Bag Mask Ventilation (Pediatrics)

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  • Airway obstruction
  • Hypoxia—documented or suspected
  • Increased metabolic demand for oxygen
  • Cardiopulmonary arrest
  • Apnea
  • Inadequate respiratory effort
  • Contraindications to bag mask ventilation
    • Severe facial trauma
    • Foreign material in the airway should be removed before BMV is initiated
    • Complete, irreversible airway obstruction
  • Contraindication to airway maneuvers
    • Cervical spine injury
    • Severe facial injury
  • Contraindications to supplemental oxygen
    • Chronic respiratory disease and carbon dioxide retention (relative; requires close observation)
    • Some congenital heart diseases (relative; requires close observation)
  • Equipment required to deliver supplemental oxygen
    • Oxygen tubing
    • Oxygen source
  • Other equipment required for basic airway management
    • Suction and suction catheter, of appropriate size, in case of secretions and/or emesis
    • Supplies for universal precautions, including gloves, mask, and eye protection **UNIVERSAL PRECAUTIONS**
    • Cardiorespiratory monitor
    • Pulse oximeter
    • Capnography device
  • Airway patency devices to provide adequate relief of obstruction.
  • Bag mask equipment checklist
    • Bag, self-inflating or anesthesia bag
    • Mask

Pediatric Anatomic Considerations

  • The occiput in neonates, infants, and toddlers is large. In the supine position, the cervical spine is flexed, and the airway tends to buckle. A roll under the child's shoulders and airway positioning may allow more favorable anatomic airway alignment.
  • Neonates and infants up to 4 months of age are obligate nose breathers.
  • The tongue is disproportionately large in children and tends to fall back into the oropharynx. Airway positioning and airway adjuncts such as OPA, NPA, and an intubation tube may be necessary to establish and maintain airway patency.
  • The narrower pediatric airway is vulnerable to obstruction due to edema, foreign body, secretions, and/or vomitus.
  • Infants are obligate nasal breathers until approximately 6 months of age, necessitating patency of the nasopharynx to allow for effective spontaneous respirations in this age-group.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Patients who require basic airway maneuvers or adjuncts will (1) improve to the point of no longer requiring these devices/techniques, or (2) require definitive airway management with endotracheal intubation.
  • Supplemental oxygen can be delivered acutely or for prolonged periods.
  • Frequent reassessment with continuous or spot oxygen saturation monitoring is crucial.
  • Soft tissue injuries
  • Vagal response
  • Gastric distention
    • Careful attention to the volume and delivery of assisted breaths, as well as Sellick's maneuver, can help reduce this risk.
  • Barotrauma
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