Optimal Bag-Valve-Mask Ventilation

Sexy Bagging


  1. Remember to connect the device to an Oxygen Supply
  2. Use two providers wherever possible – one to maintain a good seal by lifting the face into the mask and applying a steady downward counter pressure to the mask using both hands (see image) and the other colleague squeezes the bag to ventilate.
  3. Don’t ‘bag’ too fast or hard – we recommend aiming for 1 breath every 6 seconds and just enough volume to make the chest rise (it’s a patient, not a balloon)
  4. Patients receiving BVM for cardiac arrest can do as well if not better than those who are intubated (there is NO EVIDENCE that use of an advanced airway in resuscitation saves lives)


Managing a ‘tet spell’ (In sequence of escalation)

  1. Knee to chest position (increases PVR).
  2. IV/IM/SC morphine (0.1-0.2mg/kg)
  3. Fluid bolus (10-20cc/kg)
  4. IV beta blockers, i.e. propranolol – decrease RVOT spasm
  5. Phenylephrine – increase PVR.
  6. Emergent surgical repair or shunt.

~ Neonates may need prostaglandins if they are dependent on their ductus arteriosus.