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I usually use BMV for 10-20 minutes waiting to see if patient's level of consciousness would improve and be able to protect his airway. I think the question here is about balancing risk of aspiration with risk of intubation/ventilation. After how much time of unprotected airway and need to bag should we intubate ? This is a question that must be individualized I think and depends on likehood of patient to regain airway protection soon (ie., how much time convulsion lasted for, which medication he received, evolution of mental status) and NPO status 
(eg. patient ingested a big mac 1 hour ago ?). I am not aware of any published expert opinion on the question, nor any studies.I have never seen non-invasive used for this indication and I assume that if a patient needs non-invasive ventilation to improve ventilation in a post-ictal state that he is probably not protecting his airway so I would be reluctant to use non-invasive for a long period of time and prefer to use BMV and see the evolution. BMV helps to know how much patient is breathing on his own (RR, rough idea of tidal volume specially if using a flow-inflating bag) and it's evolution.
my 2 cents
Matthieu

Matthieu Vincent

MD, FRCPC

Emergency medicine
and Pediatric emergency medicine specialistEmergency departement, CHU St-Justine, Quebec, CanadaAdjunct professor in the department of Paediatrics, Faculty of Medicine, McGill University

Emergency
departement, Charles Lemoyne hospital, Quebec, Canada

Clinical assistant
professor, Faculty of Medicine, Sherbrooke University


> Date: Thu, 17 Dec 2015 20:07:54 +0000
> From: [log in to unmask]
> Subject: Re: Bipap and apnea
> To: [log in to unmask]
> 
> I have had this story (apnea following prehospital benzo) a number of times ( was always related to Valium so it must've been a good number of years ago)
> Almost alway, a short BVM was all that was required I do recall  a number of times where I had to intubate for short time
> 
> Gill (Giora) Winnik
> 
> > On Dec 17, 2015, at 2:33 PM, ejhaines . <[log in to unmask]> wrote:
> > 
> > I haven't had this scenario in a pediatric patient but in adults I have
> > seen benzo (and other tox) related apnea.  In such circumstances BVM to a
> > definitive airway (not BiPAP) were used.
> > 
> > Liz Haines
> > Icahn School of Medicine at Mount Sinai
> > 
> > On Thu, Dec 17, 2015 at 9:35 AM, Wiener, Ethan Dr <
> > [log in to unmask]> wrote:
> > 
> >> I have a clinical scenario and a question to present:
> >> 
> >> 
> >> 
> >> A 10 year old girl with spastic CP and seizure disorder presents with EMS
> >> receiving BVM secondary to apnea following administration of rectal
> >> diazepam for seizure. On presentation, she has spontaneous respiratory
> >> effort and is placed on NRB. Shortly afterward, she is noted to have
> >> worsening hypopnea and additional measures are required to assist
> >> ventilation. Is it appropriate to place a patient who has true apnea for
> >> this (presumed) etiology on facemask BiPap for a period? Is it OK if she is
> >> not overbreathing your set rate at all? Even if the presumption is the
> >> benzo, and the assumption is that it will resolve shortly, is true
> >> intubation mandated in this circumstance if it will be required for a few
> >> hours? The clinical markers used to establish efficacy of the intervention
> >> in this case are chest wall excursion, breath sounds, oxygen sats, and
> >> nasal in-line end tidal CO2 (no blood gas is yet taken, but will be done so
> >> to determine efficacy of intervention). I am curious as to your
> >> opinions/experience and if there is any data that you are aware of on Bipap
> >> for apnea other than OSA?
> >> 
> >> 
> >> 
> >> Thanks for your thoughts.
> >> 
> >> Ethan
> >> 
> >> 
> >> 
> >> 
> >> 
> >> Ethan Wiener, MD
> >> 
> >> PEM, Goryeb Children's Hospital
> >> 
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> >> 
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