While performing mouth-to-mouth ventilation, the therapist is concerned about causing gastric insufflation. Which of the following actions can the therapist take to minimize this risk?

A. Use the Sellick maneuver during mouth-to-mouth ventilation.
B. Deliver a larger Vt to the patient's lungs.
C. The therapist should wear a nasal cannula operating at 5 L/min during mouth-to-mouth ventilation.
D. Assuming no cervical spine injury, hyperextend the victim's neck as much as possible.

ANS: A
A. Correct response: Gastric insufflation with the potential sequelae of pulmonary aspiration is a problem whenever ventilation via an unprotected airway is attempted. Using less forceful inspirations, longer inspiratory times, and smaller tidal volumes are effective strategies in limiting gastric insufflation. The application of pressure to the anterior aspect of the cricoid cartilage (i.e., the Sellick maneuver) is another technique to prevent gastric insufflation. The cricoid cartilage completely encircles the upper airway. Therefore this region is the strongest part of the airway. Applying gentle pressure on the anterior neck at the level of the cricoid cartilage will pinch the esophagus between the cervical vertebrae and the cricoid cartilage. This effectively increases the esophageal opening pressure, making the entry of air into the stomach more difficult. In the event that the stomach is already distended, the Sellick maneuver may reduce the chance of vomiting.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A