Face masks provide a barrier between the rescuer and the victim. Some masks are equipped with a one-way valve that allows the rescuer’s breaths to enter the victim’s airway, but prevents the victim’s expired air from entering the rescuer’s airway. These masks also prevent contact with vomitus and blood, which could pose an infection risk to the rescuer. It takes practice to learn how to use these masks effectively to provide ventilations.
Using a Face Mask:
- Position yourself at the victim’s side. If you are a lone (single) rescuer, positioning yourself at the victim’s side will allow you to provide both ventilations and compressions without having to move.
- Position the mask on the victim’s face. Masks are usually triangular in shape, and you will notice that the mask has a “pointy” end- this end goes over the bridge of the victim’s nose.
- Seal the mask against the victim’s face. To do this, take the hand that is closest to the top of the victim’s head and place it along the edge of the mask. Some people find it easier to form a ‘C’ with their index finger and thumb and use these digits to grasp the mask around the base of the mouthpiece. With the thumb of your other hand, apply pressure along the bottom edge of the mask. Then place the remaining fingers of your second hand along the bony edge of the jaw and lift the jaw upwards. Open the airway by performing a head-tilt chin-lift procedure. While you lift the jaw, ensure that you are sealing the mask all the way around the outside edge of the mask to obtain a good seal against the victim’s face.
- Deliver air over 1 second, ensuring that the victim’s chest rises.
- If the victim’s chest does not rise, reposition the mask and try to get a better seal. Remember, you should be lifting the victim’s jaw into the mask, rather than simply pushing the mask down onto the victim’s face.
- Provide 2 ventilations over 1 second each with the mask after every 30 compressions.
- If the victim has a pulse but is not breathing, provide rescue breathing by providing 1 breath every 5 to 6 seconds (10-12 breaths/minute). Check for a pulse every 2 minutes- if there is no pulse, start chest compressions along with ventilations at a rate of 30:2.
Using a Bag-Mask Device:
A bag-mask device (or BVM, bag-valve mask) consists of a mask attached to a reservoir bag. They are commonly used to provide positive-pressure ventilations during CPR. They can be attached to an oxygen source to provide 100% oxygenation during resuscitation. As with the face mask, it takes practice to be able to use a bag-mask device. It can also be very difficult for one person to use a bag-mask device; therefore, it is recommended that use of a bag-mask device be used only when there are two rescuers available.
The steps to using a bag-mask device are as follows:
- Position yourself at the top of the victim’s head- this allows room for the second rescuer to provide compressions.
- Place the mask of the bag-mask device on the victim’s face, using the bridge of the patient’s nose as a guide to correct positioning.
- Use the E-C clamp technique to hold the mask in the correct position while you lift the jaw to obtain an open airway. To perform the E-C clamp technique, take the index finger and thumb of your non-dominant hand and form them into a ‘C’ around the top of the mask. Your other fingers of the same hand are used to lift the jaw (the ‘E’ part of the E-C clamp technique.
- Squeeze the bag to deliver a breath- each breath should be delivered over 1 second. Watch for chest rise. If you do not observe chest rise, you do not have a tight seal. If this occurs, reposition the mask and try again. Be careful not to overinflate the lungs- each breath should result in visible and natural chest rise.
- Provide 2 ventilations after every 30 compressions. If the patient has a pulse but is not breathing, provide one breath every 5-6 seconds (10-12 breaths/minute) and check for a pulse every 2 minutes. If the victim loses their pulse, you will need to begin chest compressions.
The Jaw Thrust Maneuver
If you suspect that a victim may have a neck or spinal cord injury (i.e., the victim has fallen, been in a motor vehicle accident or suffered another mechanism of injury that could result in injury to the neck or spinal cord), you should not use the head tilt-chin lift maneuver to open the victim’s airway. This could further damage the neck or spinal cord. Instead, you should use the jaw thrust maneuver to open and maintain the victim’s airway.
To perform this maneuver:
- Place your hands on either side of the victim’s head. Rest your elbows on the surface that the victim is laying on.
- Put the fingers of both your hands under the angle of the victim’s lower jaw and lift so that the jaw slides forward.
- Use your thumb to push the lower lip away from you if the victim’s lips close.