hey guys Andrew with prime medical trainingand today we're going to do case review of a cardiac arrest that I worked yesterday soit was not my patient it was initially brought into the ERdropped it off and then and then the staff took over the patient coded soonafter and they started CPR I took over doing ventilations at the head with abag valve mask while one of the nurses started doing compressions while she'sdoing compressions she's going for a little longer thanthen I would normally anticipated i said hey what number you want and she saidim on 35 I said wow I got to get my two
breaths you need to stop for a secondand at that point the overheard me saying this and he says no no here we do continuous compressions with breath whenever you feel like it exactly what he told me I said uh okayso she continues doing compressions I start doing ventilations at one breathevery six seconds and and then he makes a remark that see look his oxygen saturations ahundred percent we're doing great let me explain why we do not docontinuous compressions when there's not
an advanced airway place yeah he might have had a hundred percent oxygensaturation he also probably had that in the stomach take a look over here so what we've gotis this very shrewd outline of the person you got compressions happeningover here and you have on the the bag of mass of the ventilations when youcompress you're compressing the lung and pushing air out so if i try to push air inat the same time that a person is trying to compress air is not going into thelungs so wewheres it gonna go it's gonna go
someplace it can't go out there mouthand it can't go into Long's so its forced into the stomach so when you're doingcontinuous compressions with a bag valve mask you just pumping oxygen into thestomach yeah there's definitely oxygen gettinginto the lungs but you're causing a lot more complications seen so manyfatalities happen because air gets pushed in the stomach gastric distensionoccurs they vomit and they aspirated into the lungs andthey end up dying from that infection so let's talk about when you do docontinuous compressions and in breast
that's when you have an advanced airway inplace knows this is the trachea here this is going to be your ET tube when youintubated somebody you blow up the little balloon that ecludes that airwayso now even if the person still doing continuous compressions and you'reblowing air in there's no chance of the air being able to get pushed back outand then into the stomach okay this protects it it creates adefinitive airway and it secures it from any kind of gastric distension or aspiration so just wanted to point that out guys
if your or if your instructoris telling you that that compressions are superimportant and you just need to do not stopcompressions regardless that is absolutely wrong there is such a thingas creating harm to a patient when we do continuous compressions and give breathswith a bag valve mask that's case review number one this is andrew with Primemedical training.
EMS Skills Bag Valve Mask Ventilation
If a patient is not adequatelyventilating on his or her own, which may mean the patient isnot breathing at all or the patient is breathing but notexchanging adequate amounts of air, it is necessary for theEMT to support ventilations mechanically. For the EMT, the tool of choiceto ventilate a patient is a bag valve mask.
The device consists of aface mask, a one way valve, and a bag. Many bag valve masks will alsoincorporate an oxygen reservoir as well. When utilizing a bag valve mask,the EMT should always utilize manual airwaytechniques, airway adjuncts, and supplemental oxygen todeliver high concentrations of oxygen to the patient whileinsuring a patent airway.
Do not hesitate to suctionthe airway if necessary. Also remember to takeappropriate cervical spine stabilization precautionsif warranted. Assembly of the bag valve maskis relatively simple. Begin by expandingthe bag itself. Attach the action reservoirbag, if included, and the face mask. Attach the oxygen tubing to thebag valve mask and connect
the other end to the regulatoron an oxygen cylinder or to a regulator withinthe ambulance. Ensure the oxygen supply is onand set the regulator at a high flow rate, typically15 liters per minute. If the EMT is functioning alone,he or she should use the EC technique forestablishing a face mask seal over the patient's face. Grasp the face mask using thepalm, thumb, and index finger
to form a C overthe face mask. Place the face mask over thepatient's nose and mouth. Utilize the remaining fingersunder the patient's jaw to form an E and anchor thehand to the face. Squeeze the bag with the otherhand delivering enough air to produce visible chestrise in the patient. Release the bag and allowit to refill with air. Squeeze again and repeat asnecessary at an appropriate
rate determined by AHA standardsor local protocol. If at any time chest rise doesnot occur when the bag is squeezed, reassessthe equipment, technique, and patient. In some instances, the rescuerfailed to maintain an adequate seal between the face maskand the patient's face. In other instances, thepatient's airway may be occluded given a foreign bodyor in proper positioning.