Paediatric Acute care Guidelines PMH Emergency Department

Equipment

  • A bag and mask refers to a self-inflating bag with a one way valve and an attached face mask
  • There is a pressure relief valve on the top (usually opens at 35cm H2O), an adaptor to connect an oxygen line, and a reservoir bag
  • It gives positive pressure ventilation and up to 100% FiO2 (if there is a reservoir bag)
  • Ensure oxygen delivery is high flow: 10 – 15L/min
  • Consider using an airway adjunct – an oropharyngeal or nasophrayngeal airway to improve airway patency

Bag Sizes:

  • Bags come in 3 sizes
  • 250mL – used only in pre-term neonates
  • 500mL – used for infants, small children
  • 1500mL – used for most children

Mask Types:

  • Circular masks – plastic, best used in infants and young children
  • Laerdal masks – used in children and conform to the shape of the face, have an air filled rim
  • Ensure that the mask rim is adequately filled with air but not overfilled (use a syringe to inject more air if required)
Mask Sizing:
  • Place the mask over the child’s face to size – it should go across the nasal bridge and around the inferior aspect of the mouth
  • It is vital to achieve an good seal
Bag and Mask Technique:
  • Is best done with two operators – one to apply the mask and ensure the seal whilst the other compresses the bag
  • With a single operator, use one hand to hold the mask and ensure a good seal – thumb and 2nd digit pushing down on the top of the mask, and the 3rd to 5th digits underneath the mandible pulling the jaw forward to the mask. Be careful not to compress the soft tissues of the neck. The other hand compresses the bag.
  • Use a respiratory rate appropriate to the child’s age and/or medical issues, with a ratio of inspiration to expiration of 1 : 2

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