Bag-Mask Ventilation



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Bag-Mask Ventilation

Consider nasogastric or orogastric tube

Position patient to gain access to their mouth (usually flat on their back unless specific reason - mediastinal mass, wound, trauma, etc)

Patient unconscious?

Nasopharyngeal airway

Oral airway

>1 airway provider?

Immobilize c-spine with collar or manual in-line positioning

Obtain the smallest mask that covers the mouth and nose without covering the eyes or hanging over the chin

Severe abdominal distension?

Possible c-spine injury?

Adequate chest rise?

Attempt to trouble-shoot potential problems

Potential problems

  • Bilateral pneumothoraces -> needle decompression or chest tube
  • Abdominal distention -> nasogastric/orogastric tube, Cricoid pressure (Sellicks maneuver)
  • Inadequate pressure -> check mask size/seal, two-hand technique
  • Venting pop-off valve -> close valve
  • Foreign body -> remove, Heimlich maneuver, abdominal thrusts, CPR

Consider definitive airway intervention

Consider other airway device or consult advanced airway provider

Inclusion Criteria
  • Clinical need for assisted ventilation (poor respiratory effort , airway obstruction)
Exclusion Criteria
  • Acute airway obstruction unlikely to be resolved with positive pressure alone
  • Airway/facial anatomy or trauma that prevents air tight seal of mask
  • Trachostomy or other artificial airway device or surgical history

Optimize airway positioning (chin lift, jaw thrust, etc.)

Select bag type and attach 100% oxygen source

Two-hand mask technique

Determine ventilation rate and volume and begin

Benefit from airway adjunct?

One-hand mask technique




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