Bag Mask Ventilation 1
What is the correct head position for bag mask ventilation? And, what can you do with infants to help with correct position?
Adults and adolescents- should be midline, sniffing position
Infants and small children- should be midline, slight sniffing position
A small towel under infants may be used to maintain adequate positioning. Hyperextension should be avoided because it can cause the airways to collapse.
If your patient has a neck injury, what do you want to avoid during bag mask ventilation?
Avoid movement
The nares of a patient should be what percentage occluded for HHF?
60 %
Demonstration: Review the HHF setup and point out 5 errors in the setup.
Point out errors.
Watch video of RT explaining how to trouble shoot HHF.
What is included in the PAS score?
Respiratory rate
Oxygen requirement
Auscultation
Retractions
Dyspnea
How do you determine appropriate mask fit for patients?
It should extend from the bridge of the nose to the indentation of the chin and should be wide enough to cover the entire mouth without resting on the eyes.
Why should ocular pressure be avoided during bask mask ventilation?
It can cause reflex bradycardia and may damage the eyes.
How much should a patient be weaned to within the first couple hours?
70%
When can you transition a patient to low flow from HHF?
FiO2 30%
Flow 3 Liters
Bonus: Your patient needs oxygen!
Match up the oxygen delivery devices to the amount of oxygen to deliver using each device.
Hands on Demonstration:
Nasal cannula-
Neonate- max rate- 1
Pediatric- max rate 3
Adult- max rate 6
Simple mask- 5-8
Non-rebreather- must keep bag partially full with each breath up to 15
Oxymask- 1-15
How do you determine the size of resuscitation for your patient?
Neonates and small children- Less than 10kg (300 ml self-inflating or 500 ml flow-inflating)
Medium child- Teenager- 10-40 kg (1 liter bag)
Adults- Greater than 40 kg (1 liter bag)
What is the proper technique for holding the mask?
One hand E-C technique
Bring mandible up towards mask rather than pushing mask down on face
Once your patient is stable, consider weaning ________ first to maintain oxygen sats?
FiO2
What would you increase for work of breathing or tachypnea while patient is on HHF?
Liters/Flow
Can we deliver Albuterol through HHF on the floor?
No
Once bag is attached to an oxygen source how many liters per minute should your oxygen flow be set at?
10-15
What is the proper rate of breaths for rescue breathing? How should breaths be delivered during rescue breathing?
Neonate- 30 breaths per min (1 breath every 2 sec)
Child- 1 year and older- 20 breaths per min (1 breath every 2-3 sec)
Adult- 10-12 breaths per min (1 breath every 5-6 seconds)
The breath should be delivered slowly, over 1 second and deliver only enough volume for adequate chest rise. (Do not over-inflate or hyperventilate).
What is the max flow rate for kids on HHF on the floor?
6 months to 12 months- 8
13 months to 24 months- 10
25 months to 5 years- 12
Greater than 5 years old- 16
What would you increase for hypoxia when a patient is on HHF?
FiO2
When can you advance to the next phase of the bronchodilator weaning protocol?
PAS score decreases by 2 or 7 or better
Can you deliver Blowby with a self-inflating bag?
False
* DEMONSTRATION/Bonus
Bag mask ventilation with both self-inflating and flow-inflating masks
(How can you tell patient is getting adequate ventilation?)
DEMONSTRATION: Hands on
You should watch for symmetrical chest rise and that you can auscultate equal breath sounds.
Verbalize how to wean flow rate and FiO2 based on clinical evaluation?
If FiO2 is greater than 50%, start with FiO2 wean to 50 %. Then once FiO2 is at 50% wean flow by at least 1 LPM or FiO2 by 5-10% every 1-2 (or assessment) or faster if tolerated by the patient.
Bonus/Demonstrate how to transport a patient on HHF!
DEMONSTRATION:
Hands on
* BONUS/DEMONSTRATION:
How would you refill continuous albuterol?
DEMONSTRATION:
Hands on