Need some tips on mask ventilation

[aimedicine]

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I understand that mask vent. is one of the most important skill you need to have as anesthesiologist..

.as a medical student i struggle sometimes with mask ventilation, i have very large hands and proper hand placement but sometimes i have trouble getting a proper seal/air leakage...when i move the mask to cover the air leakage on one side, it just starts leaking somewhere else...any tips?? how can i improve?

 

[nap$ter]

I understand that mask vent. is one of the most important skill you need to have as anesthesiologist..

.as a medical student i struggle sometimes with mask ventilation, i have very large hands and proper hand placement but sometimes i have trouble getting a proper seal/air leakage...when i move the mask to cover the air leakage on one side, it just starts leaking somewhere else...any tips?? how can i improve?

practice.

use both hands to pull the mask wide and apply to the face. thumbs holding the mask on, use both hands to pull the mandible up towards the ceiling, then transition the vector of your force to pulling towards the wall behind your back. this extends the neck a bit. keep the left hand on the mask and face pulling back towards you and bag with the right. this way you can use the big muscles in your back and arm to keep the jaw up while you bag. it is very difficult to try to do this with the small muscles in your hand and anterior shoulder with a vector towards the ceiling.

it is difficult to try to pull the mandible up with the fingers of one hand. it is easier to use both hands to apply the mask, get a good fit, pull the mandible up, and then pull back to keep the mandible up and transition to bagging with one hand.

oral airways make this easier, especially when beginning.

pull hollow cheeks up to the mask edges.

shave beards or cut a hole in a large tegaderm and apply to face with hole over mouth.

use assistants to help with mask leaks and bagging.

turn the vent on and hold the mask on with two handed jaw lift.

give the patient enough drug to make em soft enough to bag.

 

[k12balla]

^^Great post

 

[Noyac]

practice.

use both hands to pull the mask wide and apply to the face. thumbs holding the mask on, use both hands to pull the mandible up towards the ceiling, then transition the vector of your force to pulling towards the wall behind your back. this extends the neck a bit. keep the left hand on the mask and face pulling back towards you and bag with the right. this way you can use the big muscles in your back and arm to keep the jaw up while you bag. it is very difficult to try to do this with the small muscles in your hand and anterior shoulder with a vector towards the ceiling.

Most important part of this post. I see too many novices press the mask down on the pts face. This doesn't work. You should be pulling the mandible up into the mask. Control the top of the mask over the nose with your thumb and the right side of the mask with your index finger. You 3rd and 4th fingers pull the mandible up and the5th finger usually does little but can assist with the angle of the mandible. With proper tech pique you should be able to mask a pt for a long time without fatigue. I had an attending that would make us mask 1-2 hr cases. You learn good technique real quickly.

 

[aimedicine]

Most important part of this post. I see too many novices press the mask down on the pts face. This doesn't work. You should be pulling the mandible up into the mask. Control the top of the mask over the nose with your thumb and the right side of the mask with your index finger. You 3rd and 4th fingers pull the mandible up and the5th finger usually does little but can assist with the angle of the mandible. With proper tech pique you should be able to mask a pt for a long time without fatigue. I had an attending that would make us mask 1-2 hr cases. You learn good technique real quickly.

practice.

use both hands to pull the mask wide and apply to the face. thumbs holding the mask on, use both hands to pull the mandible up towards the ceiling, then transition the vector of your force to pulling towards the wall behind your back. this extends the neck a bit. keep the left hand on the mask and face pulling back towards you and bag with the right. this way you can use the big muscles in your back and arm to keep the jaw up while you bag. it is very difficult to try to do this with the small muscles in your hand and anterior shoulder with a vector towards the ceiling.

it is difficult to try to pull the mandible up with the fingers of one hand. it is easier to use both hands to apply the mask, get a good fit, pull the mandible up, and then pull back to keep the mandible up and transition to bagging with one hand.

oral airways make this easier, especially when beginning.

pull hollow cheeks up to the mask edges.

shave beards or cut a hole in a large tegaderm and apply to face with hole over mouth.

use assistants to help with mask leaks and bagging.

turn the vent on and hold the mask on with two handed jaw lift.

give the patient enough drug to make em soft enough to bag.

That 2 hand technique to pull the mandible up and then transition to one hand...WORKED LIKE MAGIC...i had no issue mask ventilating all 3 of my cases today...thanks! hopefully i keep improving.


Now do you have Any tips on getting the mouth open to intubate without making contact with the teeth...again i know the technique for intubation and what i'm looking for....but i always get called out by resident/attending for making too much contact with the teeth...

 

[ZzzPlz]

I find that using your right hand on the back of the patient's head to extend the neck naturally opens the jaw. I only use the scissor technique if that doesn't work. Give it a shot

 

[aimedicine]

I find that using your right hand on the back of the patient's head to extend the neck naturally opens the jaw. I only use the scissor technique if that doesn't work. Give it a shot

ill give it a shot! thx

 

[PianoMedic]

We had a thread awhile back about this. Noyac had a great technique that I have seen and seems to work quite well. Very similar to the one that ZzzPlz explained just a little more detailed. Just going to quote it here:

...I just have a different way of doing it than you do. I grab the top of the head with my right hand and slightly tilt it backwards. This maneuver will open the mouth enough to gently slide the blade into the posterior oral pharynx while resting my little finger on the chin in order to pull the lower lip away from the blade so as not to pinch it btw the blade and lower incisors. I then see the epiglottis and position the blade appropriately. Very little pressure needed. Works well for me.
I do something very similar for LMAs. I grab the top of the head and gently tilt backwards. As the mouth opens I slide the LMA in with a slight sideways approach to allow the tongue to not be pulled back in the throat. Once past the base of the tongue I twist it back upright and advance until seated. Works every time.

 

[ZzzPlz]

Boom. Exactly.