Difficult Bag Mask Ventilation

🔑 Key Priorities

• Declare emergency: "This is a CRISIS – Difficult Mask Ventilation"

• Ensure oxygenation while troubleshooting

• Prepare for escalation to supraglottic airway or intubation

---

🧠 Team Actions

Role	Task
Team Leader	Coordinate airway plan and escalation pathway
Assistant	Two-handed mask ventilation, jaw thrust, airway adjuncts
Drug Assistant	Prepare paralytics and induction agents
Runner	Retrieve difficult airway trolley
Recorder	Document times and escalation steps

---

🧭 Management Algorithm

1. Call for help early

2. Ensure 100% O₂ via circuit

3. Optimise airway:

   • Reposition head (sniffing)

   • Use oral/nasal airways

   • Ensure proper mask seal (2-handed technique)

   • Check for obstruction, bite, secretions

4. Attempt supraglottic airway (e.g., LMA):

   • Up to 3 attempts with different size/type

5. Deepen anaesthesia +/- paralytic agent

6. Reattempt mask ventilation

7. If still unsuccessful, prepare for CICO protocol

---

🔄 Ideal Crisis Flow

    Difficult Mask Ventilation
              ↓
      Optimise Basic Techniques
              ↓
      Insert Supraglottic Airway
              ↓
     Deepen Anaesthesia & Retry
              ↓
        Reassess: Ventilation?
              ↓
    If unsuccessful → Prepare for CICO