Give PPV (Positive Pressure Ventilation)

Edited by Train Wreck, VisiHow, Eng

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Positive pressure ventilation (PPV), also known as face mask ventilation, is providing air for the lungs using a face mask and a bag-valve device. You've probably seen it in a TV of film drama, where an emergency medical person was using a facial mask with a balloon attached to it, performing some task that involved reviving someone; but you probably didn't know that it was PPV. That's why it should only be administered by a trained medical professional. The purpose of this article is to explain to you how it is done and what is happening. This is part of our series on how to give first aid, and provide CPR to a person in need. These articles are not intended as medical advice and should never be substituted in place of a properly trained and certified professional. If you are interested in what PPV is and how it works, this article will assist you. More importantly, if you're considering getting your own certifications so that you're able to provide help in an emergency and maybe even save someone's life, then this article should help you decide. It's intended to explain enough about the process in order for you to be able to determine if it is something you are capable of and interested in learning.

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When Face Mask Ventilation is Used

This is used when a patient has experienced or exhibited any of the following:

  • general anesthesia;
  • medical or narcotic overdoses (including alcohol poisoning or alcohol related seizures);
  • a head injury;
  • a stroke;
  • CPR administered before the patient is fully recovered;
  • respiratory failure or not breathing at all.

When Face Mask Ventilation Not Used

PPV is not used when a patient has experienced or exhibited any of the following:

  • a blocked mouth or a mouth that cannot be opened;
  • facial injuries, including eye injuries.
  • throat injuries.

Understanding PPV Terms and Considerations

As we mentioned previously, PPV is something that requires very specialized training, and should only be done by an expert. The list of terms and functions below will give you an idea of why. If you're interested in receiving your own certification to administer PPV, understanding these terms will help you achieve that.

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  1. 1
    Vacuum sealing.
    Putting the rim of the mask against the face of the person provides a seal. You can use inflatable rims to create a more effective seal. In other cases, just mold the mask to provide a seal. Some masks offer straps that can be tightened and tied to keep the mask on someone's face. Be sure to use the straps only when sudden removal of the mask is not required. {
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  2. 2
    Size.
    It is important that the mask conforms to the facial anatomy. Pick a mask in the correct size.
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  3. 3
    Mask color.
    Transparent masks are better, offering inspection of lip color, condensation (breathing), and traces of other objects in the airway.
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  4. 4
    Connection within the PPV device.
    The bag-valve device is connected to the face mask by a tube connector. The bag-valve can be different, but it always inflates itself automatically as it is compressed.
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  5. 5
    Oxygen.
    Always have oxygen available for the bag-valve device. It must always flow through the bag-valve device. There are oxygen reservoirs for bag-valve devices. If the reservoir inflates, then oxygen is flowing. There are tubes that you can extend in order to listen. Using these tubes, you can confirm that oxygen is flowing.
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  6. 6
    Test the bag-valve device.
    Check the capability of delivering PPV by obstructing the valve-bag device connector with your finger. Then, squeeze the bag. If it is hard to squeeze the bag or hold it with your finger, then the device is functional.
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  7. 7
    Prepare suction.
    You may need to use a suction tube by placing it into the mouth of the person to get all the unnecessary liquids out. The tube must suck the air in at all times.
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  8. 8
    Examine the patient's oral cavity.
    Remove any foreign bodies, including false teeth. This will help avoid swallowing or inhaling objects. In some cases, such as to improve sealing, it may be important to leave false teeth untouched.
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Understanding How PPV Works

To understand how Face Mask ventilation is administered, you need to be familiar with the terminologies, and also understand what goes into the actual process. Below, we discuss the process of administering PPV.

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  1. 1
    Place the mask onto the face of the person you will treat.
    Use your thumb and index finger to hold and put the mask on their face. Use your other fingers to pull the patient's chin up and keep their entire mouth in the mask.
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  2. 2
    Pull the chin up.
    Pulling the patient's chin up helps airflow. Keep your index and ring fingers at the edge of their jaw. Place your small finger on the angle of the mandible, close to the neck. Your fingers must not push the soft part of the jaw, which will prevent airflow. Extending the neck (pulling the chin up) should be avoided for people with neck or spine injuries. For people without such injuries, extending the neck will happen naturally when pulling the chin up.
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  3. 3
    Coordinate your actions.
    Keep the head with the chin up with three fingers. Hold the mask against the face so that it is sealed, and inflate the airbag with your other hand. This requires a lot of strength as well. Sealing with one hand might be challenging, and you may need help from someone else.
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  4. 4
    To assess whether you need help, check:
    • the size of your hands and the patient's head size;
    • the facial hair of the person;
    • obesity;
    • the absence of dental prostheses;
    • your own strength.
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  5. 5
    If you need help.
    Hold the mask with two hands while another person squeezes the airbag. Position the fingers of both hands as described in step 2 of this section.
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  6. 6
    Assess breathing.
    You can either listen to the chest with a stethoscope and abdomen or look at the chest to see whether or not it rises and falls. You can also listen to the breathing sounds that should be harmonious with the ventilation provided. It is important not to hear any "stomach" or gurgling sounds and to note any abdominal swelling, which can be caused by excessive pressure on the airbag. You can measure the patient's pulse, as well.
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  7. 7
    Obstructions in airways may require airway tube insertions.
    You can use nasal or oral airways. You must make sure that the person has no gag reflex or spasms (unconscious or medicated appropriately).
    • Nasal airways are good for an obstructed oral cavity (mouth cannot be opened) and greater tolerance of the patient towards insertion. To pick the right size of the airway, put it against the cheek and see how it runs along the anatomy. Add lubrication. Push it inside the nasal cavity at the right angle to the face and away from the roof of the nose. Practice extreme caution in patients with facial injuries. You can lift the torso at a small angle above the ground if it is possible to further oxygenation.
    • Oral airways. Select the proper size of the airway tube. To estimate the correct size, hold the airway against the patient's check to see how it is positioned. The end of the airway must be positioned exactly at the angle of the jaw. Smaller and larger airways will only obstruct breathing. To insert an airway, press the tongue with a tongue blade and push the airway in. If no blade is available, insert the airway upside-down and then turn it as you push it towards the base of the tongue.
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  8. 8
    Synchronize squeezes.
    Pay attention to when the patient breathes in, and squeeze the bag-valve device. Non-synchronized movements can lead to complications, some of which can be life threatening.
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Final Considerations

Basic first aid is to PPV what driving a car is to flying a helicopter. It's an extremely complicated procedure. If you decide you're interested in learning how to administer PPV, make sure you attend first aid training to get the basics of this advanced procedure, and then follow up with some additional classes. Just keep in mind that while this article is intended to help you better understand the procedure of Face Mask Ventilation, it is not intended as medical advice, and should not be considered as a substitute for the help or assistance of a trained professional. With that in mind, get out there and get your first aid certification, and let us know about it in the comments section below!

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See our other tutorials on health: Give First Aid, Recognize a Seizure, Give CPR to an Infant, Treat a Seizure, Give CPR, Get Help with a Drinking Problem, Make Yourself Throw Up, and Setup Emergency Medical ID on an iPhone 6s Plus.

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See more tutorials on emergencies: Plan for an Emergency, Call an Ambulance, Give First Aid, and Call the Police.

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Recent edits by: VisiHow, Train Wreck

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