ambu vs BVM

[lawrencewellsbourne]

Incident report

adult female arrives to emergency department
the ER doc asks the nurses for a BVM
nobody responds, the doc continues to yell for a BVM
pt goes into cardiac arrest
minutes later a second doc arrives and asks why the pt isnt ventilated.
that doc then yells for an Ambu
the nurses then go retrieve an "Ambu" and start ventilating pt.

was it the ER docs responsibility to realize nobody knew what a BVM was and try switching terminology?

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[mehc012]

The doc should clarify, especially if using shorthand/initialisms and not getting a response. If nobody listens, pick A person and tell them to do the task so that it can't just be ignored by everyone assuming that someone else understands and is going to do it.

Everyone else should ask for clarification if they need it, and not just ignore a command because nobody knows what is meant. This is why you so often hear people repeat back orders; to confirm that someone heard it, understood it, and is taking responsibility for it. If nobody does that, it's probably not happening...and the docs aren't usually yelling random, unnecessary gibberish during a code, so that's not good.

And, really...whether anyone understood the term 'BVM' or not, ventilation is kind of a basic thing to miss. You'd think that somebody besides the doc would notice that there was no airway or bagging.

Plenty of opportunities to improve, but the goal is to make things run better in the future, which comes from EVERYONE working to make the system function better, not from finding a single party 'responsible' for the incident.

*Disclaimer* This is just common sense and trying to pick out what I've seen in other situations that could help avoid the problem seen here in this case that I assume is completely hypothetical. I'm not by any means an expert, and my opinion means nothing.

 

[lawrencewellsbourne]

thanks for the feedback,

and believe it or not this really did happen.

 

[MSTPlease]

Was he yelling for a "BVM" or a "bag valve mask." If the former, it's absolutely the ER doc's fault - I've never heard anyone actually say out loud "BVM." If the latter, it's still on him for not picking an individual nurse and telling them to get a bag valve mask. This should then prompt the nurse to ask what one is or say she doesn't know what one is and that should lead to resolution of the issue.

To add to above, this is also why it's best not to just randomly shout out orders but to assign roles/tasks.

 

[lawrencewellsbourne]

Was he yelling for a "BVM" or a "bag valve mask." If the former, it's absolutely the ER doc's fault - I've never heard anyone actually say out loud "BVM." If the latter, it's still on him for not picking an individual nurse and telling them to get a bag valve mask. This should then prompt the nurse to ask what one is or say she doesn't know what one is and that should lead to resolution of the issue.

To add to above, this is also why it's best not to just randomly shout out orders but to assign roles/tasks.

the ER doc used the abbreviation. BVM

 

[lemurcatta]

Was he yelling for a "BVM" or a "bag valve mask." If the former, it's absolutely the ER doc's fault - I've never heard anyone actually say out loud "BVM." If the latter, it's still on him for not picking an individual nurse and telling them to get a bag valve mask. This should then prompt the nurse to ask what one is or say she doesn't know what one is and that should lead to resolution of the issue.

To add to above, this is also why it's best not to just randomly shout out orders but to assign roles/tasks.

I'm guessing this is a regional thing. Where I worked as a paramedic, everyone knew what a BVM was. Another place used "ambu bag". Saying "bag valve mask" would have elicited strange looks at both. All of those are better than the AHA's preferred term "bag mask device" lol.

 

[mehc012]

thanks for the feedback,

and believe it or not this really did happen.

I believe it, I'm just disclaimer-ing myself.
It's not that farfetched...it's literally why it's recommended to assign tasks to individuals, not announce them to the forming crowd.

 

[Psai]

I believe it, I'm just disclaimer-ing myself.
It's not that farfetched...it's literally why it's recommended to assign tasks to individuals, not announce them to the forming crowd.

This is why I like the idea of having a nurse leader as well as a physician leader. The physician makes decisions, the nurse leader delegates the tasks to people.

 

[mehc012]

This is why I like the idea of having a nurse leader as well as a physician leader. The physician makes decisions, the nurse leader delegates the tasks to people.

That's a good strategy! I'm not sure we always had the resources for a dedicated nurse leader where I used to work, but someone always seemed to end up playing that role in some way, shape, or form, even if it was the person originally assigned to man the IVs who just happened to have the delegating-type personality.

 

[MSTPlease]

I'm guessing this is a regional thing. Where I worked as a paramedic, everyone knew what a BVM was. Another place used "ambu bag". Saying "bag valve mask" would have elicited strange looks at both. All of those are better than the AHA's preferred term "bag mask device" lol.

Fair enough, I do hear "bag mask" a lot which is almost the AHA's term, lol. It's that or "ambu bag" or just "bag," although that's usually more of a transitive verb ("you, bag him") than it is a noun ("you, get me a bag"). The latter should evoke the response "get you a bag of what?"

 

[RNthenDoc]

Nomenclature-wise I’ve mostly heard “bag” or bag-valve mask.

My real question is how minutes go by sans respiro and nobody goes through ABCs/CABs?

I’ll echo the above posts about closed-loop communication.

 

[AnatomyGrey12]

This is why I like the idea of having a nurse leader as well as a physician leader. The physician makes decisions, the nurse leader delegates the tasks to people.

The old hospital I worked at had this set up and it worked really well. The anesthesiologist ran the code and made the decisions but the circulating nurse would make the assignments.

 

[Matthew9Thirtyfive]

The old hospital I worked at had this set up and it worked really well. The anesthesiologist ran the code and made the decisions but the circulating nurse would make the assignments.

We did the same thing at one of the hospitals I worked at.