2 Where to IO Early IGel Pop Off Valve

We know that with cardiac arrest, don't go for the iv, go right for the IO. The better place is the distal femur. We know that the distal femur is a bigger bone, much more kind of area to go into. And when you stick it in there, it sticks. So don't use the pink needle. You'll need either the blue or the yellow needle. But this is the place we want to go in cardiac arrest. Not for the awake kid who's septic, who needs IV fluids, what have you. For those kids, you can still use a proximal tibia. So make sure that use a distal femur as our go to place in cardiac arrest. And I think that we'll have better outcomes there, better flow rates, just better all around.

So another tip that we want to share with you is an early eye gel insertion for your pediatric cardiac arrest. I think where we deviate from that sometimes is the way that we find the 4 year old versus the 64 year old. And what I mean is when you pull the child from the pool, it's very easy to see the overwhelming amount of water that's in the patient's airway. And for some reason we think that immediately we have to secure that with an endotracheal tube. Unfortunately, that's not true. I'm not saying that we don't upgrade that airway in time, but for cardiac arrest, we're asking you to give two big breaths, suction that airway if you need to, and put the eye gel in early. And remember, the key here is to ventilate the child early. And sometimes it becomes very difficult and cumbersome when we're trying to intubate the child. It makes it difficult to perform high quality cpr. Unfortunately, we don't get enough practice with intubation in the pediatric population. So again, remember, ventilation is king here. You could almost say ventilations are almost as important as chest compressions. But if there's two things that we have to get right, it's that combination.

So I think just to summarize, it's BVM IGEL with a potential for ET2.

Okay, so we're going to just review something that I think that maybe we know or maybe we don't know, but the equipment, especially the bvm, when we talk about our child BVM as well as our infant bvm, there's something on those bags that are different than the adult bag and that's the pop off valve. So I want you to understand that you have a pop off valve that at 35cm of water pressure, it pops off. So if you were bagging into a very tight space, you would see in the pediatric or infant bag or the child or infant bag, you would see the valve pop off.

So understand that it comes from the manufacturer with that valve screwed completely off. So it's not doing anything. It's allowed for when you meet that resistance pressure to not cause barrel trauma. You're going to hear a little poof, poof. It's going to be venting at the top of the bvm.

If you were to screw that valve down, you would override that system and you could squeeze as hard as you want. But just understand this, that that could be very deadly. And what we mean is when you squeeze with no pop off pressure release, remember a child has a very small lung and now you've overrode that pop off pressure. So when you squeeze, you could squeeze that lung and cause barotrauma and rupture the lung. So we want you to be very careful. But more importantly, be aware that the child and infant bag has this feature on it.

So I think there's a couple of cases where you actually may need to screw that valve down. And it's a child that may need higher pressures. So for example, if you have a child who does have a lung full of water after a drowning, and you're using the BVM on either just with a face mask or through an ET tube or an eye gel, and you're noticing that that pop off pressure is happening, that means that you may need higher pressure and you then should consider screwing that down. But if you do, like Chief was just saying, be very careful with not overdoing that pressure.