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Introduction

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Bag-mask ventilation is often used as a way to supplement or replace spontaneous patient respiratory attempts prior to endotracheal intubation. Various anatomic issues (ie, excess soft tissue, large tongue) may necessitate the insertion of an artificial airway to permit bag-mask ventilation.

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Definitions and Terms

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  • ▪  Resuscitation bag: Typically a self-reinflating bag with standard connectors for oxygen administration and connection to a face mask and/or endotracheal tube connector (Figure 24-1)
    • —Valved to separate inhaled gas from exhaled gas
    • —Permits ventilation with room air in the absence of a supplemental oxygen supply
    • —Permits ventilation with oxygen enriched gas when connected to an oxygen supply
  • ▪  Face mask: A soft cuff mask designed to fit over the nose and mouth of a patient with a seal permitting positive pressure ventilation without gas leak (Figure 24-2)
    • —Various sized masks permit selection of the appropriate size for a given patient.
    • —Masks are equipped with a universal connector for attachment to resuscitation bag and/or ventilator tubing.
    • —Transparent plastic masks permit recognition of vomitus if the patient regurgitates.
    Figure 24-1.Graphic Jump Location

    Resuscitation bag, mask, and tubing.

    Figure 24-2.Graphic Jump Location

    Face mask with attached PEEP valve.

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Figure 24-1.
Graphic Jump Location

Resuscitation bag, mask, and tubing.

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Figure 24-2.
Graphic Jump Location

Face mask with attached PEEP valve.

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Techniques

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  • ▪  Select appropriate mask for patient’s face size.
  • ▪  Apply mask to face over nose and mouth with left hand.
  • ▪  The thumb should be above the endotracheal tube connector and the index finger below, with the remaining fingers spread along mandible (Figure 24-3).
  • ▪  The bag should be compressed in coordination with the patient’s inspiratory effort, if present or at a rate between 10 and 20 breaths/min if patient efforts absent.
  • ▪  The chest should be inspected for appropriate rise and fall with bag compressions.
  • ▪  The abdomen should be inspected for enlargement to determine whether the stomach is being inflated with bag compressions.

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Figure 24-3.
Graphic Jump Location

Hand position on mask.

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Clinical Pearls and Pitfalls

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  • ▪  Patients with certain kinds of facial anatomy (ie, beard, edentulous, excess soft tissue) are difficult to ventilate with a mask.
  • ▪  The mask can be rocked in various directions to enhance the seal.
  • ▪  If it becomes apparent that the stomach is inflating, an artificial airway should be placed, and Sellick’s maneuver performed (see Chapter 27) to compress esophagus during ventilation—the stomach should then be decompressed following endotracheal intubation if applicable.

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