A pocket mask is a barrier device designed to facilitate rescue breathing during cardiopulmonary resuscitation (CPR). This portable tool features a one-way valve to direct the rescuer’s breath into the patient while diverting exhaled air and bodily fluids away from the rescuer. Effective ventilation requires precise positioning of the patient’s airway and the rescuer’s body to maintain an airtight seal and maximize air delivery. Improper placement can lead to air leaks, ineffective breaths, or injury, so mastering the correct technique is necessary.
Establishing an Open Airway
The first step in effective rescue breathing is ensuring the patient’s airway is clear and open. In an unconscious person, the relaxed tongue often falls back and blocks the throat. The standard maneuver to correct this is the Head-Tilt/Chin-Lift (HTCL). This involves placing one hand on the forehead and the fingertips of the other hand under the bony part of the chin, then gently tilting the head back while lifting the chin. This action repositions the mandible, moving the tongue away from the throat and creating a clear path for air.
The HTCL is the preferred method when there is no suspicion of a head, neck, or spinal injury. If the patient may have sustained trauma—such as from a fall or collision—a different maneuver is required to minimize movement of the cervical spine. In these cases, the Jaw Thrust maneuver is used. The rescuer positions their fingers behind the angle of the patient’s jaw and pushes the jaw forward and upward without tilting the head. This technique lifts the tongue and soft tissues off the airway while significantly reducing the risk of exacerbating a potential spinal injury.
Optimal Rescuer Placement
The rescuer’s physical position is a deciding factor in maintaining the necessary mask seal and airway maneuver. For single-rescuer ventilation, the optimal position is to kneel directly at the top of the patient’s head, facing the patient’s feet. This placement allows the rescuer to use both hands simultaneously to manage the mask and the airway, maximizing leverage and control.
Kneeling above the patient’s head provides a stable base. This allows the rescuer to apply downward pressure on the mask while simultaneously applying upward force to the jaw. This two-handed approach is more effective for achieving a tight, symmetric seal than attempting the procedure from the patient’s side. The “above the head” position optimizes the mechanical advantage needed for effective ventilation.
Securing the Seal with Proper Hand Placement
The final component of correct positioning involves the manual technique used to hold the mask and maintain the airway. This is accomplished using the “C-E” technique, which utilizes the rescuer’s hands to achieve both a tight seal and an open airway. The thumb and index finger form a “C” shape over the dome of the mask, pressing the mask rim firmly against the patient’s face over the bridge of the nose and chin.
The remaining three fingers—the middle, ring, and pinky fingers—form an “E” shape. These fingers are positioned along the bony prominence of the patient’s jawline near the ear. The “E” fingers actively lift the jaw, keeping the airway open and pulling the face into the mask. Pressure must be applied only to the bony parts of the jaw and chin, avoiding the soft tissue beneath the chin, which could compress the airway.
A common error is pressing the mask down onto the face without lifting the jaw, which can push the tongue back and obstruct the airway. The action should be a strong upward and forward lift of the jaw, ensuring the mask is sealed without forcing the head out of the proper alignment. By focusing on this upward lift, the rescuer ensures the air delivered through the mask travels directly into the lungs, confirmed by a visible rise of the patient’s chest.