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
- Clinical need for assisted ventilation (poor respiratory effort , airway obstruction)
- 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
