Troubleshooting Ventilation Problems
Adequate ventilation can be confirmed by looking for chest wall movement and improvement in oxygen saturation.
Table 2 gives examples of difficulties in securing an adequate seal or ventilating with practical solutions.
Table 2: Markers for difficult bag-mask ventilation
| Poor mask seal | Solution |
| Blood and vomit creating a slippery surface | Clear the airway with suction; use a towel to dry the patient’s face |
| Edentulous patient | Replace the dentures or pack the cheeks with gauze if dentures missing |
| Unstable facial fractures | Use a two-person technique Consider early intubation |
| Beard | Apply gel to improve the seal |
| Facial asymmetry | Use a two-person technique?? |
| Difficult ventilation | Solution |
| History of snoring | Attention to correct head/neck positioning +/-adjuncts +/- two-person technique |
| Abdominal distension including obesity, third trimester and ascites | Consider elevating the head end in non-traumatic patients |
| Stiff or immobilised neck | No options available. Do not force elderly patients necks |
| COPD/asthma | Aggressive medical therapy |
| ??Big tongue | Consider oropharyngeal airway |