| In some instances we have to use the tools we have on the ambulance to piece together alternate and unconventional means to care for our patients. In the event the tracheal tube cannot be reinserted you should attempt to ventilate with conventional BLS means. EMS providers may use a round pediatric mask to create a light seal completely over the stoma and attempt ventilation (AHA ECC Class IIb, LOE C). This can be performed using an adult bag-valve-mask as most airway products are interchangeable; as in the pediatric mask will fit an adult BVM. In this case, EMS providers may have to cover the mouth and nose of the patient. One technique is to use an adult mask to cover the mouth and nose and occlude the opening with a glove, a thumb or piece of tape. One study of patients with laryngectomies showed that a pediatric facemask created a better peristomal seal than a standard ventilation mask. There is no published evidence on the safety, effectiveness, or feasibility of mouth-to-stoma ventilation. (33)
| | | | |
