Download Mask Ventilation

MASK VENTILATION
MASK VENTILATION !
THEORY The purpose of mask ventilation is to assist with ventilation and/or oxygenation in a patient with respiratory insufficiency or failure. Mask ventilation is an extremely important skill to master, and can provide life saving assistance while waiting for a patient’s underlying condition to resolve or while an artificial airway is secured. !
PATIENT !!! SELECTION
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EQUIPMENT !
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PROCEDURE
Contraindications: •Patients with respiratory insufficiency or failure, while awaiting for •Caution in patients with: resolution of the underlying condition or prior to securing an artificial ‣a full stomach airway in conditions such as: ‣nasal/facial fractures ‣ respiratory diseases, such as pneumonia ‣recent nasal/facial surgery ‣ neurological illnesses, such as apnea, seizure, or encephalitis ‣unrepaired congenital diaphragmatic ‣ traumatic injuries, such as pulmonary contusion or flail chest hernia without a nasogastric tube in place •Patients undergoing elective intubation for general anesthesia for ‣esophageal injuries
surgical procedures
•Manual ventilation bag •Appropriately-­‐sized mask
•Oxygen source •Appropriately-­‐sized oral and/or nasal airway
•Water-­‐based lubricating jelly •Tongue blade
1. Position the patient. The goal is to align your eyes with the patient’s mouth and trachea, which will make it easier to intubate the patient. • Infant. Put the baby into sniffing position by extending the neck and lifting the chin (Figure 1a). Babies easily go into sniffing Figure 1. Position the patient. a: Place the infant into sniffing position by position because of their large occiput. extending the neck and lifting the chin. b: Flex the neck and place a towel • Older child. Flex the patient’s neck. Slide under the head of an older child.
the towel underneath the head (Figure 1b). 2. Open the airway. Pull the jaw forward to relieve any airway obstruction (Figure 2), i.e. the tongue. 3. Choose an appropriately-­‐sized mask. The mask should cover the nose and mouth (Figure 3). It should not have any leaks, such as over the eyes or below the chin. Figure 2: Pull the jaw forward to 4. Apply the mask and maintain the open airway. Figure 3: The mask should cover the nose and mouth without leaks, such Put your last three fingers on the mandible and pull relieve obstruction by the tongue.
as over the eyes or below the chin.
up in order to maintain the unobstructed airway. Place the mask over the nose and mouth and put your thumb and forefinger on top of the mask to hold it in place (Figure 4). 5. Squeeze the manual ventilation bag to deliver a breath. 6. Consider use of an oral or nasal airway. If you are having difficulty achieving or maintaining an open airway, an oral or nasal airway may help relieve obstruction from the tongue or soft tissues of the posterior oropharynx. !
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Figure 4: One hand holds the mask in place while the other squeezed the bag. MASK VENTILATION
Oral Airway 1. Choose an appropriately-­‐sized oral airway. Measure from the mouth to the tragus or mouth to angle of the jaw (Figure 5). 2. Insert oral airway. Slide the oral airway in over the Figure 5: The oral airway can be Figure 6: Oral airway positioned tongue to displace the tongue forward (Figure 6). sized b
y fi
tting f
rom t
he m
outh t
o properly, displacing the tongue Consider using a tongue blade to push the tongue the tragus, or from the mouth to forward.
down as you insert the oral airway. In an older child, the angle of the jaw.
you may want to insert the airway with the concave surface up and rotate the airway into place. Caution this technique in a younger as you may cause damage to the fragile oral mucosa as you rotate the firm plastic airway into place. !
Nasal Airway 1. Choose an appropriately-­‐sized nasal airway. Measure from the nose to the tragus or nose to the angle of the jaw (Figure 7). 2.If necessary, adjust the length of nasal airway. Some nasal airways come equipped with a collar, which can be used to adjust the length of the airway. Figure 7: The nasal airway can be Figure 8: Nasal airway positioned 3. Insert nasal airway. Lubricate the nasal airway with sized by measuring from the nose properly, displacing soft tissues water-­‐based lubricating jelly. Insert the nasal airway to the tragus, or from the nose to forward.
the angle of the jaw.
into the nare until you reach the collar (Figure 8). 4. Secure the nasal airway. The airway can be taped in position at the collar. !!
Troubleshooting : What if I have a leak around the mask that prevents me from effectively ventilating the patient? •Reposition yourself. Even a small change in the angle of the mask may help you to get a better seal on the patient’s face. •More vigorous pushing and pulling. Pulling up more firmly with you finger on the patient’s chin and pushing down more vigorously with your thumb on the top of the mask. •Change the mask size. If you’re having trouble getting a good seal, switch to a small mask rather than a larger mask, since a smaller mask may fit more tightly to the anatomy of the patient’s face. •Use two people to ventilate. Have one focus on getting a good seal with the mask by using two hands, while the second person manually delivers breaths with the bag (Figure 9). !
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COMPLICATIONS •Gaseous distension of the stomach •Vomiting and aspiration •Patient dysynchrony with mask ventilation
•Hyper-­‐ or hypo-­‐ ventilation •Inadequate oxygenation •Pneumothorax
Figure 9: Two person technique. One person attempts to get a good seal with the mask using two hands, while the other person ventilates the patient with the bag.
•Cardiovascular compromise •Pain and/or anxiety
REFERENCES •Fink MP, Abraham E, Vincent J, Kochanek PM (2005). Textbook of critical care medicine. 5th ed. Philadelphia (PA): Elsevier. p. 313.
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decision making and judgment by a qualified health care professional. Users of this guideline assume full responsibility for utilizing the information contained
in this guideline. OPENPediatrics™ and its affiliations are not responsible or liable for any claim, loss, or damage resulting from the use of this information.
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