NREMT Emergency Medical Technician (EMT) Cognitive ExamAirway, Respiration & VentilationMedium
A 1-year-old infant is found unresponsive and apneic. After opening the airway and confirming apnea, you attempt to deliver two initial ventilations with a bag-valve mask. You observe minimal chest rise with the first ventilation. What is your next immediate action?
- AReposition the head and attempt to ventilate again.
- BPerform 30 chest compressions.
- CIncrease the force of the ventilation.
- DCheck for a foreign body in the airway.
Show answer & explanationAnswer & explanation
Correct answer: A. Reposition the head and attempt to ventilate again.
When initial ventilations with a BVM result in minimal chest rise, the most common cause is improper head position. Repositioning the head (e.g., slight head-tilt/chin-lift for an infant) and reattempting ventilation is the immediate next step before escalating to other interventions.
Why the other options are wrong
- B. Chest compressions are indicated if the infant is pulseless or has a heart rate less than 60 bpm, not solely for ineffective ventilations after the first attempt.
- C. Increasing the force without repositioning first could lead to gastric insufflation. Also, excessive force can cause barotrauma.
- D. While a foreign body is possible, it's less likely than airway positioning. A foreign body check would be done if repositioning and re-attempted ventilations are still unsuccessful.
Ineffective BVM Ventilation
When delivering positive pressure ventilation with a BVM, minimal or no chest rise indicates ineffective ventilation, most commonly due to improper airway positioning or a poor mask seal.
- Always ensure proper head positioning (e.g., 'sniffing position' for adults, neutral for infants).
- Ensure a tight mask seal over the patient's nose and mouth.
- If initial ventilation is ineffective, reposition first, then reattempt. If still ineffective, suspect foreign body obstruction.
Memory trick: If the chest doesn't rise, adjust the head and try again, don't just despise!