BVM Vs. PPV

Jonathan Rawls

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Mar 15, 1998, 3:00:00 AM3/15/98

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I'd like your opinions on the use of bag-valve-mask vs. positive
pressure devices for ventiliations in cpr and/or respiratory arrest. Any
preferences? Any concerns with the volume exchanged with a bag?

Thanks,

Jonathan Rawls
EMT P

Carey Gregory

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Mar 16, 1998, 3:00:00 AM3/16/98

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Jonathan Rawls wrote:
>
> I'd like your opinions on the use of bag-valve-mask vs. positive
> pressure devices for ventiliations in cpr and/or respiratory arrest. Any
> preferences? Any concerns with the volume exchanged with a bag?

The BVM is far from perfect. It's volume often doesn't match the patient's,
and it takes a lot of skill and practice to use correctly. However, except
for some of the newer models, most PP devices infuse air too rapidly,
accidental overinflation is very easy, and pneumothorax is a definite risk.
Personally I feel much better with a BVM I can *feel*.

--
Carey Gregory

Gary Hecker RN, EMT

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Mar 16, 1998, 3:00:00 AM3/16/98

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On 15 Mar 1998 22:27:07 Jonathan Rawls Writes:

>I'd like your opinions on the use of bag-valve-mask vs. positive
>pressure devices for ventiliations in cpr and/or respiratory arrest. Any
>preferences? Any concerns with the volume exchanged with a bag?
>

>Thanks,
>
>Jonathan Rawls
>EMT P
>
>

There is good and bad with both devices. The problem with demand
valve/positive pressure devices is that because of the bad press they have
recieved over time, many people don't teach its use, but because they may
still be on the ambulance, people use them without propper training. Older
positive pressure devices are dangerious because they may still have the
high flow valve instead of the 40 psi valve on them. If you are using an
older device make sure that it has been modified.

The good things about the positive pressure mask, especially if it has the
extension trigger on it, is that the rescuer uses both hands to make a seal
(As you may know, the good old one handed c-clamp hold with a BVM is one of
the least retained skills by EMT's). This allows a better seal and is the
only way one rescuer can ventilate the nonintubated patient while
maintaining c-spine control.

The good things about the BVM are that you have greater control over the
tidal volume delivered. You are also able to "feel the ventilation" you can
pick up partial obstructions and developing hemo/pneumo's by feeling changes
in lung compliance.

THey are botgood tools in the hands of properly trained individuals, used in
the propper manner.

Gary Hecker RN, EMT
Graduate Student Agency Nurse
University of Cincinnati Emergency Ward
College of Nursing Bellevue Hospital NY, NY

PGBFH since '97

Yesterday is History, Tommorow is a mystery, Today is a gift,
That's why they call it the present.

Robert Ball

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Mar 17, 1998, 3:00:00 AM3/17/98

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Jonathan Rawls <cd...@MINDSPRING.COM> wrote in article
<350C9C0A...@mindspring.com>...

> I'd like your opinions on the use of bag-valve-mask vs. positive
> pressure devices for ventiliations in cpr and/or respiratory arrest. Any
> preferences? Any concerns with the volume exchanged with a bag?
>
> Thanks,

Jonathan,

In our area, our First Responders use PPV for arrest situations. It's
easier for them to use, and ensures an adequate tidal volume (the dangers
of "overinflation" are pounded into them each refresher). Mind you this is
for the patient with an oral or nasal airway.

After we intubate, we switch to a Bag-Valve Device. Tidal volumes are ok
after the pateint is intubated, and you have a better feel for compliance.
Kind of the best of both worlds...

Bob
--
Robert Ball, EMT-P *My opinions are my own*
Paramedic, Hennepin County Medical Center EMS/Ambulance, Minneapolis, MN
Contributing Editor, Journal of Emergency Medical Services (JEMS)

Matt Cohen

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Mar 18, 1998, 3:00:00 AM3/18/98

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Jonathan Rawls wrote in message <350C9C0A...@mindspring.com>...

>I'd like your opinions on the use of bag-valve-mask vs. positive
>pressure devices for ventiliations in cpr and/or respiratory arrest. Any
>preferences? Any concerns with the volume exchanged with a bag?
>
>Thanks,
>

>Jonathan Rawls
>EMT P

Our service recently purchased the parapac ventilator(I think Pneupack
makes it) and it is great! Our clinincal services director did some research
and found that it is practically impossible to deliver a good tidal
volume(>500cc) with a BVM at a low pressure(<20mmHg). Anything over 20mmHg
is enough to force the cardiac schincter(I know I spelled that wrong, sorry)
at the opening of the stomach open, allowing gastric distention. With our
ventilators we can set the pressure from between 10-80mmHg. Since we have
put the ventilators on the trucks I don't think anyone has used a BVM
regularly. Once we intubate the patient we can continue with the vent and
free up a set of hands. With the vent we can adjust the following:
inspiratory pressure, tidal volume, resp./ min, FiO2 1.0 or .5. I am
becoming spoiled with it, I am going to hate going back to just a BVM
whenever I leave!

Matt Cohen