A 68-year-old male is found unresponsive and apneic. You immediately begin bag-valve-mask (BVM) ventilation. After several ventilations, you notice significant gastric distension and hear gurgling sounds from the patient's stomach. What is the MOST appropriate immediate action to address this?
- AApply cricoid pressure (Sellick's maneuver).
- BReposition the airway and reduce the force/volume of ventilations.
- CIncrease the ventilatory rate to overcome the distension.
- DInsert a nasogastric tube to decompress the stomach.
Show answer & explanationAnswer & explanation
Correct answer: B. Reposition the airway and reduce the force/volume of ventilations.
Gastric distension during BVM ventilation is usually caused by air entering the stomach, often due to improper airway positioning or excessive ventilatory force/volume. The immediate priority is to correct the cause: repositioning the airway and reducing the force/volume of ventilations while ensuring chest rise. This minimizes the risk of aspiration and further distension, which can impair lung ventilation.
Why the other options are wrong
- A. Cricoid pressure (Sellick's maneuver) is controversial and not routinely recommended; it may worsen gastric distension or compromise the airway if improperly applied.
- C. Increasing ventilatory rate would worsen gastric distension and increase the risk of aspiration.
- D. Inserting a nasogastric tube is a definitive measure but not the immediate first action in the prehospital setting for acute gastric distension during BVM, and it can delay critical ventilation.
Minimizing Gastric Distension in BVM
Gastric distension during BVM ventilation occurs when air enters the stomach instead of the lungs, typically due to improper airway positioning, excessive ventilatory force, or rapid ventilation. It can lead to aspiration and impaired lung ventilation.
- Causes: poor mask seal, improper head position, too much force/volume, too rapid ventilation.
- Consequences: increased risk of aspiration, decreased lung compliance, diaphragmatic impingement.
- Management: reposition airway, reduce force/volume, ensure visible chest rise with each breath.
Memory trick: Stomach's full? Realignment and gentle air, that's the cure.