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