Limitations of the Bag-ValveMask VentilatorThe bag-valve mask ventilator is difficult to useunless the user has had sufficient practice with it. Itmust not be used by inexperienced individuals. Thesystem can be hard to clean and reassemble properly;the bagging hand can tire easily; and an airtight seal atthe face is hard to maintain, especially if a singlerescuer must also keep the airway open. In addition,the amount of air delivered to the victim is limited tothe volume that the hand can displace from the bag(approximately 1 liter per compression).Procedures for Operating the Bag-ValveMask VentilatorTo use the bag-valve mask ventilator, hook the bagup to an oxygen supply and adjust the flow in the rangeof 10 to 15 liters per minute, depending on the desiredconcentration (15 liters per minute will deliver anoxygen concentration of 90 percent). After openingthe airway or inserting an oropharyngeal airway, placethe mask over the face and hold it firmly in positionwith the index finger and thumb, while keeping the jawtilted upward with the remaining fingers (fig. 4-23).Use the other hand to compress the bag once every 5seconds. Observe the chest for expansion. If none isobserved, the face mask seal may not be airtight, theairway may be blocked, or some component of thebag-valve mask ventilator may be malfunctioning.POCKET FACE MASKA pocket face mask designed with an oxygen-inletflow valve for mouth-to-mask ventilation can be usedto give oxygen-enriched artificial ventilation.Although a pocket face mask system cannot achieveoxygen concentrations as high as the bag-valve masksystem, it has the advantages of providing greater airvolume (up to 4 liters per breath) and of being mucheasier to use (since both hands are free to maintain theairway and keep the mask firmly in place). See figure4-24. The pocket face mask also acts as a barrierdevice. It prevents the rescuer from coming in contactwith the patient’s body fluids and breath, which arepossible sources of infection.To use the pocket face mask, stand behind the headof the victim, and open the airway by tilting the headbackward. Place the mask over the victim’s face (foradults, the apex goes over the bridge of the nose; forinfants, the apex fits over the chin, with the base restingon the bridge of the nose). Form an airtight sealbetween the mask and the face, and keep the airwayopen by pressing down on the mask with both thumbswhile using the other fingers to lift the jaw up and back.Ventilate into the open chimney of the mask.4-27Figure 4-23.—Bag-valve mask ventilator in use.Figure 4-24.—Providing mouth-to-mask ventilations withpocket face mask.
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