Ventilation With BVM and Rescue Breathing
Key Takeaways
- Ventilation is needed when breathing is absent or inadequate, even if oxygen is available.
- Bag-valve-mask ventilation depends on airway position, mask seal, correct rate, visible chest rise, and ongoing reassessment.
- Two-rescuer BVM ventilation is often more effective because one rescuer can maintain seal while the other squeezes the bag.
- Excessive force or rate can worsen ventilation quality, so the EMR should ventilate enough to make the chest rise.
Ventilate When the Patient Cannot Move Air
Ventilation means moving air into and out of the lungs. Oxygenation means getting oxygen into the blood. These are related but not identical. A patient can receive oxygen and still need ventilations if breathing is too slow, too shallow, absent, or ineffective.
The updated EMR test plan specifically includes managing airway, ventilation, and oxygenation under Patient Treatment and Transport. Scenario questions may describe altered mental status, agonal breathing, overdose, drowning, severe asthma fatigue, trauma, or cardiac arrest. The task is to notice that breathing is not adequate and act.
A bag-valve-mask can be difficult to use well. The airway must be opened, the mask must seal, and the bag should be squeezed only enough to create visible chest rise. If the chest does not rise, reassess head position, jaw position, mask seal, obstruction, adjunct use, and whether another rescuer can help.
Two-rescuer BVM use is a common quality improvement. One rescuer can hold the mask with both hands and maintain airway position while the second rescuer squeezes the bag. This is especially useful with larger faces, beards, dentures, small children, trauma precautions, or any patient in whom one-rescuer seal is poor.
| Ventilation problem | Likely cause | Corrective thinking |
|---|---|---|
| No chest rise | Poor airway position or obstruction | Reposition, suction, consider adjunct |
| Air leaks around mask | Poor seal or wrong size | Reseat mask and use two rescuers if possible |
| Stomach inflation risk | Too much force or fast ventilation | Slow down and ventilate to chest rise |
| Patient vomits | Airway contamination | Turn or position as appropriate, clear, resume care |
| Fatigue during BVM | Rescuer exhaustion | Switch roles and request help |
Rescue breathing with a barrier device may be used when a BVM is not immediately available, depending on training and protocol. The same principle applies: open airway, deliver breaths that make the chest rise, avoid excessive ventilation, and reassess pulse and breathing according to current CPR training.
Do not let ventilation become isolated from the rest of the call. If the patient has no pulse, CPR and AED use take priority with minimal interruptions. If the patient has a pulse but inadequate breathing, ventilation support and rapid transport planning are critical. Handoff should include initial breathing status, rate and quality of assisted ventilations, oxygen use, response, and any complications.
Ventilation rate is another common scenario trap. Too fast can reduce quality, increase air entering the stomach, and interrupt other care. Too slow leaves the patient under-ventilated. Follow current CPR training and local protocol, and use visible chest rise plus patient response as the field check that breaths are actually reaching the lungs.
A patient has a pulse but is breathing only four times per minute with poor chest rise. What should the EMR do?
During BVM ventilation, the chest does not rise. What is the best immediate response?
Why is two-rescuer BVM ventilation often preferred when help is available?