A barrier mask, often called a pocket mask, is a protective device used in emergencies to safely deliver rescue breaths to a non-breathing person. Its primary function is to create a physical barrier between the rescuer and the patient, reducing the risk of disease transmission during ventilation. The mask typically features a one-way valve, allowing air to pass from the rescuer to the patient while blocking the patient’s exhalations. Understanding the correct application of this mask is fundamental for effective ventilation, a core component of cardiopulmonary resuscitation (CPR). Proper technique ensures the air enters the patient’s lungs and helps maintain oxygenation until advanced medical help arrives.
Preparing the Patient and Airway
Before ventilation, ensure the immediate environment is safe for both the patient and the rescuer. The patient should be lying flat on their back on a firm surface to facilitate effective care. The rescuer must quickly check for responsiveness by tapping the patient and shouting, and confirm the absence of normal breathing.
Once the patient’s status is confirmed, the airway must be opened using the head-tilt/chin-lift maneuver, unless a neck injury is suspected. This involves gently tilting the forehead back while lifting the chin forward, moving the tongue away from the back of the throat and clearing the upper airway. The barrier mask is then placed over the patient’s face. Ensure the narrow end covers the bridge of the nose and the wide end rests below the lower lip, covering both the mouth and nose completely.
Proper Technique for Delivering Rescue Breaths
Achieving an airtight seal between the mask and the patient’s face is necessary for successful ventilation. Rescuers use the “E-C” clamp method to ensure this seal while maintaining the open airway. The thumb and index finger form a “C” shape over the rim of the mask, pressing it firmly against the patient’s face to prevent air leakage.
Simultaneously, the remaining three fingers form an “E” shape under the patient’s jawline, lifting the jaw forward to maintain the head-tilt/chin-lift position. This combination keeps the airway open and prevents air from escaping around the mask edges. The rescuer then takes a normal breath and exhales slowly and steadily through the mask’s one-way valve port.
Each rescue breath should be delivered over approximately one second, allowing the patient’s chest to visibly rise. Use only enough volume to achieve this modest chest rise. Excessive or forceful ventilation can lead to air entering the stomach (gastric inflation). After delivering the air, the rescuer should lift their mouth away from the mask port to allow the patient’s chest to fall and passive exhalation to occur.
Two full rescue breaths are typically delivered before initiating chest compressions. The seal must be maintained throughout the delivery of both breaths to maximize ventilation efficiency. If the chest does not rise during the first breath, the rescuer must quickly reposition the head and re-attempt the head-tilt/chin-lift before delivering the second breath.
Variations for Children and Infants
Modifications are necessary when administering breaths to pediatric patients, including children and infants, due to anatomical differences. The head-tilt/chin-lift maneuver must be performed more gently to avoid hyperextension of the neck, which can close the airway. For infants and small children, the “sniffing position” is often preferred, where the head is only slightly extended.
The volume of air delivered must be significantly reduced compared to an adult, using small puffs of air, only enough to cause the chest to rise visibly. Delivering too much air or breathing too forcefully can easily over-inflate a child’s lungs and increase the risk of gastric inflation. For the smallest patients, a pediatric-sized mask must be used, as standard adult masks are inappropriate.
The rate of ventilation is generally increased when performing rescue breaths alone on a child or infant, reflecting their higher metabolic needs. While the E-C clamp technique remains similar, the rescuer must apply much less pressure to secure the mask, accounting for the fragility of pediatric facial structures.
Context: Integrating Breaths into Full CPR
Rescue breaths are almost always performed as part of cardiopulmonary resuscitation (CPR), alternating with chest compressions. For a single rescuer performing CPR on an adult, the standard ratio is thirty compressions followed by two rescue breaths, repeated continuously. This ratio prioritizes blood circulation while providing necessary oxygenation.
This sequence requires the rescuer to transition quickly from compressions to securing the mask seal and administering the two breaths with minimal delay. The goal is to limit the pause in chest compressions to less than ten seconds, as prolonged interruptions reduce the effectiveness of blood flow to the brain and heart. Once the two breaths are delivered, the rescuer must immediately return to chest compressions.
The ratio changes when two rescuers are present or when treating a child or infant, typically shifting to fifteen compressions followed by two breaths. This modification reflects that children are more likely to suffer from respiratory arrest than cardiac arrest, making ventilation a higher priority. Regardless of the ratio, the physical technique of sealing the mask and delivering the one-second breath remains consistent.