A 30yoM presents with a GCS of 7 after a trauma to the head, shallow respirations, saturating 100% RA, otherwise normal vitals. You decide that the patient needs to be intubated and begin preparing your equipment. You place the patient on high flow nasal cannula. Your attending asks that you hold your standard bag valve mask over the patients face while preparing to intubate. Why is this not an appropriate pre-oxygenation technique? What is an alternative?
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A standard BVM held over the patients face will only provide an FiO2 close to room air. In addition to the high flow nasal cannula, this patient should actually be placed on high flow non-rebreather 30-60 liters/min which would provide FiO2 close to 100%