The Bagvalvemask Unit

The bag-valve-mask (BVM) unit (Fig 14.-4) is a self-inflating bag with a nonrebreathing valve that can be attached to a face mask. This design allows room air or oxygenated air to be manually delivered into the victim's lungs after any obstruction has been eliminated. This apparatus can be used initially while preparing for definitive airway maintenance. After the mask is placed, the handler clamps it snugly to the face. The thumb and index finger grasp the mask while the other fingers grasp the chin and pull it forward to hyperextend the stable neck. The other hand compresses the bag, expelling air into the patient's respiratory tree. This procedure can be used to manage respiratory failure temporarily, to assist poor inspiratory effort, or to temporize respiratory fatigue. The most common problem with a one-person operation is air leaks around the mask. A two-person operation employs two hands to hold the mask flush and has been shown to result in more effective ventilation.2 After an intubation, the BVM unit can be attached to the proximal end of the endotracheal tube. Placement of an oral or nasal airway further facilitates airflow. The BVM unit may also be used prior to rapid-sequence intubation (RSI) to quickly assess the ease of BVM ventilation in cases where oral intubation fails.

FIG. 14-4. Bag-valve-mask unit.

To deliver 100% oxygen, there must be a reservoir with the same volume as the bag and an oxygen flow rate equal to the respiratory minute volume of the patient. By using a 2.5-L reservoir bag with an oxygen flow of 15 L/min, 100% oxygen can be delivered. Similarly, a demand valve attached to the reservoir port of the ventilation bag will deliver a high concentration of oxygen.

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