Knox County SChoolS Andrew JohnSon Building

HealtH ServiceS
MANUAL RESUSCITATION (AMBU) BAG PROTOCOL
INDICATIONS: A manual resuscitation bag, or self-inflating bag, is used to deliver breaths manually (in order to maintain adequate oxygen to the brain and other vital organs) when an individual is unable to breathe on his or her own. It is used with a face mask, or can be attached to a tracheostomy tube. Additional oxygen may be administrated by means of tubing from an oxygen source to the bag. It is used as part of CPR when breathing is absent or inadequate. It is also used to temporarily increase oxygen supply as part of routine respiratory care for a student on a ventilator or with a tracheostomy tube. A manual resuscitation bag should be used by individuals trained in its use, as part of a standard CPR course, or as part of competency based training by a nurse according to state medical and nursing practice standards. PROCEDURE: 1. Check for responsiveness and adequacy of breathing. If unresponsive or not breathing, instruct someone to call EMS, and begin CPR. Call for assistance, per school protocol, instructing someone to bring emergency equipment including AED and oxygen (if available) and a manual resuscitation bag and mask. 2. Position head to open airway using the head tilt-chin lift method. (Use the jaw thrust only if neck injury is suspected.) Do mouth-to-mouth resuscitation while awaiting arrival of the resuscitation bag and mask. 3. As soon as the bag and mask arrive, place the mask with bag attached over the mouth and nose to make a tight seal. Attach oxygen tubing if available. 4. Compress the bag at the prescribed rate with slow even motions. Allow the bag to reinflate between compressions. 5. It is helpful to have two people, one to position the head and hold the mask firmly in place to keep a tight seal, the other person to compress the bag with two hands. If only one person is available to provide breaths he/she may hold the mask in place with one hand and compress the bag with the other, steadying the bag against the leg if necessary. Or he/she may hold the mask with two hands if necessary and hold the bag and compress it against the body with the upper arm. It is important to maintain a tight seal with the mask at all times. 6. Watch to see if the chest rises with each breath. If not, reposition the head and assure there is a good seal of the mask over the mouth and nose. 7. Rate for breaths: a. Under 8 years of age: one breath every three (3) seconds b. 8 years of age and older: one breath every five (5) seconds 8. Continue use of resuscitator until individual is able to adequately breath on his/her own or until EMS arrives to take over. 9. Document the incident including all pertinent information. Use of Manual Resuscitation Bags and Mask 1. When an individual is unable to breathe on his or her own, a manual resuscitation bag, or self-inflating bag, is used to deliver breaths manually, in order to maintain adequate oxygen to the brain and other vital organs. It is used with a face mask, or can be attached to a tracheostomy tube. Additional oxygen may be administered by means of tubing from an oxygen source to the bag. It is used as part of CPR when breathing is absent or inadequate. It is also used to temporarily increase oxygen supply as part of routine respiratory care for a student on a ventilator or with a tracheostomy tube. 2. A manual resuscitation bag should be used by individuals trained in its use as part of a standard CPR course, or as part of competency based training by a nurse, according to state medical and nursing practice standards.

ADH398 (9/07)

P.O. Box 2188 912 South Gay Street Knoxville, Tennessee 37901-2188 Telephone (865) 594-1800

3. Procedure: a. Follow CPR guidelines for checking responsiveness, airway and breathing. If unresponsive and/or not breathing call for assistance and call EMS per school protocol. b. Position head to open airway using the head-tilt-chin-lift method. (Use the jaw-thrust maneuver if neck injury is suspected.) Do mouth-to-mouth rescue breathing while awaiting arrival of the resuscitation bag and mask. c. As soon as the bag and mask arrive, place the mask with bag attached over the mouth and nose to make a tight seal. Attach oxygen tubing if available. d. Compress the bag at the prescribed rate with slow even motions. Allow the bag to reinflate between compressions. e. It is helpful to have two people, one to position the head and hold the mask firmly in place to keep a tight seal, and the other person to compress the bag with two hands. If only one person is available to provide breaths, he/she may hold the mask in place with one hand, and compress the bag with the other, steadying the bag against the leg. Or he/she may hold the mask with two hands if necessary and hold the bag and compress it against the body with the upper arm. It is important to maintain a tight seal with the mask at all times. f. Watch to see if the chest rises with each breath. If not, reposition the head and assure there is a good seal of the mask over the mouth and nose. g. Rate for breaths: 1) Under 8 years of age: one breath every 3 seconds 2) 8 years and older: one breath every 5 seconds h. Continue use of resuscitation bag until the individual is able to adequately breath on his/her own, or until EMS arrives to take over.