BVM for difficulty breathing

[benasack2000]

Hey guys. I was just wondering what's your way of BVMing a patient with difficulty breathing. Is the pace the same for bagging a PT not breathing?

Thanks

[DFIB]

First of all welcome to your own thread! Good on you for stepping out and asking a very good question! I am only an EMT so I hope some of the medics will chime in. I am interested in their opinion as well.

I have found that many patients with dyspnea that are alert are not receptive to rescue breathing. I find that pulse oximetry is a useful tool in determining how well a patient is perfusing and shape my interventions accordingly. If they need oxygen, that is a good place to start. I try to keep the pulse oximetry around 94%.

Discovering the underlying condition that is the causal factor for the difficult breathing will ultimately be the key to improving their ventilation through interventions. The patient might benefit from nebulization or a dose from their measured dose inhaler. The patient might be having an allergic reaction, or have a host of pulmonary and cardiac pathologies or diseases that could be causing their increased work of breathing. If we can identify and rectify the cause we will do the most good in reducing their respiratory distress.

I always ventilate adults at the same rate for rescue breathing although there are cases when we would want to ventilate slower of faster such as head trauma or preparing for an advanced airway intervention.

In pediatrics I only ventilate if the patient will accept the ventilation. A child that will let us breath for them is an indication that they need the help. If the baby is well enough to fight off the mask he most likely is ventilating well on their own with the exception of an occluded airway which would require other interventions.

Good on you for starting an airway thread!

[Arctickat]

A good question, my preference is to ventilate as a piggyback to spontaneous resps, increasing the tidal volume, then I will also include additional ventilation between them to ensure the SpO₂, etCO₂, and most importantly, the patient himself are all within normal ranges. Regardless if they're spontaneously breathing or apniec.

Like Dfib said, a crying baby is a good baby.

Edited February 13, 2013 by Arctickat

[MikeEMT]

I don't bag conscious patients. Not saying I never would - I just haven't found it clinically necessary to do so yet. If a patient is hypoventilating they probably aren't conscious anyways, and if they are they won't be much longer. If they are hyperventilating I will put them on oxygen and coach their breathing. I recently had an adult patient with an anxiety attack breathing at 42 times a minute and shallow. I got them down to about 24 / min before we even left the scene. Fire was impressed. At ER arrival they were breathing 14 - 16 times / min.

Obviously it is impossible to give you a cover-all answer. You will need to do what is in the best interest of the patient for their presenting condition. If you bag a patient you need to do so at the normal rate (about once every 4-5 seconds for adult). I dont like bagging a conscious patient for a variety of reasons. Mainly the perceived fear of the bvm and the increase of gastric distention. I would think gastric distention would be minimized in a conscious patient but I don't know. A bvm is a last resort in a conscious patient for me.

Dfib hit it - ultimately you need to find and correct the cause.

[benasack2000]

I understand. Base the type of Delivery System of O2 based on the Pulse Ox and the cause of respiratory distress of the PT. Im only asking because I keep an Adult BVM in my "Jump Bag" and I don't carry O2. I know that hooking the BVM to O2 will increase the Oxygen Concentration and is recommended. By the way, im technically not the "official" term of a CFR. I have about 23 hours of Advanced First Aid W/Obstetrics and Backboarding and 12 Hours CPR/AED For Healthcare Providers W/Administering Oxygen, Suction, Airway Adjuncts, Ect. Attended a few EMT lectures. Im not a nut or scanner chaser . I just tried to find the closest certification level to my training and this almost matched it if it wasn't for taking BPs (:. Im with CERT and hopefully going to get my EMT in a few years.

Thanks Guys

I don't bag conscious patients. Not saying I never would - I just haven't found it clinically necessary to do so yet. If a patient is hypoventilating they probably aren't conscious anyways, and if they are they won't be much longer. If they are hyperventilating I will put them on oxygen and coach their breathing. I recently had an adult patient with an anxiety attack breathing at 42 times a minute and shallow. I got them down to about 24 / min before we even left the scene. Fire was impressed. At ER arrival they were breathing 14 - 16 times / min.

Obviously it is impossible to give you a cover-all answer. You will need to do what is in the best interest of the patient for their presenting condition. If you bag a patient you need to do so at the normal rate (about once every 4-5 seconds for adult). I dont like bagging a conscious patient for a variety of reasons. Mainly the perceived fear of the bvm and the increase of gastric distention. I would think gastric distention would be minimized in a conscious patient but I don't know. A bvm is a last resort in a conscious patient for me.

Dfib hit it - ultimately you need to find and correct the cause.

Mike, if its alright, would you mind giving me a BVM rate for say, an Infant and a Child, who are having difficulty breathing.

Thanks

Edited February 14, 2013 by benasack2000

[paramedicmike]

How old are you?

If you really want to know the answer to your last question why not go look up an answer and come back here with the information you've found? That way you'll actually learn it and retain it better than if we just tell you here.

Also, with all the stuff you're carrying, why haven't you taken an EMT course yet?

[benasack2000]

Ok Mike. I'll look it up. I don't carry that much stuff. Yes i have stashed a BVM in there.

[Kiwiology]

This is actually a very complex question.

The short answer, as said above, is that a patient having difficulty breathing needs the underlying problem fixed.

Oxygenation is more the key problem, sub optimal ventilation can, in the short term, be tolerated as long as oxygenation is adequate. \

Do not confuse oxygenation and ventilation; one is a physiologic process and the other is mechanical; they are separate yet intimately connected.

Somebody who is ventilating poorly but oxygenating adequately is less of a concern than somebody who is adequately ventilated but poorly oxygenated.

[Arctickat]

Why do you carry a BVM? Do you also carry the oxygen it needs to be connected to? What do you do with the rest of the patient while you're using the BVM? It takes one extremely competent person to provide proper PPV with a BVM, or two typically average people, all of which are trained and experienced in the use of such a device. As mentioned, while you're using the BVM on the patient, who is looking for and treating the reason you have to use it in the first place?

[Bernhard]

Throw the BVM out and attend an EMT class if you really want to know more. Performing mask to mouth is NOT easy for an unexperienced person and mostly will fail then, making things worse. Don't compare mannequin training to real patients.