How do you test a bag-and-mask system for positive pressure generation?
achieved by sealing the bag-valve device connector with your thumb and squeezing the bag with reasonable force. If it is difficult to compress the bag or if air is forced between the connector and your thumb, positive pressure can be delivered
how do you test a bag-and-mask system for no rebreathing?
? does the system have adequate FGF ?
How do you test a bag-and-mask system (ambu bag) for oxygen flow?
listen at distal end (near reservoir) for O2 flow sound (hissing)
Which part of the device supports bidirectional flow?
How do you position the patient? Position yourself?
patient supine with head in "sniff postion" with sheets properly supporting ociput You patients head should be at endoscopist's waiste level Stand up straight – do not bend over Upper arm relaxed at your chest wall Lower arm at horizontal with wrist fixed Grasp laryngocope handle – you are not golfing Lift toward ceiling-wall intersection
what are anatomic points engaged in one-handed mask technique?
Left hand Thumb - body of mask (near point) at bridge of nose index f. - boby of mask (near base) over pt's chin middle and ring f.f. - rim of mandible pinky f. - behing angle of mandible
What are points engaged in two-handed mask technique?
same as single but using both left and right or place each thumb on body of mask with index, middle, and ring ff. of each hand hooking around angle of madible. (perform tripple airway maneuver - head extension, mouth open, chin lift)
what tissue should be avoided during bag mask technique?
the floor of the mouth, (i.e. the supra hyoid muscles). these tissues can cause obstruction
how should you apply face mask strap?
1. place body of strap behind patients head 2. attach one strap to the attachment ring 3. now attach strap located opposite and diagonal to the first strap (for stability) 4. attach (2) remaining straps
What anatomical point should be avoided when applying face mask straps?
Discuss troubleshooting ventilation difficulties, including edentulous patients, mandibular prognathism, mandibular retrognathism, beard.
1st - if you think it's going to difficult, ask for help/assistance. Use a OAW or NAW. edentulous - attempt to pull any excess cheek tissue up into the mask. Most often a 2 handed technique is needed.
How do you maintain a gas-tight seal?
press the mask down onto the face by using your thumb and index finger while pulling the mandible up with the middle and ring finger
what is the ID of a Face mask connection?
How do you size a face mask?
It should sit over the bridge of the patient’s nose with the upper
border aligned with the pupils. The sides should seal just lateral to
the nasolabial folds with the bottom of the face mask sitting between
the lower lip and chin.
what part of the mask do you apply first to the patient's face?
point of the mask to the bridge of the nose
Above what inflation pressures during bag mask ventilation, might you begin to contribute to gastric insuflation?
> 20 cmH2O
what are some contraindications for bag-mask ventilation?
Full stomach - risk of aspiration after regurgitation (however, if hypoxemia is occuring then it is more important to ventilate the patient however you can)
potential cervical spinal injury - avoid cervical flexion
Severe facial trauma
Upper airway foreign body obstruction -- attemp to clear it first
What are some complications related to bag-mask ventilation?
hypoxia and/or hypercarbia due to ineffective ventilation
regurgitation/aspiration of gastric contents
trauma or bleeding from OAW or NAW
larygospasm or bronchospasm from airways that have to the potential to stimulate these areas if placed to low
When is the only time we avoid bag mask ventilation in an anesthesia case?
when it's an RSI
how do we confirm effective ventilation
Visible Chest Rise
Condensation in the mask
ETCO2 / Capnogram
Compliance of bag
NOTE: it is possible to see ETCO2 /Capnogram from the stomach if you have accidentally intubated the esophagus. It is good to confirm placement of ETT via breath sounds and observing a few (6 or more) manual breath cycles with capnogram waveform
Which nerve is at risk of injury when applying a face strap?
during bag and mask ventillation, what pressure do we try to stay below in order to avoid insufflating the stomach?
how do you determine if there is O2 flow in a hand operated self-inflating resussitation bag?
listen at the distal end