Imagine dining at a popular fast-food restaurant when you notice a child in the play area that appears to be choking. You move quickly to him, but just as you arrive, he collapses in your arms, seemingly lifeless and not breathing. Being able to perform rescue breathing on this child with a bag-valve-mask device can make a life or death difference. According to the book, "Pediatric Education for Prehospital Professionals," bag-mask ventilation is one of the most useful skills and best techniques for providing oxygenation and ventilation.
Step 1
Contact 911 and don your gloves, if available, prior to touching the patient. According to "CPR for the Professional Rescuer," donning gloves protects you from body substances such as vomit, blood and saliva, and minimizes your risk of contracting or transmitting infectious diseases.
Step 2
Ensure that the child is not breathing. With the child lying on a flat surface, gently tilt the child's head upwards so that the chin is slightly elevated above the forehead. This is called the head-tilt-chin-lift maneuver. Place your cheek up to the child's mouth and feel for a breath while you watch the chest for rise and fall. If no breath is felt and no rise and fall is noted, then the child is not breathing.
Step 3
Attach the appropriately sized mask to the bag-valve device. The mask is cone shaped with a plastic sleeve that slides into another sleeve on the device. The other side is surrounded by an air chamber in the shape of a tear drop.
Step 4
Expand the bag portion of the device. These devices are typically packaged in a compressed position to make shipping easier. Expand the bag by pulling the two ends of the compressed bag apart. The bag holds the "breath" of air to be squeezed into the child's lungs.
Step 5
Place the hard plastic "J"-shaped device into the child's mouth, or pliable tube through the child's nose, if available. Both devices are called airway adjuncts, and are used to lift the tongue from the back of the throat to prevent it from becoming an obstruction. According to "Emergency Care," even though the head-tilt method is effective at lifting the tongue, it may still fall back and cause obstruction.
Step 6
Place the mask over the child's mouth and nose, and seal with one hand. Placement is critical to ensure a tight seal. The narrow end of the tear drop mask should cover the nose, while the curved end covers the mouth. Secure the mask with your hand using the "E-C" method: your thumb and pointer finger make the shape of a "C" around the plastic sleeve at the top of the mask, while the other three fingers form the "E" gripping under the child's jaw.
Step 7
Squeeze the bag slowly and completely over a "one, two" count every 3 to 5 seconds. Squeezing too fast or too hard will cause ineffective rescue breathing, and may force air into the stomach and cause vomiting. Watch for the child's chest to rise and fall with each squeeze. If available, attach the bag-valve-mask device to supplemental oxygen with the regulator adjusted to at least 15 L per minute.
Step 8
Reassess the child every 2 to 3 minutes. Check to see if the child has resumed spontaneous breathing. If not, resume rescue breathing. Also check to ensure the child has a pulse. If there's no pulse, start chest compressions along with rescue breathing.
Tips and Warnings
- Call 911 immediately prior to interventions with the child, or have a bystander call while you perform rescue breathing. Latex-gloves are preferred due to the possibility of a latex allergy; however, this should not deter you from providing care.
- Be aware of the possibility of an obstruction prohibiting air from going into the lungs. Try repositioning the head once, and try again to ventilate. If you are still unable to ventilate, assume there is an obstruction and move to abdominal thrusts. Be prepared with suction for vomit or other foreign material that might block ventilation or be pushed into the lungs.
Things You'll Need
- Gloves
- Airway Adjunct (optional)
- Bag-Valve-Mask Device
- Oxygen Cylinder (optional)
- Adjustable Regulator (optional)
References
- "Pediatric Education for Prehospital Professionals"; Ronald Dieckmann, M.D.; 2006
- "CPR for the Professional Rescuer"; American Red Cross; 1993
- "Emergency Care, 10th Edition"; Daniel Limmer, Michael O'Keefe; 2005
