Bag valve mask

The BiPAP is loaded with two full tanks of oxygen.

I had the BVM and a couple amps of epinephrine, some flushes and antiarrhythmic, you know, just in case.

The path to the OR has been cleared.

The chart's in the bed.

Keep in mind that intubating or inserting another advanced airway is not a priority when running a code.

We can do adequate CPR of 30 compressions to two breaths, defibrillate and monitor end-tidal CO2 using a BVM with an oral airway in place.

Once an advanced airway such as an endotracheal tube, LMA, or esophageal tube is placed, we'll change to constant uninterrupted chest compressions and give one breath every six seconds to deliver approximately 10 breaths per minute.

It's common at some institutions to use an oral airway as a bite block to protect the tube from occluding should the patient bite down.

And we learn that a lot in interprofessional education.

And it's the same thing with these resuscitation responses, is that people are able to you know, give their feedback on what they think, you know, going through the checklist of like, oh, well, maybe we should have an LMA instead of a, you know, BVM available or, you know, whatever it is that they're offering for a suggestion, or maybe we should have more people responding or less or whatever.

You're getting that feedback, but it also helps the team to kind of, they do, they solidify.

There is a trauma bond there that, you know, Next time they go to an event and even if it's just one of them, they're like, oh, hey, Joe, I remember you from last time.

No, that makes sense.

You know, drastic changes, especially with the BVM, which is probably an underappreciated skill of changing interthrastic pressures.

We talked that how important avoiding hypotension is.

Dramatic changes in ventilation and interthoracic pressure can definitely do that to us.

Anytime that we're making a clinical decision like that, we're always looking at what's the benefit and what's the risk.

And it's no different in this case.

It's like, okay, if I'm going to increase my ventillary rate in order to correct a 51 event title CO2 or a PA CO2, if I increase my ventillary rate with my BVM or even my tidal volume with my BVM, is that going to have a massive impact on my cardiac output and ultimately my perfusion? If I was to choose between which one's worse, I would be like the ones that worse is the lack of the perfusion impact that it could have to hyperventilate this patient.

I would rather have an end tidal CO2 or a PA CO2 of 51 or 55 than drastically increase my intrathoracic pressures and dump my cardiac output.

Like that patient starts crashing in front of you.

How long does it take you to get out your BVM? We're not using a BVM on every call, but it's a critical piece of equipment.

Where is it located? Where's your airways? So starting with the training equipment, not just the throwaways, the thing that the zippers are busted and held together with safety pins and stuff's in Ziploc bags instead of regular bags.

That's the time to kind of war game a lot of these plans and how are you going to lay stuff out.

Like your trauma gear should always be together.

Your airway or your crike gear should always be together.

You know, your BVM should have NPAs or OPAs right next to it because you're going to bag a patient.

Like just using a mask is pretty hard.

Like, you'll forget how to attach the med code, so like put the med codes together.

You'll, you'll completely fumble putting the, the mask on the BVM.

Like, basic, basic things just stop computing in your brain, and that's that adrenaline response, right? It's taking up all this processing power in your brain, leaving you feeling kind of dumb, though you are not, but you can feel that way, right? And it doesn't feel good.

And it really can feel like it's your first day of nursing school clinical all over again.