A Bag-Valve-Mask (BVM) is a handheld medical tool designed to provide breathing support when a person is unable to breathe adequately on their own. A common question is whether a BVM can be effectively used on a conscious patient. This article explores the circumstances and challenges of providing BVM ventilation to an awake individual.
Understanding the Bag-Valve-Mask
A BVM consists of three main parts: a self-inflating bag, a non-rebreathing valve, and a face mask. The self-inflating bag manually forces air or oxygen through the one-way valve into the patient’s lungs. An oxygen source and a reservoir bag can be attached to the BVM to deliver nearly 100% oxygen with each breath. This device works by creating positive pressure ventilation, pushing air into the lungs. It is employed when a patient’s breathing is inadequate or has stopped, providing temporary respiratory support until further medical care.
Medical Scenarios Requiring Assistance
Even a conscious patient may require BVM assistance if their breathing becomes severely compromised. Conditions such as hypercapnic respiratory failure (high carbon dioxide) or hypoxic respiratory failure (low oxygen) can necessitate this intervention. Patients experiencing acute exacerbations of severe asthma or chronic obstructive pulmonary disease (COPD) might struggle to move enough air. Certain drug overdoses can also suppress the respiratory drive, leading to shallow or slow breathing. In these situations, the BVM provides supplemental oxygen and mechanical ventilation.
The Patient Experience and Challenges
Using a BVM on a conscious patient presents difficulties due to the patient’s natural responses and anxiety. The forced air delivery can trigger a strong gag reflex, leading to discomfort, vomiting, or aspiration of stomach contents. Patients may also experience a feeling of suffocation or “air hunger,” causing resistance. Achieving a tight seal with the mask can be challenging, particularly with facial hair, obesity, or dental issues, which can lead to air leakage and ineffective ventilation. The patient’s distress and involuntary movements make obtaining and maintaining their cooperation difficult, yet their participation is important for effective ventilation.
Techniques for Effective Ventilation
Medical professionals use specific techniques for effective BVM ventilation on conscious patients, and clear communication, though challenging, can help guide the patient. Proper positioning, such as the head-tilt/chin-lift or jaw-thrust maneuver, opens the airway. Achieving a tight mask seal is important and may require a two-person technique, where one provider maintains the seal while the other squeezes the bag. Airway adjuncts, like a nasopharyngeal airway (NPA), can be inserted into the nostril to help keep the airway open, especially in conscious patients who may still have an intact gag reflex and cannot tolerate an oropharyngeal airway (OPA). Healthcare providers synchronize ventilations with the patient’s own breathing efforts to reduce resistance and improve comfort.