BVM on breathing pt

[Explorer127]

ok....so can you bag a pt. with respirations less than 12... lets say u have pt with a rr of 8 or 10...would u bag them? how would you go about doing this? btw...the pt is conscious.. what if the pt is not conscious?

 

[MedicPrincess]

You absolutley can bag a pt that is still breathing, consicous or not. With a RR of 8 or 10 I would try postion first, although not for very long....depending on quality/depth of those 8-10.

Bag with them. That is when they take a breath, you squeeze the bag to give'em a little more. If they are conscious, make sure you are talking to them, telling them what your going to do next.

 

[emtwacker710]

You absolutley can bag a pt that is still breathing, consicous or not. With a RR of 8 or 10 I would try postion first, although not for very long....depending on quality/depth of those 8-10.

Bag with them. That is when they take a breath, you squeeze the bag to give'em a little more. If they are conscious, make sure you are talking to them, telling them what your going to do next.

I would do the same thing, I remember from my EMT class, you can assist ventilations with a BVM, I've actually done it twice so far on 2 respiratory distress calls..

 

[skyemt]

you may or may not want to do this...

remember, you don't treat numbers, you treat patients...

are there folks who are very comfortable breathing 8-10 times a minute? absolutely!! you will not bag these patients...

are there patients breathing 12 times a minute, shallow, that can't finish full sentences? you might need to bag them. are they 10 up from 8? or 10 down from 18? have you taken their rate once? well you can't tell trend that way...

you mentioned, rate, but what about tidal volume? 14RR and shallow vs 10 and full... which is worse?? have you even considered tidal volume? or just rate?

yes, i know it was a simple question, but EMS done well is not simple. there are many factors to consider other than, "hmm my chart says 8-10 bag them"...

just my .02.

 

[emtwacker710]

I know what your saying, I always keep the numbers in mind but I also look for other stuff too, like how the pt. is feeling, responding to questions, I'll ask the family members, "is this normal for him?" or "is this his normal color?" because you don't see these people everyday you don't know what is normal and not normal, I actually know a kid 2 years younger than me, I can't remember what it is but he actually has a bluish/grey tint to his extremities...keep that in mind..

 

[BruceD]

... I actually know a kid 2 years younger than me, I can't remember what it is but he actually has a bluish/grey tint to his extremities...keep that in mind..

Might be Methemoglobinemia, but I believe it's relatively rare.

 

[MSDeltaFlt]

I personally do not look at the numbers (RR) to determine if I'm going to bag a pt or not. I look at GCS, quality of respirations, and then the SpO2's.

Case in point; I had a transfer of a retired physician who was on BiPAP of 10/5 and 80% FiO2. I couldn't take the BiPAP with me even if it could fit in the aircraft. The pt was also C/A/O X 4 and verbally appropriate with a GCS = 15 stating that he did not want to be intubated if we could help it.

The AMBU with 10 PEEP got us to the aircraft, but the noninvasive facemask ventilation on the vent really did the trick.

So, yes, you can bag a conscious pt.

 

[VentMedic]

The AMBU with 10 PEEP got us to the aircraft, but the noninvasive facemask ventilation on the vent really did the trick.

But the vent you were using was probably pt triggered sensitivity? You also have an RRT background. That gives you a little edge with the BVM and vents when it comes to accomondating or "adjusting" for pt synchrony.

For those not familiar with ventilators and/or BiPAP (trade name for 2 levels), each breath initiated can be mechanically assisted. The machine senses the patient's respiratory effort.

That same sensitivity should be recognized when attempting to ventilate a conscious or unconscious pt with some respiratory effort. If not, expect some complications like ineffective volume delivery and vomiting.

 

[Explorer127]

wouldn't the pt resist it though? like im thinking if someone were to bag me now, it would feel kind of weird... am i wrong? and would u compress the bag between breaths, or while the pt breathes? lets say u dont have a bvm...what would happen if u used a face mask instead?

 

[SwissEMT]

I'm just going to rant a little, so excuse the comma splices.

Sometimes I cry a little, I mean, I keep it on the inside obviously, but when I read posts like this and I'm here working the hardest I can to become the best medical professional I can, I can't help but just get depressed.
I feel like I'm swimming against the current, like I'm on the edge of the niagara falls and everyone is just falling off the waterfall of stupidity.
I try to swim so hard, by reading more, by studying more, by asking the doctors about all the questions to develop my mindset. I usually feel like I'm managing to hold on, but sometimes I read or hear things that really test my grip.
Everytime I see a post like this, or I'm at the hospital and hear providers ask similarly painful questions, it's as if a tumbling body slams into me, almost pushing me off the edge of the waterfall.
I mean, is it that bad? Am I one of the few souls out there who actually reads my books and have some sort of common-sensical approach to medicine? Do people ever use instinct anymore? I'm just an EMT-B, not a FCEPNREMTCC-EMTP or whatever. Hell, I'm probably younger than a lot of you.
Know what? I feel like this guy

I know you'll all probably yell at me or give me negative points (or whatever the internet equivalent is), stating that this is a personal attack against this poster, but it isn't. I really don't mean to attack or make fun of anybody. I just sometimes really feel like I'm fighting a losing battle against the river of stupid people.

 

[Explorer127]

ok...first of all, im just an emt-explorer doing first responder training, and u say u think ur younger? are you younger than 14? i didn't think so. how about you actually answer the question?

 

[basic]

You have to remember that every one has different experience levels though. It's better that people with these questions ask them and learn than to not ask and pretend that they know. Don't you agree?

You've got to understand that it is easy to pass the NR and that people can become EMTs in less than 6 months. In a perfect world all EMTs would be able to know and do everything right. But in reality most people try to get by with all they need to move up and on.

I think that the experience and learning that goes on in the field plays a huge roll in truly becoming an EMT. No matter how many times I reread my books, until my hands get to do it, I can't do anything else to remember it more than I already do.

 

[basic]

ok...first of all, im just an emt-explorer doing first responder training, and u say u think ur younger? are you younger than 14? i didn't think so. how about you actually answer the question?

Glad to see you online and trying to figure this stuff out

 

[Explorer127]

hey, thanks. so wouldn't a conscious pt. resist the bvm?

 

[ffemt8978]

Play nice, people.

 

[Explorer127]

ahahahahahaha

 

[VentMedic]

We had another thread recently with the same questions. There is some very good advice in that thread from several forum members. I definitely recommend reading it.

http://www.emtlife.com/showthread.php?t=5594&highlight=bagging

You do have a very valid question and that is why even ACLS is putting more emphasis on the BVM than immediate intubation. Intubation should not be a skill taught in a few minutes of playing around at a manikin station as what happened in many ACLS classes. Teaching intubation can also be a waste if someone has no idea how to use a BVM or BVT on an untubated or intubated patient whether conscious or unconscious. Even the BVT requires a special touch to keep in synch with a breathing patient. Unfortunately even Paramedics want to get to the "more exciting" skills and some fail to master the BVM and sometimes not even the BVT.

Not everybody has the same expertise as with many skills regardless of their credentials. Some doctors and RNs as well as a few RRTs suck at using the BVM because they may never have fully been trained in its use as well as getting experience using it. Even the RT profession had its share of problems with "quick mart" training centers in the 1980s. Members of these professions as well as EMTs and Paramedics may also work in jobs where they may rarely if ever use a BVM.

 

[Topher38]

hey, thanks. so wouldn't a conscious pt. resist the bvm?

Not always, I mean I can only imagine that it is very wierd to have someone trying to breath for you but if you explain to them what you are going to do and coach them to try and control thier breathing.

 

[MSDeltaFlt]

I feel as if I need to apologize for not clarifying my original post. My response to the original question was to give an example of how far you could actually go with ventilating a conscious pt providing you actually have the proper knowledge, training, AND experiece as Vent said. Vent and Rid have probably done this (the vent thing) at least once in their careers if I'm not mistaken.

Sometimes I have a tendency to chase rabbits.

Swiss, I apologize if I confused you. It truly was unintentional. If I do this again, please call me on it. I do not want to be counter productive to someone's learning.

With respect.

 

[SwissEMT]

I don't think I'm smarter than everyone else, matter fact, I consider myself pretty stupid. I simply think that EMS in general is going down the drain because incoming EMTs aren't reading their books and aren't using their brains and want everything on a platter.
Ask yourself this: Are guidelines and texts in the book going to encompass enough circumstances to be able to make decisions for you? No. You'll find yourself having to use your sense of judgement.
It's exactly that which is the answer to your question. It depends. If a guy is breathing at 33/minute, should you bag him? You don't need a pulseOx, or wave-form capnography to give you an answer. Know what the best indicator is for when to do an intervention? Using your sense of judgement. If you're genuinely worried about the patient's respiratory status, bag him.
It's silly to ask questions about small variations in circumstances or being ridiculously vague.
The most common answer you'll hear is "IT DEPENDS" and that's what people mean when they say "don't trust the numbers"

Now though my first post may have come off as mean, I'm sure there are many others out there who will share the same opinion. We're all working and are surrounded by idiots. They're giving us a bad name. They're the ones showing up on the news. They're the national average. And it's pretty taxing to be working your *** off to become a great provider when you'll just end up being veiled by mediocrity.
See? I'm not such a huge ******* afterall. Now go buy some books and read your *** off and become the best provider you can. Lights and sirens won't save lives, your brain will.

MSDelta, I wasn't pointing fingers at you at all. Don't worry about it. I did think it was funny that you were using Fi02, PEEP, ETCO2 in a reply to a poster with basic medical training.