What are all the things that must be done to achieve optimal BVM?
Here are some ways to remember and various pearls.
3X4 ways to BVM
There is the 3 step program (3 sets of quadruplets).
1) BVM, PEEP at 15, Mask O2 at 15, Nasal O2 at 15
2) OAW, Jaw thrust, Clear FB’s and fluids, Position head and neck with head of bed up
3) Two person BVM, good Mask seal, Considering shock, Considering pulse ox lag/poor sat reading
And then there is @cptjcook‘s (Jason N. Cook) Sex (6) steps to #SexyBagging
Step 1: Use airways (oral and nasal)
And some tweeted thoughts about that
Step 2 Two thumbs down mask seal grip with jaw lift
Lift the jaw and face into the mask and feel for leaks. Little, ring +/- middle fingers reach behind the angle of the jaw to pull it up.
Step 3 Two person BVM technique
An underhand grip on the BVM is preferred. You tend to squeeze the bag less hard and you have a firm hold on the bag.
Step 4 Position optimally for the airway
I usually don’t use pillows for positioning
I love this pearl from George Kovacs on dynamic head positioning and this can be for both BVM as well as intubation and insertion of supraglottic airways.
My mantra for positioning of all airway interventions (except cric where neck is hyperextended if possible):
Step 5 Squeeze with care and coordination
Also there is JAWS: Love this from Rich Levitan!
Step 6 Use PEEP
Other options might be Mapleson C-Circuit (I have no experience) and the Oxylator.
Yen Chow and Sameer Mal at Ornge on BVM
Tips from Nick Chrimes at SMACC
This was from smaccGold (Hat tip to @DentonGavin for reminding me!)
Tweet me or leave me comments on your favorite approach to optimal BVM or if I have missed anything or other good resources! I will update this page from time to time as more things come to me. (Yen 2016-01-23)