What are the usual suspects when it comes to poor patient ventilation using BVMs or other basic airway management devices?
Airway expert Charlie Eisele has listed his top 3 reasons and top 5 of anatomical features that affect good ventilation. List your top 5 and read "Five Anatomical Features that Affect Ventilation" to see how yours compares.
The back. Scoliosis also contorts the airway, more difficulty mask ventilating and great difficulty visualizing the airway,
Laryngospasm in child. If you are mask ventilating a child and the airway is suddenly occluded it is likely laryngospasm. I visualized this one to see for myself then carefully suctioned, keeping the catheter off the vocal cords, and the spasm relaxed and airway opened.
Making a seal with pressure. If the chest does not expand or air leaks past the mask some people push down harder onto the mask. This presses the base of the mandible (and therefore tongue) against the supraglottic airway, occluding it. Pull the jaw up into the mask which also helps hyperextend the neck.
Holding tight to the jaw. Press your thumb into your submental area to note the difficulty it causes you to breath. I have seen fingernail imprints in that area.
Breathing too fast. In airways with a long time constant (time it takes for 63% of the airway to fill or empty, similar to time constant and discharge for a defibrillator) if you give a breathe before the full exhalation the lung traps air. If you use more pressure for upper airway obstruction (to overcome the obstruction), the same thing with long time constants, the air simply fills the belly. (Time constant equals resistance times compliance.)
Many times its the Practitioner making it harder for themselves. Most times its not the anatomical features of the patient. Many Providers/Practitioners have major issues with; trying to establish a good seal, (hyper)extending the neck, applying the mask where it does not obstruct the nasal or oral opening, and squeezing the bag part of the BVM appropriately.
I just recently completed my AHA BLS Instructor Update (03/24/11) and most of the "Instructors" had problems ventilating with a BVM and a Pocket Face Mask. It was their poor technique; it wasn't the manikin; it was the standard Rescue Annie they couldn't ventilate.
However, I did read the airway article; it was a good article... All the best...
The five anatomical features that make it more difficult:
1) Sore knees (the medic's)
2) Sore back (the medic's)
3) Sore hands (the medic's)
4) Overly full stomach (the medic's)
5) Sleepy brain (the medic's)
I'm just sayin'...