Sunday, January 29, 2017

Abandon Face-Mask Ventilation?

ACEP Now - January 11, 2017 - By Richard M. Levitan
"Face-mask ventilation is considered a fundamental procedural skill in emergency medicine. We have historically deployed it when patients are apneic, are hypoventilating, or need assistance with oxygenation. We keep bag-mask units at the head of every bed in the emergency department.
The world of airway management has evolved since the self-inflating bag-valve mask (BVM) was first created more than 50 years ago. In elective anesthesia, the laryngeal mask airway (LMA) has entirely replaced face-mask ventilation as a strategy for airway and anesthetic management in cases with a low risk of aspiration. In fact, the laryngeal mask is now used in the majority of elective anesthesia cases worldwide. It also has a rapidly growing presence in the world of prehospital care, especially in the United Kingdom and Europe...
The role of face-mask ventilation in emergency situations is rapidly diminishing. I believe the first response to hypoxia should always be Os up the nose, either a standard nasal cannula combined with a non-rebreather to get flows >30 lpm or special high-flow, warm, humidified nasal cannula systems. Sit the patient upright as much as possible and pull on the mandible. In cardiac arrest, passive oxygenation and an LMA-type device should be used preferentially over bagging a patient in a flat position. If you have to use a face mask to provide PEEP (ie, BVM with a PEEP valve or continuous positive airway pressure mask), always do so in an upright position."