Jaw Thrust! Pet Peeve

[Sessamoid]

As Spyder and I were talking about this today, I thought I'd bring up one of my medicine pet peeves. I can't count the number of times I've come onto a resuscitation in progress in which somebody is trying to ventilate the patient with a BVM.

What I see too often is the person doing airway merely pressing the mask over the face. No jaw thrust, no oral airway, and definitely no good seal! They're pushing air out the bag, through the mask, and around the mask into the open room because the airway isn't open. I've seen pretty much all levels of medical providers doing this--residents, attendings, nurses, respiratory techs, paramedics, etc.

I mean, I realize it makes your hands tired to do a jaw thrust, but unless you want a brain-dead patient that's what you have to do! Argh.

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[spyderdoc]

As Spyder and I were talking about this today, I thought I'd bring up one of my medicine pet peeves. I can't count the number of times I've come onto a resuscitation in progress in which somebody is trying to ventilate the patient with a BVM.

What I see too often is the person doing airway merely pressing the mask over the face. No jaw thrust, no oral airway, and definitely no good seal! They're pushing air out the bag, through the mask, and around the mask into the open room because the airway isn't open. I've seen pretty much all levels of medical providers doing this--residents, attendings, nurses, respiratory techs, paramedics, etc.

I mean, I realize it makes your hands tired to do a jaw thrust, but unless you want a brain-dead patient that's what you have to do! Argh.

Yep, all you hear is the farting noise as the air escapes out from between the mask and the skin, instead of going into the lungs....

 

[mikecwru]

Yep, all you hear is the farting noise as the air escapes out from between the mask and the skin, instead of going into the lungs....

The first thing I do for new students rotating through our ED is to go over bagging. Most of them usually look pretty bored when I go over it. If you know how to bag properly, you can buy yourself a decent amount of time in actually securing an airway.

I've luckily (?unlucky?) had anesthesiologists during med school that thought this was important enough that they'd make me bag through the whole case ("Not good seal!").

mike

 

[DrQuinn]

What's even worse than a bad seal is when the RT forgets to hook up the BVM to O2.

Q

 

[Sessamoid]

What's even worse than a bad seal is when the RT forgets to hook up the BVM to O2.

Q

I'd rather be ventilating with room air than not ventilating at all.

I also had an anesthesiologist during med school who was fond of having students bag through a case to demonstrate the importance of a good seal.

 

[Vince]

What about the steps before getting a good seal!

That's the funny part. Watching Initial ACLS students try to put the BVM together.....LOL

It's not so funny when its the med student or intern/resident having trouble putting it together when the patient is blue....and I'm sure some of us have seen too many of those too.

 

[Jeff698]

I'd rather be ventilating with room air than not ventilating at all./QUOTE]

Yep, much better to ventilate the patient with room air than ventilate the room with patient air (i.e. 100% oxygen).

Take care,
Jeff

T-3 hours, 24 minutes (not that I'm counting)

 

[leviathan]

What about the steps before getting a good seal!

That's the funny part. Watching Initial ACLS students try to put the BVM together.....LOL

It's not so funny when its the med student or intern/resident having trouble putting it together when the patient is blue....and I'm sure some of us have seen too many of those too.

That thing is a bitch to assemble with all the seals and the valve...I had to do that when I was getting trained on it. But why would a BVM be disassembled in an emergency department, or on an ambulance?

 

[Febrifuge]

If the BVM is lying in the trauma bay in pieces, talk to whomever is in charge of equipment (Nurse Manager, maybe?). And show the techs what the problem is. A good tech with a basic understanding of things should be horrified that you're asked to assemble the pieces at the start of a case. It's easy enough to put the thing together in between, as part of making the bay ready, and stow the assembled BVM on the airway cart or column or whatever.

 

[leviathan]

If the BVM is lying in the trauma bay in pieces, talk to whomever is in charge of equipment (Nurse Manager, maybe?). And show the techs what the problem is. A good tech with a basic understanding of things should be horrified that you're asked to assemble the pieces at the start of a case. It's easy enough to put the thing together in between, as part of making the bay ready, and stow the assembled BVM on the airway cart or column or whatever.

Yeah, well that's definitely strange. Our BVMs are always assembled on our ambulances, including the pediatric ones, and we have plenty of space.