In honor of No-Shave November, we asked the bearded Steve Carleton, MD, PhD (senior faculty of The Difficult Airway Course: Emergency) and Darren Braude, MD, EMT-P (Medical Director of The Difficult Airway Course: EMS) how to overcome challenges related to bag-mask ventilation and facial hair.
They offered these practical recommendations:
A mustache, as long as it fits within the confines of the mask cuff, is no impediment at all to effective bag-facemask ventilation. It those big, bushy beards that create the biggest problems.
The two-handed, two-rescuer, thenar Mask grip technique usually allows effective ventilation even with a moderate-sized beard.
Smearing surgilube or other substance on the beard to matte the fur together is sometimes suggested but it makes the face more slippery and keeping the mask in the optimal location more difficult so we don’t generally recommend it.
There is recent, anecdotal literature support for putting plastic wrap or large Tegaderm® over the beard (with hole cut for the mouth!) to serve as a more air-tight seal between the mask cuff and the facial skin, but Dr. Braude and his team just studied this in the OR at UNM and it didn’t work out so well so we can’t recommend that either.
If you have to shave the lower-central portion of the face to effectively bag the patient, do it! Better ugly and alive than pretty and anoxically injured.
Our favorite technique, when good two-rescuer mask ventilation doesn’t do the trick, is to place an extraglottic airway and bypass the whole furry morass! Of course, this requires an appropriate candidate with no gag reflex and always consider the RODS mnemonic, but in the event of difficult mask ventilation and critical desaturation an extraglottic is never absolutely contraindicated.
Wondering about these and other airway challenges? Join us for one of the many offerings of The Difficult Airway Course™. There’s a course designed for each practice environment – so the simulated patient you treat with us will be the real patient you see when you return home!
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