Technique

a. Choose ventilation face mask based on patient's facial size. Mask opening should completely cover patient's nose and mouth, without pressing on eyes.

b. Ensure that inflatable rim is inflated to allow airtight seal.

c. Hold mask firmly against patient's face with thumb and index finger encircling base, allowing remaining fingers to support patient's mandible. Avoid pressing on soft tissue under the mandible, which could potentially occlude airway d. Squeeze attached resuscitator bag with sufficient pressure to inflate patient's chest. In some cases (eg, with poor lung compliance or large body habitus), two-person technique may be necessary; one person to hold mask and maintain a good seal, and the other to squeeze resuscitator bag.

3. Potential complications. Bag-mask ventilation may cause gastric distention and pneumothorax.

VI. Problem Case Diagnosis. During physical exam, the 3-year-old patient was found to have rales at the right base of the lung and was diagnosed with pneumonia. He tolerated oxygen via simple face mask, and oxygenation status improved.

VII. Teaching Pearl: Question. A patient with an upper airway obstruction requires an appropriately sized NP airway but one cannot be located. What can be substituted?

VIII. Teaching Pearl: Answer. A shortened endotracheal tube may be substituted for an NP airway. Remove the end 15-mm adapter piece, trim the tube to length from the proximal end (tragus to tip of nose), firmly reinsert the 15-mm adapter, and insert the tube into the nasopharynx. The endotracheal tube is slightly more rigid than the usual NP airways and may not become occluded as easily, although it is potentially more damaging to tissues.

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