Procedural videos

Bag-valve-mask ventilation animated demonstration

Equipment needed

  • Personal protective equipment, including gloves

  • Bag-valve-mask apparatus

  • Oxygen

  • Reservoir bag attached to the bag-valve-mask apparatus

  • Suction

  • Oropharyngeal airway (have available to use if needed)

  • Nasopharyngeal airway (have available to use if needed)

  • Resuscitation kit.

Contraindications

Complete upper airway obstruction is an absolute contraindication for bag-valve-mask ventilation.

If there is suspicion of a cervical spine injury, airway opening should ideally be achieved by jaw thrust or chin lift rather than head tilt, while maintaining manual inline stabilisation (MILS). If the airway remains obstructed despite these measures, perform a head tilt using small increments until the airway is open, while maintaining MILS.[78]

When it is clear from the outset that the patient needs a definitive airway (e.g., in the unconscious patient with a severe head and facial injury) call for help early while maintaining a patent airway by simple means until skilled help arrives.

Consider the level of the airway obstruction. Laryngospasm due to anaphylaxis, an inhalation burn, near drowning, or a foreign body will not improve significantly with simple airway manoeuvres, and the patient may need intubation or advanced airway procedure.

Indications

  • Respiratory failure

  • Failed intubation.

Complications

  • Aspiration

  • Hypoventilation

  • Hyperventilation

  • Cervical spine injury.

Any significant leak will cause hypoventilation of the airway and can cause gas to be forced into the stomach, heightening the risk of aspiration.

Aftercare

Continue to resuscitate the patient in keeping with life support guidelines, using ABCDE principles. Send for assistance as soon as possible.

If resuscitation is successful and the patient regains control of their own airway, this should be regularly reassessed. Measure arterial blood oxygen saturation as soon as practical by arterial blood gas sampling and/or pulse oximetry and titrate inspired oxygen to maintain a blood arterial oxygen saturation in the range of 94% to 98%.[78]

If the resuscitation continues or the patient’s Glasgow Coma Scale is less than 8, consider insertion of an endotracheal tube.