ambu bag

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AMBU BAG VENTILATION:

AMBU BAG VENTILATION Dr. Jitendra Agrawal M D Assistant Professor Anesthesiology G R Medical College

Introduction :

Introduction Mask pressure gauze Rebreathing bag Oxygen connecting Tube Oxygen reservoir

What is Ambu bag ventilation? :

What is Ambu bag ventilation? It is an essential emergency skill. This basic airway management technique allows for oxygenation and ventilation of patients until a more definitive airway can be established and/or in cases where endotracheal intubation or other definitive control of the airway is not possible.

History :

History In 1953, Dr. Holger Hesse , a Danish engineer, with Professor Henning Ruben, an anesthesiologist, design a breathing apparatus to improve the survival chances of patients in emergencies outside the hospital. " Ambu " came from the word ambulance and the reference to "bagging" was coined by rescue workers. Hesse and Ruben named the company " Ambu ," and it still was in operation in 2010

Slide 5:

It requires good seal and patent airway. Adjuncts Oral/ nasal airway Difficulty hair , teeth, BMI, age, h/o snoring. mouth-to-mouth resuscitation, caused more problems than they solved. The problems of abdominal distention, vomiting, aspiration and poor ventilation carried a poor prognosis. The success of the Ambu bag in rescue breathing improved emergency services in rural and urban communities

Indications:

Indications Respiratory Failure Failure of ventilation Failure of oxygenation Failed intubation

Contraindications :

Contraindications BVM ventilation is absolutely contraindicated in the presence of complete upper airway obstruction . BVM ventilation is relatively contraindicated after paralysis and induction (because of the increased risk of aspiration).

Figure : Mechanisms of the manual resuscitators: A and B in the normal conditions, C and D in the presence of big negative pressure in the breathing circuit.:

Figure : Mechanisms of the manual resuscitators: A and B in the normal conditions, C and D in the presence of big negative pressure in the breathing circuit.

Slide 9:

Positioning Place towels under the patient’s head to position the ear level with the sternal notch . Extend the patient’s head slightly.

Technique :

Technique Open the airway (head-tilt chin-lift maneuver or the jaw thrust). In patients with suspected cervical spine injury, do not perform a head-tilt; rather, only perform a chin-lift maneuver . Use an airway adjunct. Place an OPA in unresponsive patients without a gag reflex. 6 If the patient is awake, place one or two NPA ( because of the risk of intracranial placement, avoid the use of a NPA in patients with significant head and facial trauma ) . 6 Place the mask on the patient’s face before attaching the bag. 4 Cover the nose and the mouth with the mask without extending it over the chin . Change the size of the mask, as appropriate, to create a good seal . Hold the mask in place using the one-hand E-C technique, as shown below.

Contd…. :

Contd…. Use the non dominant hand. Create a C-shape with the thumb and index finger over the top of the mask and apply gentle downward pressure. Hook the remaining fingers around the mandible and lift it upward toward the mask, creating the E.

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Alternate one-hand technique .

Two-hand technique If a second person is available to provide ventilations by compressing the bag :

Two-hand technique If a second person is available to provide ventilations by compressing the bag Create two opposing semicircles with the thumb and index finger of each hand to form a ring around the mask connector, and hold the mask on the patient’s face. Then, lift up on the mandible with the remaining digits. Alternatively , place both thumbs opposing the mask connector, using the thenar eminences to hold the mask on the patient’s face, while lifting up the mandible with the fingers. No matter which technique is being used, avoid applying pressure on the soft tissues of the neck or on the eyes

Ventilation :

Ventilation volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult). 6 Ventilate at a rate of 10-12 breaths per minute. 6 (for a patient with perfusing rhythm) During cardiopulmonary resuscitation (CPR), give 2 breaths after each series of 30 chest compressions until an advanced airway is placed. Then ventilate at a rate of 8-10 breaths per minute. 6 Give each breath over 1 second. 6 If the patient has intrinsic respiratory drive, assist the patient’s breaths. In a patient with tachypnea, assist every few breaths. 7 Ventilate with low pressure and low volume to decrease gastric distension .

Cont.. :

Cont.. Maintain cricoid pressure consistently . to compress the esophagus and reduce the risk of aspiration. However, it does not completely protect against regurgitation, especially in cases of prolonged ventilation or poor technique. 1 Care must be taken to avoid excessive pressure, which can result in compression of the trachea . Assess the adequacy of ventilation. - Observe for chest rise, improving color, and oxygen saturation. - Monitor for air leak. - Be cognizant of increasing gastric distention .

Pearls :

Pearls Lift the mandible up to the mask rather than pushing the mask down onto the face . An adequate seal can more easily be made with a mask that is too big than one that is too small . Leave dentures in place, when possible, to improve mask seal . If the patient's facial hair makes a seal difficult to obtain, apply a water-soluble lubricant over the beard to improve the contact between the face and the mask . If the one-handed mask ventilation is not effective, switch to the two-handed technique.

Cont.. :

Cont.. Insert NPA devices bilaterally if necessary . The best way to prevent aspiration is with good technique, including low-pressure, low-volume ventilation with slow insufflation. Newer bags have built-in pressure valves. The green zone includes pressures up to 20 cm of water and corresponds to the lowest risk of gastric distention . Note the type of bag being used. Bags with one-way expiratory valves allow greater than 90% oxygen delivery during both positive pressure and spontaneous ventilation, while bags lacking this feature only deliver about 30% oxygen during spontaneous breaths.

Complications :

Complications Aspiration Hypoventilation Hyperventilation

References :

References Levitan RM. The Airway Cam Guide to Intubation and Practical Emergency Airway Management . Wayne, Pa: Airway Cam Technologies, Inc ; 2004:49-54. Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA . Feb 9 2000;283(6):783-90. Miller, RD. Miller's Anesthesia . 6 th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:1617-25. Walls RM. Manual of Emergency Airway Management . 2 nd ed. Philadelphia, Pa: Lippincott Williams and Williams; 2004:43-51. Roberts H, Hedges J, Chanmugam A. Clinical Procedures in Emergency Medicine . 4 th ed. Philadelphia, Pa: WB Saunders; 2003. ECC Committee; Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation . Dec 13 2005;112(24 Suppl ):IV1-203 . Kovacs G, Law JA. Airway Management in Emergencies . New York: McGraw-Hill; 2008:33-52 . American College of Emergency Physicians: Focus On Bag-Valve Mask Ventilation Ambu : Ambu's History Critical Care Nurse: Airway Management

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