Options for Ventilation in Emergency

The final common pathway for death in toxic trauma is respiratory failure and arrest leading to secondary cardiac arrest and brain death. Therefore, immediate steps must be taken to ensure adequate oxygenation by artificial ventilation. 

The bag-valve mask (BVM) device (Fig. 8.2) is the most commonly used primary emergency ventilation option around the world. It appears to offer simplicity and rapidity as an option. Ventilation of this type originated in the anaesthetic rooms of operating theatres where it is used to ensure oxygenation on a patient, shortly after induction of general anaesthesia before intubation. In this situation (often where 

In this situation, there are a number of potential dangers in the use of the BVM  

There is no adequate Vt, Fi02 or frequency control. Many devices do not allow the addition of 100 % oxygen to overcome shunting, which will occur in most trauma situations. 

Therefore, both hyperventilation and hypoventilation are possible. If hypoventilation occurs, the hypoxia will not be corrected. 

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