Troubleshooting Ventilation Problems

Adequate ventilation can be confirmed by looking for chest wall movement and improvement in oxygen saturation.

Table 2 gives examples of difficulties in securing an adequate seal or ventilating with practical solutions.

Table 2: Markers for difficult bag-mask ventilation
Poor mask seal	Solution
Blood and vomit creating a slippery surface	Clear the airway with suction; use a towel to dry the patient’s face
Edentulous patient	Replace the dentures or pack the cheeks with gauze if dentures missing
Unstable facial fractures	Use a two-person technique Consider early intubation
Beard	Apply gel to improve the seal
Facial asymmetry	Use a two-person technique??
Difficult ventilation	Solution
History of snoring	Attention to correct head/neck positioning +/-adjuncts +/- two-person technique
Abdominal distension including obesity, third trimester and ascites	Consider elevating the head end in non-traumatic patients
Stiff or immobilised neck	No options available. Do not force elderly patients necks
COPD/asthma	Aggressive medical therapy
??Big tongue	Consider oropharyngeal airway