Create a seal.
Bring the mask and face together as a controlled interface. Look for evidence that gas is escaping instead of moving through the intended route.
Room 01 // Tools of the trade
A system—not a squeeze bag.
Face-mask ventilation begins before the mask reaches the patient. The mask, patient connector and valve assembly, self-inflating bag, oxygen connection, and reservoir must be understood as one connected system.
→
Every connection is a place to look when the expected result is absent. The useful question is not simply, “Did I squeeze the bag?” It is, “Did gas move through the intended route?”
Trace the route.Follow gas from the oxygen connection through the BVM and mask toward the patient. Name every connection you would inspect before use.
Deep Cuts // optionalWatch the BVM more closely.+
What to watchFollow gas across the connections and valves.
Pause where the route is not obvious. Use the manufacturer’s checks for the device in front of you; this film gives the system a closer look.
Next // Connect the system to the patient
Tracing the gas path explains the object. The next room follows the work at its patient end: create the seal, keep the upper airway open, and read the result.
Room 02 // Build the first attempt
Leak and obstruction are different problems.
The mask seal and the upper-airway route are separate pieces of work. Study how the hands bring them together, then compare how one operator and two operators divide that work.
Keep the upper airway open.
A sealed mask cannot compensate for an obstructed route. Position, airway maneuvers, adjuncts, and help are separate variables within the approved clinical plan.
Then assess the result.
Read the hands. Then watch the sequence.
The seal and airway stay connected; the division of work changes. Inspect the hand positions, then watch the movement.
Study 01 // One operatorSeal and lift with one pair of hands.
One operator brings the mask interface, airway, and bag operation together. Follow the hand position before studying the complete movement.
Practice the CE grip →Study 02 // Two operatorsBring both hands to the airway.
Separate the seal and airway work from bag operation. Name the roles, then assess the result together.
Practice the two-handed grip →Listen // Two-person sealLegacy PAC audio · Transcript pending
Deep Cuts // Curated demonstrationsCompare another presentation of the same work.+
Optional external material. Use these segments to compare how the one-person and two-person techniques are demonstrated.
Localize before repeating.Is the problem at the mask, in the upper airway, in the BVM system, or beyond this model?
Next // Change what is not working
The first attempt gives you information. Use that result to locate the impediment before choosing an optimization.
Room 03 // Best effort
Best effort changes the condition—not the attempt count.
Oxygen may escape around the mask or meet a closed upper airway. A disconnected or malfunctioning component can interrupt the route before O2 reaches the patient. Start with this pathway, then widen the differential when the findings do not fit. Find the failing part before you repeat the same attempt.
- Optimization
- changes a condition that may be limiting ventilation.
- Best effort
- is the efficient, context-specific use of viable changes before the team moves on.
Reference study // The Vortex optimization matrix
First actionName the change.
- Identify the impediment
- Choose a viable change
- Reassess the result
Optimization atlas // Vortex source
Find the impediment. Open the category that can change it.
The source matrix organizes viable changes by what they act on. The objects below make those categories visible without turning them into a universal sequence.
Category 01 // Manipulations
Change anatomy, interface, or operator mechanics.
The useful manipulation is the one that addresses the suspected impediment. Inspect the geometry, then watch one movement in context.
PatencySeal
Category 02 // Adjuncts
Use an object only when it fits the problem.
OPA and NPA are upper-airway patency tools. Their selection, sizing, preparation, placement, confirmation, and removal require the approved clinical standard.
Patency
Object 01Oropharyngeal airwayOpen the object +
An OPA may be considered when upper-airway patency is the problem and the patient and plan are appropriate.
Object in preparation // Device cue card
OPA: connect the object to its use.
A concise PAC card is needed for selection, sizing, placement, and reassessment, tied to the exact device and clinical review. The retained source studies above remain available; they are not a completed practice checklist.
Object 02Nasopharyngeal airwayOpen the object +
An NPA may be considered when upper-airway patency is the problem and the patient and plan are appropriate.
Object in preparation // Device cue card
NPA: connect the object to its use.
A concise PAC card is needed for selection, preparation, sizing, placement, and reassessment, tied to the exact device and clinical review. The retained source studies above remain available; they are not a completed practice checklist.
Category 03 // Size / type
Read the interface before blaming the hands.
A mask must cover the nose and mouth while creating a usable interface with the face. Compare the four studies as one sequence.
Seal
Category 04 // Suction / O2 flow
Preserve the route through the equipment.
Suction and oxygen-flow changes address material in the route or conditions in the delivery system. Equipment compatibility and the local plan control what can be used.
PatencySeal
Connected system objectPEEPOpen the object +
PEEP changes the ventilation system. It should be considered only within the approved device, patient, and clinical plan.
Object in preparation // Device cue card
PEEP: connect the object to its use.
A concise PAC card is needed for device compatibility, attachment, settings, and monitoring, tied to the exact device and clinical review. The retained source studies above remain available; they are not a completed practice checklist.
Category 05 // Muscle tone
A clinical decision—not a page control.
The source matrix includes anesthesia and paralysis because muscle tone can alter upper-airway patency. These interventions require authorized clinicians, medication standards, monitoring, rescue capability, and the local plan.
Patency
Keep this category visible. Keep it inside its authority boundary.
Room 03 names the category so the team can recognize the complete model. It does not teach medication selection, dosing, or patient-care authorization.
Open the source matrix →Gallery complete // Practice remains
Move from system to hands.
Use the approved BVM, mask, trainer, and station prompts to rehearse a deliberate sequence: prepare, act, assess, optimize, and reset.
Practice Studio // Exhibit 04
Make the next breath visible.
Check the system, practice both grips, then work the installed optimization cues until chest rise returns or the Station stopping condition is reached.
Trainer only. Use only the labeled equipment and actions authorized at this Station.1. Check the system.
Screen → handsSet the device down. Trace the route in your hands.
Self-inflating BVM
Use its labeled pre-use check. Trace the simulated gas route through every connection.
Face mask
Match the connector and the size labeled for this trainer.
Adult trainer
Find the visible chest-rise cue before the first breath.
Stop. Report anything missing, dirty, damaged, unlabeled, or mismatched.
2. Practice two grips.
Screen → handsSet the device down. Build each grip on the trainer.
One hand
C–E grip
- Center the mask.
- Form the C; lift the mandible with the E fingers.
- Ventilate once. Read chest rise and leak.
Two hands
Two thumbs down
- Place both thumbs and thenar surfaces on the mask.
- Lift the mandible and face into the mask.
- Say, “Seal and airway ready—ventilate.” The bag operator names chest rise or no chest rise.
3. Optimize. Ventilate. Reassess.
Use only options authorized by the installed Station. This rehearsal order does not prove physical performance, clinical Best Effort, or competence.
Screen → handsRead one cue. Set the device down. Make the change. Return for the result.
Position, lift, and rebuild the two-handed grip.
Use the head position permitted by the Station. Lift the mandible, rebuild the seal, ventilate once, and watch the chest.
Change mask fit or size.
Recenter the mask. If another approved size or type is supplied, use its Station label. Do not improvise a substitute.
Add the authorized airway adjunct.
Use only the adjunct installed at this Station and follow its device-specific trainer instructions. If none is installed, name the category and move on.
Use authorized suction or flow support.
Use the labeled option only when the Station authorizes it. Then check the system connections before the next breath.
Ventilate and decide.
If chest rise remains absent after the assigned viable options are used or ruled out, state: “Face-mask ventilation has reached Best Effort. Oxygenation is not established. Move to the next lifeline.”
Ventilate once, then choose the result.
Reset the table.
Finish after both grips and the installed optimization pathway have been practiced on the trainer.
- Disconnect the simulated connection as labeled.
- Return the BVM, mask, accessories, and prompts to their marked positions.
- Follow the posted cleaning instructions. Report any missing or damaged item.
Installation Guide // build the physical Station →
Facilitator route // Exhibit 04
Build the table around the learner's next action.
The learner task and clinical language are approved. This guide turns that task into a repeatable installation without inventing the equipment, cleaning rules, or support system that only the local program can authorize.
Learner taskApproved
Base configurationReady to specify
Station openingCold-start required
Start with the system. Work on the trainer. Solve one problem. Reset.
Relational rule: every object sits beside the action it supports. A learner should not have to cross the table to discover the next instruction.
Eight fields must describe the table that actually exists.
Complete the local fields on the printed Station record. A placeholder is not permission to open the Station.
- BVMSpecify locally
- Record manufacturer, model, adult size, valve type, reservoir, tubing, and the exact manufacturer pre-use check displayed at Zone A.
- MaskSpecify locally
- Record manufacturer, type, available sizes, selected trainer fit, and cuff-inflation rule when the installed mask has an inflatable cuff.
- TrainerSpecify locally
- Record model, installed position, chest-rise cue, known limitations, and the head or jaw movement the trainer permits.
- Gas sourceBase default
- Use a clearly labeled simulated connection with no live oxygen for the base Station. Live oxygen requires a separately approved setup, supervision, flow-control, and shutdown plan.
- TechniqueApproved task
- One-person C-E and two-person V-E/vice-grip actions are approved. Before opening, verify that the BVM, mask, trainer, and graphics support those exact actions.
- OptimizationBounded default
- Prepare one prompt each for system, seal, and upper airway. Permit only the installed correction named on the card. OPA/NPA insertion and PEEP remain outside the base Station.
- Infection controlSpecify locally
- Post the approved cleaning product, contact time, reusable/disposable boundary, consumable supply, and replacement owner beside Zone D.
- SupportSpecify locally
- Name the Station-lead role and contact route. Place the out-of-service label where a learner can find it without leaving the table.
Open only a complete table.
- Match every object to the Installation record.
- Complete the exact BVM pre-use check.
- Confirm the mask fits the connector and trainer.
- Place the prompt cards face down at Zone C.
- Open the QR and confirm the first action appears.
Do not improvise around a missing object.
Stop when equipment is missing, damaged, dirty, unlabeled, mismatched, or fails the installed pre-use check. Leave the object in place, display the out-of-service marker, and contact the named Station lead.
Return the complete system.
- Disconnect the simulated connection as labeled.
- Return BVM, mask, and cards to marked positions.
- Remove only authorized trainer components.
- Use the posted cleaning method and replace consumables.
- Confirm the next learner can begin at Zone A.
Give the phone and table to someone who did not build either one.
No spoken instructions. A facilitator prompt counts as a failed self-guided step.
- □ArrivalThe learner opens the exact QR route and identifies the Station, objective, materials, first action, and finish line.
- □SequenceThe learner begins at Zone A, completes the one-person and two-person actions, and uses the digital resource only at its assigned step.
- □RecoveryAfter one staged absent cue, the learner draws one prompt, makes only the authorized correction, and reassesses.
- □BoundaryIf the cue remains absent, the learner states the transition sentence and finds the support route without prompting.
- □ResetThe learner restores every object, follows the posted cleaning process, replaces consumables, and finds the next destination.
Opening ruleAll eight fields completed. All five cold-start checks passed. Final media record complete.Until then, this remains an installation candidate—not an open learner Station.