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Critical Care Mailbag - The Super BVM

Anand Swaminathan, MD FAAEM and Scott Weingart, MD
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14:18
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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01:41

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EM:RAP 2019 July Written Summary 289 KB - PDF

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Matthew Oliver -

Hi EM:RAP,

The summary of this section by Stuart and Jan asks the question "why don't companies make BVMs with built-in expiratory ports?" and the answer is that some do and some don't. If folks are considering buying BVMs for their department, they should ensure that they have a built-in exp valve.

A colleague of mine has written a blog post on this topic with a list of BVMs available and more detail on the issues that Scott discussed.
https://www.psnetwork.org/bvm-no-expiratory-valve-very-poor-preoxygenation/

Thanks for the great discussion Scott and Swami!

David G., M.D. -

Scott talked about having a pressure monitor on the BMV so as not to bag too forcefully. In lieu of such a monitor, he also talked about squeezing just the top of the bag and administering "small, tiny, little, wee breaths."

Another option could be taken from the NEJM PreVent trial ("Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults", Feb 28, 2019). Those who received BMV ventilation prior to intubation had "ventilation at 10 breaths per minute with the smallest volume required to generate a visible chest rise." This might be an easier end-point!

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EM:RAP 2019 July Full episode audio for MD edition 192:37 min - 268 MB - M4AEM:RAP 2019 July German Edition Deutsche 103:01 min - 142 MB - MP3EM:RAP 2019 July Aussie Edition Australian 10:50 min - 15 MB - MP3EM:RAP 2019 July Farsi Edition Farsi 164:39 min - 226 MB - MP3EM:RAP 2019 July Canadian Edition Canadian 20:02 min - 28 MB - MP3EM:RAP 2019 July Spanish Edition Español 61:20 min - 84 MB - MP3EM:RAP 2019 July French Edition Français 24:38 min - 34 MB - MP3EM:RAP 2019 July Board Review Answers 237 KB - PDFEM:RAP 2019 July Board Review Questions 111 KB - PDFEMRAP 2019 July Individual MP3 250 MB - ZIPEM:RAP 2019 July Written Summary 289 KB - PDF

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