On - Bag - Valve Mask Ventilation ACEP

The management of the emergency airway is continually evolving with the introduction of new airway devices. There is a large body of literature regarding a variety of rescue devices and algorithms for managing the difficult airway. Despite these important advances in emergency airway management, it is imperative for the emergency physician to be facile at basic airway maneuvers. Bag-valve mask (BVM) ventilation is a life-saving skill that can easily be overlooked because of its apparent simplicity. Poor BVM ventilation technique can lead to the need for more invasive means of airway management and their inherent complications. The authors will present a detailed approach to BVM ventilation with a focus on good technique and overcoming obstacles. BVM ventilation is a critical component of airway management. It provides oxygenation and ventilation prior to the placement of a definitive airway and can be used as a rescue maneuver alone. Proper BVM ventilation is important for pre-hospital providers as well. One study suggests that endotracheal intubation for trauma does not improve survival over BVM ventilation, indicating a vital need for successful BVM ventilation techniques. BVM ventilation is a difficult skill to master. There are many impediments to successful mask ventilation. Kheterpal, et al2 described these factors that hinder BVM ventilation: a body mass index of 30 kg/square meter or more presence of a beard Mallampati score of three or four age of 57 or older severely limited jaw protrusion, and snoring. Predictors of impossible mask ventilation include snoring and a small thyromental distance (less than 6 cm). In addition to these wellstudied factors, emergency care providers must also overcome possible airway obstruction caused by vomitus or blood and trauma to 1