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Some people have a surgical airway in their neck to breath through and if you had to ventilate them, you would need to blow in to the stoma rather than their mouth or nose.

There is no need to open their airway with the head tilt chin lift, as it will make no difference when you ventilate through their stoma. So you simply place the head in a neutral position, ideally with the shoulders raised slightly by placing a coat or blanket under their shoulders.

If the patient has a stoma, you can ventilate with a bag valve mask or a pocket mask. If using a BVM it is best to use a child or infant sized mask as these will seal better on the neck of the patient.

The next stage is to seal the mouth and nose of the patient with your hand or you could use a pocket mask without the valve to seal the mouth and nose. You need to seal the mouth and nose when you ventilate and release when they exhale to allow the air to come out through the upper airway.

If you are using a pocket mask you can do this on your own but if you have a bag valve mask you will need two people, one to apply the BVM and seal the mouth and the other to squeeze the BVM.

If trained to do so and have help, you can listen to the chest with a stethoscope to ensure the air is entering the lungs correctly. If ventilations are not possible in this way and you are trained to use suction, you can try using a soft tip suction tube in the stoma and if that does not work you may be able to seal the stoma and try ventilation through the mouth and nose which may clear the obstruction.

Finally, if oxygen is available you can connect the BVM or pocket mask to a supply of oxygen at 15 litres per minute.