Advanced Medical Certification

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Bag-Mask Ventilation Protocols

Bag-mask ventilation is a crucial action in PALS when executed properly. The mask should not cover the child’s eyes and should only fit over the mouth or nose tightly. It is preferable to use a clear mask, as it allows you to observe the lip color of the patient and the presence of condensation in the mask, which indicates exhalation.

Flow-inflating and self-inflating masks are the most common types of bag-masks in the market. The self-inflating mask should be the primary choice in resuscitation, although it is not advisable to use with children and infants who breathe spontaneously. Flow-inflating bag-masks require more training and experience to use, as the rescuer is expected to regulate gas flow, neck position, proper tidal volume, and mask fit. The minimum bag size for infants and children is 450 mL, while older children may require a 1,000 mL bag. Proper ventilation is crucial, as insufficient ventilation inevitably leads to respiratory acidosis.

Figure 9

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