DRABCD) it wastes time to move positions. B When using the BVM, it's not as easy as people think, to achieve a good seal. Trying to get an adequate seal (using the hands in an effective way) is that much more difficult when applying the mask to the face. C personal preference when feeling from a carotid pulse but positioning wise it seems to be easier from the head not the side to check a pulse.D When doing final checks prior to a defib, looking down the body from the head gives you a greater view without moving your neck then when you are at the side where you have to tun your head continually to make sure it is safe to shock.

I find that the head is the quickest, safest, and most comfortable way to apply resuscitation (for a EMT/Paramedic) and thus makes it really important to be at the head and not side.

 

[Melclin]

Of course being aware of anything you have learned in your classes (if someone tells u to do something, and they are writing the test, do that thing), yes being at the head is the best place to be. I may be mistaken but i believe the lateral position to be the place where nurses/physios/OTs/first aiders/EMTs are taught because its easier to teach people in those groups the simple skills of that particular level of resus in that way. But its not necessarily the best way for people who know what they're doing.

For proper airway management, you will always be at the head. How many EM physicians do you see assessing the airway using a "chin lift" or "jaw tilt" or "trigger hold" or whatever, from the lateral position, ready to give mouth to mouth?

 

[eveningsky339]

For proper airway management, you will always be at the head. How many EM physicians do you see assessing the airway using a "chin lift" or "jaw tilt" or "trigger hold" or whatever, from the lateral position, ready to give mouth to mouth?

^ This.

Being at the head is the best place for any from of airway management, and the best position for getting that elusive seal with the BVM.

 

[Aprz]

Alright, thank-you guys.

 

[EMSLaw]

Of course being aware of anything you have learned in your classes (if someone tells u to do something, and they are writing the test, do that thing), yes being at the head is the best place to be. I may be mistaken but i believe the lateral position to be the place where nurses/physios/OTs/first aiders/EMTs are taught because its easier to teach people in those groups the simple skills of that particular level of resus in that way. But its not necessarily the best way for people who know what they're doing.

I think it's more that if you are doing CPR by yourself, there is no effective way to do it positioned at the patient's head.

However, as EMTs and Medics, we are rarely if ever doing CPR ourselves. I certainly was always taught that the person at the head (or sitting in the captain's chair of the ambulance) is responsible for the airway, and I think that's the most logical thing.

 

[joeshmoe]

Whatever way you do it, make sure you observe chest rise on ventilations and place the hand on the mask in a "CE" shape to get a good seal.

 

[Aprz]

Okay another thought... If you want to minimize movement for when you reassess the pt., we are supposed to put our ears over their mouth, eyes facing the chest. If you're above the head, and you've already done 2 minutes of rescue breathing/tracking or CPR, how would you reassess without moving to the side of the pt.? Attempting to do it invisibly without a manikin, I can't imagine that I would be able to see rise and fall of the chest (easily) while listening and feeling for breaths.

Edit: I like how this guy opens the airway in this video http://www.youtube.com/watch?v=YDgdbYqYnQ8&feature=related, but we were taught to do it similar to http://www.youtube.com/watch?v=yDKcr9pYXgY where we do it from the side. In the first video from where that guy is laying, I am having a hard time imagining myself assessing the pt. breathing without having to move over to the side (to do it like this http://69.17.55.5/images/breathing.png, but with my ear over the pt. mouth)unless purely lack of signs of rise and fall of the chest is consider enough (don't have to listen and feel for breaths). I've heard that if a pt. is breathing, you can feel the resistance.

 

[Melclin]

Okay another thought... If you want to minimize movement for when you reassess the pt., we are supposed to put our ears over their mouth, eyes facing the chest. If you're above the head, and you've already done 2 minutes of rescue breathing/tracking or CPR, how would you reassess without moving to the side of the pt.? Attempting to do it invisibly without a manikin, I can't imagine that I would be able to see rise and fall of the chest (easily) while listening and feeling for breaths.

Try it with a mannequin, it just requires you to twist your head a little and move your eyes.

Edit: I like how this guy opens the airway in this video http://www.youtube.com/watch?v=YDgdbYqYnQ8&feature=related, but we were taught to do it similar to http://www.youtube.com/watch?v=yDKcr9pYXgY where we do it from the side. In the first video from where that guy is laying, I am having a hard time imagining myself assessing the pt. breathing without having to move over to the side (to do it like this http://69.17.55.5/images/breathing.png, but with my ear over the pt. mouth)unless purely lack of signs of rise and fall of the chest is consider enough (don't have to listen and feel for breaths). I've heard that if a pt. is breathing, you can feel the resistance.

The first one is how you should be doing it. The 'from the side' video is the kind of thing taught in first aid classes (EMSlaw suggest for single person CPR), which I suppose is appropriate because the EMT-B cert is just an advanced first aid. As a professional, I would still be at the head if I was by myself, it doesn't change the way you do compressions and you simply can't manage the airway properly from the side.

 

[Aprz]

Okay, thank-you guys. I greatly appreciate your comments/advice. I might even try to grab a friend or family member to see if I can/practice assessing ABC on them from above the head rather than the side (don't have class for another week and half due to Spring Break ). ^Not gonna try opening their airway by the way, just seeing if I can look, listen, and feel from above the head^

 

[Swatrous]

Of course being aware of anything you have learned in your classes (if someone tells u to do something, and they are writing the test, do that thing), yes being at the head is the best place to be. I may be mistaken but i believe the lateral position to be the place where nurses/physios/OTs/first aiders/EMTs are taught because its easier to teach people in those groups the simple skills of that particular level of resus in that way. But its not necessarily the best way for people who know what they're doing.

For proper airway management, you will always be at the head. How many EM physicians do you see assessing the airway using a "chin lift" or "jaw tilt" or "trigger hold" or whatever, from the lateral position, ready to give mouth to mouth?

I agree, as an EMS instructor it is very frustrating when a student insists on arguing with something they are taught. Although the method may work fine he is probably teaching it his way to insure you pass the states test.

 

[NomadicMedic]

I don't know if they still do, but Washington state used to teach the FATS method. (Face and thigh squeeze). Obviously, this is for single person BVM use, and for a non-traumatic injury. We were taught to apply pressure to the sides of the head with your thighs to hold the head in position and use a two handed clamp method with a jaw thrust while squeezing the bag under your arm.

I know it sounds a little odd, but works really well. I've used it to ventilate a non-breathing patient while getting set up for an intubation.

 

[gotbeerz001]

I don't know if they still do, but Washington state used to teach the FATS method. (Face and thigh squeeze). Obviously, this is for single person BVM use, and for a non-traumatic injury. We were taught to apply pressure to the sides of the head with your thighs to hold the head in position and use a two handed clamp method with a jaw thrust while squeezing the bag under your arm.

I know it sounds a little odd, but works really well. I've used it to ventilate a non-breathing patient while getting set up for an intubation.

Thigh squeeze for the win (when applicable).

 

[ERDoc]

If you are managing the airway you should be at the head of the bed. The airway is a symmetric, midline structure and the only way to properly assess/manage it is from the top down. You are not going to get a proper BVM seal from the side. Also, from the head of the bed you have full view of everything going on around the pt, which is helpful if you are the person in charge.

 

[Carlos Danger]

In the OR I often have to ventilate (or occasionally place an LMA) from the side of a patient, whether I am facing their head or their feet. I've also done it in aircraft and in patients trapped in vehicles. So it's entirely possible if you find yourself in a situation where you can't get in the normal position, but it's also certainly more difficult, so it should be avoided whenever possible.

 

[Aprz]

I would say the OP isn't here anymore, but I am right here. The thread was created a little bit over five years ago while I was still in EMT school. Now I am a fake paramedic.