Tuesday, October 19, 2010

Ventilation with a Face Mask

Providing positive-pressure ventilation with a face mask and a bag-valve device cna be a lifesaving maneuver. Although seemingly simple, the technique requires an understanding of the airway anatomy, the equipment, and the indications.Face-mask ventilation is used in patients who have respiratory failure but arestill breathing spontaneously and in patients with complete apnea. Face-mask ventilation can be indicated in any situation in which spontaneous breathing is failing or has ceased, including cardiopulmonary arrest.

Face-mask ventilation is rarely contraindicated. However, caution is advised in patients with severe facial trauma and eye injuries. In addition, foreign material (e.g., gastric contents) in the airway may lead to aspiration pneumonitis. In these circumstances, alternative approaches, including endotracheal intubation, may be necessary.
There are many types of face masks, varying in design, size, and construction materials.Transparent masks are preferred because they allow for inspection of lipcolor, condensation, secretions, and vomitus. To maintain a good seal, the mask’s size and shape must conform to the facial anatomy. Thus, several mask shapes and sizes should be readily available.
Various bag-valve designs are available. All have a self-inflating bag and a nonrebreathing, unidirectional valve. The valve is designed to function during both spontaneous and manually controlled ventilation. Because bag-valve devices can operate without an oxygen source, it is important to ascertain that supplemental oxygen is flowing through the bag-valve device when supplemental oxygen is indicated and available. Test the bag-valve device’s capability for delivering positive-pressure ventilation before use. This can be 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.
Whenever possible during face-mask ventilation, suction should be readily available.
You may need to use airway-management adjuncts, such as disposable oral or nasal airways. Before beginning face-mask ventilation, examine the patient’s oral cavity. If possible, remove any dental prostheses or other foreign bodies that might be swallowed
or aspirated

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