When delivering breaths using a bag-mask device, follow these key steps and techniques to ensure effective ventilation:

Preparation and Positioning

• Position the patient flat on their back and open the airway using the head tilt-chin lift maneuver (or jaw thrust if spinal injury is suspected) to prevent airway obstruction

• Insert airway adjuncts like oropharyngeal or nasopharyngeal airways if possible to maintain a patent airway

Mask Placement and Seal

• Select a properly sized mask that covers the nose and mouth but does not extend over the eyes

• Use the "C-E" grip to hold the mask: form a "C" with your thumb and index finger on the top of the mask applying gentle pressure to create a seal, while the other three fingers (forming an "E") lift the jaw upward to open the airway and maintain the seal

• Avoid placing hands or the mask on the eyes to prevent injury or vagal reactions

Delivering Breaths

• Attach the bag to an oxygen source if available, and squeeze the self-inflating bag slowly and steadily to deliver a breath over about 1 second, watching for chest rise as confirmation of effective ventilation

• Avoid rapid or forceful squeezing to prevent excessive airway pressure and potential lung injury (barotrauma)

• If the chest does not rise, reposition the mask and airway to ensure a proper seal and airway patency before delivering the next breath

Two-Person Technique (Preferred When Possible)

• One rescuer holds the mask with both hands using the "C-E" grip to ensure a better seal and airway opening.
• The second rescuer squeezes the bag to deliver breaths, allowing for more controlled and consistent ventilation

Ventilation Rate

• Deliver breaths at appropriate intervals depending on the patient’s condition (e.g., 1 breath every 5–6 seconds for adults in cardiac arrest)

In summary, effective breaths with a bag-mask device require a good mask seal using the "C-E" grip, slow and controlled squeezing of the bag to deliver breaths over about one second, and proper airway positioning to ensure the air enters the lungs, as indicated by visible chest rise