Emergency Medicine Book

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Positive Pressure VentilationAka: Bag Valve Mask, Ambu Bag, Anesthesia Bag

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  1. See Also
    1. Newborn Resuscitation
    2. Adult Resuscitation
    3. Pediatric Resuscitation
  2. Device: Flow-inflating bag (Anesthesia Bag)
    1. Mechanism
      1. Requires compressed oxygen source to fill
    2. Advantages
      1. Preferred for Newborn Resuscitation
      2. Lung compliance can be felt on squeezing bag
      3. Can deliver free-flow 100% oxygen
    3. Disadvantages
      1. Requires a tight facial seal
      2. Higher risk of over-inflating lung (use manometer)
      3. Technically more difficult to learn to use
    4. Technique
      1. Set oxygen supply flowmeter to 5-10 L/min
      2. Adjust bag volume with flow-control valve
  3. Device: Self-inflating bag (Bag-valve mask or Ambu Bag)
    1. Mechanism
      1. Bag fills spontaneously after being squeezed
    2. Advantages
      1. Does not require an oxygen source
      2. Easier to learn to use
    3. Disadvantages
      1. Can not deliver free flow oxygen
    4. Oxygen Delivery with ventilation (Bag-Valve Mask)
      1. No Oxygen Source
        1. Delivers 21% Oxygen (Room air)
      2. Without Oxygen Reservoir
        1. Delivers 30-80% Oxygen at 10 LPM flow
      3. With Oxygen Reservoir (required for high oxygen flow)
        1. Delivers 60-95% Oxygen at 10-15 LPM flow
    5. Pop-Off Valves (Bag Valve Mask)
      1. Usually set at 30-45 cm H2O
      2. Pop-off should be easily occluded on bags
        1. Higher pressures are needed during CPR
      3. Occlusion of the pop off valve
        1. Depress valve with finger during ventilation or
        2. Twist the pop-off valve into closed position
  4. Precautions
    1. Do not use Bag Valve Mask to deliver free flow oxygen
  5. Technique
    1. Tidal Volume
      1. Term Newborns
        1. Administer 5-8 ml/kg (15 to 25 ml per ventilation)
        2. Bag volume: 200 to 750 ml (usually >450 ml)
      2. Adults and older children
        1. Administer 10-15 ml/kg
    2. Hold mask over face with one hand
      1. Mask should fit snugly
        1. Covers mouth, nose and chin
        2. Should not cover eyes
      2. Thumb over nose
      3. Support jaw with middle or ring finger
      4. Avoid submental pressure (risk of airway obstruction)
    3. Head Tilt - chin lift (Avoid if trauma!)
      1. Infants/Toddlers
        1. Neutral sniffing position without hyperextension
      2. Children >2yo
        1. Anterior displacement of c-spine
        2. Folded towel under neck and head
    4. Observe for adequate ventilation
      1. Adequate chest rise
  6. Troubleshooting
    1. No chest rise:
      1. Reposition head
      2. Ensure mask is snug
      3. Lift the jaw
      4. Consider suctioning airway
      5. Consider equipment failure (always test before use)
        1. Test bag with hand occluding patient outlet
        2. Check for bag leak
        3. Check flow-control valve
        4. Check that oxygen line is connected
    2. Avoid stomach inflation and gastric distention
      1. Apply cricoid pressure (Sellick maneuver)
        1. In unconscious infant or child
      2. Consider NG suction
    3. Sudden decrease in lung compliance
      1. Right main bronchus intubation
      2. Obstructed Endotracheal Tube
      3. Pneumothorax

Intermittent Positive-Pressure Ventilation (C0021778)

Definition (MSH)Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator.
ConceptsTherapeutic or Preventive Procedure (T061)
EnglishInspiratory Positive Pressure Ventilation, Intermit.pos.pres.vent., Intermittent positive pressure ventilation, IPPV, Positive pressure ventilation
Spanishventilación con presión positiva intermitente, ventilacion con presion positiva intermitente
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Ambu bag (C0221812)

ConceptsMedical Device (T074)
EnglishAmbu bag
Spanishbolsa Ambu, bolsa autoinflable
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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