Bag-Vavle-Mask problem?

[Leener77]

You would only bag every 3 seconds if it's a pediatric patient (appropriate age/size). Otherwise the rate would be too fast for an adult. It's about once every 5 seconds on and adult. But yes, squeezing the bag at a somewhat slow steady rate would be the correct way to do it.

[VentMedic]

You would only bag every 3 seconds if it's a pediatric patient (appropriate age/size). Otherwise the rate would be too fast for an adult. It's about once every 5 seconds on and adult. But yes, squeezing the bag at a somewhat slow steady rate would be the correct way to do it.

Again, if the patient is on a ventilator in the hospital with known lab values taken with a known minute volume, regardless of the back up rate since there are no other settings given here or the patient's own respiratory effort, one may have to bag accordingly to maintain appropriate ventilation/oxygenation for that patient. If the patient was breathing spontaneously, those breaths must also be taken into consideration.

A recipe from the EMT protocol book does not fit all patients once known diagnostic values become available and the longer the body is "sick" by either poor perfusion and/or sepsis. The acid/base balance may have to be "chased" until some homeostasis is achieved and the problem(s) of the body are corrected.

The guidelines usually taken from the AHA for rescue breathing can be work very well in the initial phase. However, the body may get a lot sicker quickly before it gets better, thus needing more Ventilation/Oxygenation support. The hospital is going to also take into consideration time down and anticipate the acid-base consequences for the disease process. If all the patients could be on the same ventilator settings, there would be little need for high tech ventilators costing $40,000 - $100,000 each and trained specialists such as Pulmonologists and Respiratory Therapists to manage them.

In other words, you can bag the patient according to your guidelines and protocols in your ambulance. In the hospital, you may have to bag according to their guidelines and protocols as determined by actual lab values and the patient's own respiratory effort to maintain homeostasis.

[Leener77]

I'm sorry Vent, maybe I should have specified.......

I was actually responding to the reply before mine (EMTBASIC_911_911)......I believe she was referring to bagging a Pt prehospital (and not on a vent) and I was simply correcting her/making her aware of the approximate number an adult should be bagged in the field. I understand that in the case of the original post it might be different because of the circumstances and the pt being on a vent.

Make sense?

[VentMedic]

No problem.

The AHA in an attempt to simplify things may have complicated the breath rate picture somewhat with the rate being anywhere from 12 - 0 for adults depending on your level of training.

Compression Only CPR is an interesting concept. I am looking forward to seeing lab results on these patients in the ED. I have seen a couple but they were dialysis patients which should be in their own category of Cardiac Arrests.

[firedoc5]

A comment I heard one time was that in the field, you can not over hyper-ventilate a patient. The more the better.

[Scaramedic]

Our Doc, as I have mentioned before, is really into ETCO[sup:5e779841a1]2[/sup:5e779841a1] readings. One example is a head injury, he wants us to maintain between 30-35mm/hg ETCO[sup:5e779841a1]2[/sup:5e779841a1].

[VentMedic]

A comment I heard one time was that in the field, you can not over hyper-ventilate a patient. The more the better.

Hyperventilation in prehospital is one of the reasons the rate was changed with an ETT to 8 - 10 or 1 every 6 - 8 seconds.

Our Doc, as I have mentioned before, is really into ETCO[sup:9fdf1bf545]2[/sup:9fdf1bf545] readings. One example is a head injury, he wants us to maintain between 30-35mm/hg ETCO[sup:9fdf1bf545]2[/sup:9fdf1bf545].

I can see where your doctor may want that prehospital with the assumption of a 5 mmHg error. Hopefully the error is not on the low side of 30.

For TBI in the ICU , we try not to go much below 35 mmHg for PaCO2 with 33 being acceptable as minimum to avoid too many changes and that is only with an SjvO2 monitor in place to watch tissue oxygenation.

[Richard B the EMT]

Perhaps it is just me being polite, but, if I'm in the process of bagging a patient, you know I'm following my protocols. I'd tell the Respiratory Therapist that, too, but then ask, "OK, this is your area of expertise, what do you want me to do differently?"

[sportygirl]

DwayneEMTB wrote:

I’m guessing that you meant that you were told you were bagging too fast? That is the more common problem.

[align=left:4aad19ff47] I think I was bagging to slow because the RT said the pt need to be breathing 14 times a minute.[/align:4aad19ff47]

DwayneEMTB wrote:

With BVM you’ll try for a rate of one ventilation every 4-6 seconds. Once an advanced airway is placed that will drop to about once every 7-8 seconds. Can you break this problem down and tell me why that is? What are the possible differences between using just mask, and using the tube?

[align=left:4aad19ff47] Ok here is what I think with out an advanced airway the pt may not get all the air that they need. Because maybe the airway is not open all the way or not all of it is going into the lungs.With an advanced airway you want to vent once every 7-8 seconds because it is like breathing normally. Because the tube goes directly from the mouth to the lungs. [/align:4aad19ff47]

[Scaramedic]

I can see where your doctor may want that prehospital with the assumption of a 5 mmHg error. Hopefully the error is not on the low side of 30.

For TBI in the ICU , we try not to go much below 35 mmHg for PaCO2 with 33 being acceptable as minimum to avoid too many changes and that is only with an SjvO2 monitor in place to watch tissue oxygenation.

The wiggle room is for Medics using BVM's vs those of us who like the vent. For some reasons some Medics do not like using vents. I personally love having the constant control rather than have someone (cough.. a FF) setting rate and volume.