**3.3 Bag-mask-ventilation (BMV)**

*Special Considerations in Human Airway Management*

Airway management in the prehospital setting has major challenges. Achieving a successful airway management requires a collection of adjustments that involve equipment, personnel and medication in a simultaneous fashion. In addition to the logistic challenges an effort in identifying the patient who need urgent advanced airway management techniques from those whom basic airway maneuvers are adequate. Over the years prehospital airway management has become progressively formalized, local and international associations in different countries has put in place guidelines to improve patient safety and standardize the process. Although there are noticeable differences in EMS infrastructure in different countries which are reflected in those different guidelines, needless to say the purpose of those guidelines is the same, with the main focus being the patient

In general, most of the protocols suggest that advanced airway management techniques should only be carried out by appropriately skilled personnel, at the same time attention should focus on performing high quality basic airway maneuvers when personnel with advanced airway skills aren't immediately available.

**3. Airway management equipment and techniques in the prehospital** 

In certain circumstances, when other airway equipment's aren't available this technique can be used initially to maintain oxygenation and ventilation. A barrier

Head-tilt/chin-lift to open the airway while pinching the person's nose closed and the hand over his head. The lips have to surround the mouth to create a seal. Start to blow into the person's mouth for one second and watch the chest rise. This

Head-tilt/chin-lift to open the airway. The lips have to surround the mouth and nose of the child to create a seal. Blow gently the child's nose mouth for one second. Note that the infant's lungs need a smaller volume of air than an adult., Watch the

It is performed when the rescuer is dealing with a spontaneously breathing patient assisting him to maintain adequate oxygenation and ventilation, with the aid of simple of equipment such as oral or nasal airway devices that can maintain

Oxygenation can be maintained via simple face mask, nasal cannula or nonrebreathing face mask. Continuous positive pressure ventilation (CPAP) by applying a fitting mask to allow CPAP with spontaneous ventilation can also be implemented in special circumstances when deemed appropriate. This method is

found to decrease rates of intubation and mortality [2].

maneuver is contraindicated when cervical spine injuries are suspected.

**2. Challenges in airway management**

safety.

**setting**

*3.1.1 Techniques*

Adults:

Pediatrics:

chest rise while blowing.

upper airway patency.

**3.2 Spontaneous breathing**

**3.1 Mouth to mouth ventilation**

should be used to avoid infection transmission [1].

**26**

It is a standard maneuver for initial airway management, the mask applied to the patient's mouth and nose with a properly tight seal being formed between the patient's mouth and the mask to improve oxygenation and ventilation.

It can also be used if endotracheal intubation is planned to avoid oxygen desaturation during the process of intubation.

BMV can be applied by one person using one hand bag mask ventilation technique or by two providers using two hand bag mask ventilation technique in cases were mainting proper seal and proper ventilation becomes difficult.
