# CCT: Vent. Transports Gone Wrong. Air or Ground



## AeroClinician (Nov 30, 2013)

If anyone has any stories they want to share about vent. transports, and problems encountered during the course of transport, post up and lets hear about it.

Malfunctons? Vent. Setting Problems? Known limits/issues of particular vents?


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## DrankTheKoolaid (Nov 30, 2013)

Only issue for me is the 2hour portable battery on the LTV1200 not living up to its 2 hour claim.  Have always been able to plug it in thankfully anyways during the transport itself.  Don't typically rely on the battery for brief periods but on occasion while waiting on beds sometimes it will drop low enough to begin to alarm.  I would venture a guess that they do not remain plugged in and charging at all times when not in use.  Primary 911 but do IFT from the local poduck to the larger receiving facilities with vented patients. With the vents kept at the OR of the sending facility when not in use, so have little oversite of them.

That and having to have special new adapters to run nebs which I found out the hard way.  But IV Mag worked wonders in its place.


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## Clipper1 (Nov 30, 2013)

DrankTheKoolaid said:


> Only issue for me is the 2hour portable battery on the LTV1200 not living up to its 2 hour claim.  Have always been able to plug it in thankfully anyways during the transport itself.  Don't typically rely on the battery for brief periods but on occasion while waiting on beds sometimes it will drop low enough to begin to alarm.  I would venture a guess that they do not remain plugged in and charging at all times when not in use.  Primary 911 but do IFT from the local poduck to the larger receiving facilities with vented patients. With the vents kept at the OR of the sending facility when not in use, so have little oversite of them.
> 
> That and having to have special new adapters to run nebs which I found out the hard way.  But IV Mag worked wonders in its place.



You need to read the manual for all the things which influence the battery on the LTV. This includes how much O2 and PEEP is being used. Home care patients who have a deflated or no cuff on their trach with no PEEP and no need for O2 can get 2 hours. 

If you are doing CCT, you need to supply your own equipment if you want to make sure it is working okay. You can also check the charge on the battery before you attach the patient on these ventilators.


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## DrankTheKoolaid (Nov 30, 2013)

Yeah these are all emergent transfers through the ER unfortunately. But yes I agree the company should have it's own vents just for this reason


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## TransportJockey (Nov 30, 2013)

DrankTheKoolaid said:


> Only issue for me is the 2hour portable battery on the LTV1200 not living up to its 2 hour claim.



This. I had a call that was supposed to be at most an hour long with a vented patient on several drips... Inverter on the truck died in transport and the battery started to flash low power about 40 minutes into transport. Luckily we had a spare external pack that finished the job.


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## Flight-LP (Nov 30, 2013)

For those still carrying the LTV series, the sprintpack is a lifesaver. 12+ hours on the battery pack easily with hot swap capability. 

Also the Impact 731 EMV+ has an amazing battery.


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## Carlos Danger (Dec 1, 2013)

AeroClinician said:


> If anyone has any stories they want to share about vent. transports, and problems encountered during the course of transport, post up and lets hear about it.
> 
> Malfunctons? Vent. Setting Problems? Known limits/issues of particular vents?



One of my more memorable transports in recent years involved a post-cath patient in fulminant pulmonary edema who had been intubated by the referring and needed transport for emergent CABG.

He was on 18 of PEEP, Sp02 in the low 80's, hypotensive, awake and fighting the ventilator, and the tube was absolutely full of froth. We sedated him and started a fluid bolus, suctioned the ETT, re-connected and waited a minute, and suctioned again....and his sats dropped below 60 and he arrested. Well, he came really close to arresting, anyway.....some epi and atropine from my very quick-acting partner prevented him from actually losing pulses but for a moment he was _very_ bradycardic and hypotensive. Once he recovered from that we started some dobutamine and he settled right out and it was an uneventful transport.

Point is: in a patient requiring high airway pressures, disconnecting the ETT and losing your MAP should be avoided. Pretty basic concept, but I had never seen such a dramatic example of it.

Beyond that, in reference to vents I'd say it is just really important to know what you are doing. Know your vent well, thoroughly understand the modes it can do, thoroughly understand how to troubleshoot alarms and other problems.


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## NPO (Dec 6, 2013)

Slightly off topic...
Does this count?

We arrive on scene to pick up our patient. We are a BLS unit and the patient is on a vent, which in my are is far beyond out scope of practice. The sending SNF says "Well if we take the pt off the vent you can bag to the hospital right?" <_<

So I guess the call didnt go wrong, because there was no transport done. Not by me at least. I believe a CCT unit was called.


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## ExpatMedic0 (Dec 7, 2013)

I am about to start using the Oxylog 5000 plus. Anyone have experience with this? Anything I should be aware of (good or bad)?


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## CANMAN (Dec 11, 2013)

Halothane said:


> One of my more memorable transports in recent years involved a post-cath patient in fulminant pulmonary edema who had been intubated by the referring and needed transport for emergent CABG.
> 
> He was on 18 of PEEP, Sp02 in the low 80's, hypotensive, awake and fighting the ventilator, and the tube was absolutely full of froth. We sedated him and started a fluid bolus, suctioned the ETT, re-connected and waited a minute, and suctioned again....and his sats dropped below 60 and he arrested. Well, he came really close to arresting, anyway.....some epi and atropine from my very quick-acting partner prevented him from actually losing pulses but for a moment he was _very_ bradycardic and hypotensive. Once he recovered from that we started some dobutamine and he settled right out and it was an uneventful transport.
> 
> ...



Love complex patients like this. Makes you think and really use your critical thinking abilities.


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## SixEightWhiskey (Dec 13, 2013)

We got a BLS call with 'no specials' (yeah right) to do a transfer to a local medical facility last week. When we arrived at the address it was a pt on a vent and he was going to get his trach changed out. The pt had a home RN and a family member who was familiar with the vent's operation, but I was still skeptical since the RN didn't strike me as being the sharpest tool in the shed :unsure: and the family member seemed pretty far in outer space. On top of all of this, the pt required suctioning for oral secretions like every 5 minutes, needless to say a lot going on.

Our company policy is that we can do a vent call at BLS level as long as there is a family member/nurse who is familiar and can operate the vent. We ended up doing the call (and the subsequent return) and it went ok, but I really would've been happier if they had just put it out as an ALS call and sent a medic, just in the unlikely event that the vent failed or something catastrophic happened.

Any thoughts on this from anyone?


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## CANMAN (Dec 13, 2013)

If the patient is on their portable home vent then I don't see a reason the call can't be BLS provider someone rides with you. Normally the parents of special needs patients are fairly square on their care. Something catastrophic happens disconnect the vent and bag. Make sure you have a to go bag with two spare trachs one same size the other one size smaller. Trach pops out out a fresh one in, that's a BLS skill.


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## NomadicMedic (Dec 13, 2013)

CANMAN said:


> Trach pops out out a fresh one in, that's a BLS skill.



That's not a BLS skill _anywhere_ I've ever seen...


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## CANMAN (Dec 13, 2013)

Page 179 of the MD EMS provider protocols, most certainly a BLS skill.


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## NomadicMedic (Dec 13, 2013)

CANMAN said:


> Page 179 of the MD EMS provider protocols, most certainly a BLS skill.



Page 179 of the protocols? Page one hundred and seventy nine? Seriously?


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## CANMAN (Dec 13, 2013)

DEmedic said:


> Page 179 of the protocols? Page one hundred and seventy nine? Seriously?



Yes page "one hundred and seventy nine". I don't know exactly what your getting at. You said you didn't know of anywhere where this was a BLS skill and I was providing factual information to show you indeed it is in a very restrictive EMS protocol state. Don't know if you being sarcastic or what your getting at....


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## NPO (Dec 13, 2013)

I think hes trying to say thats a long protocol book.


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## NomadicMedic (Dec 14, 2013)

Right... that was my internet sarcasm. I should have enclosed it within tags.

But yeah, 179 + pages for a protocol book? That is ridiculous.

And trach replacement isn't a basic skill in Washington. Or Delaware. Or Connecticut. Or New Hampshire... thus, "_not a basic skill anywhere I've seen_"


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## Carlos Danger (Dec 14, 2013)

DEmedic said:


> Right... that was my internet sarcasm. I should have enclosed it within tags.
> 
> But yeah, 179 + pages for a protocol book? That is ridiculous.
> 
> And trach replacement isn't a basic skill in Washington. Or Delaware. Or Connecticut. Or New Hampshire... thus, "_not a basic skill anywhere I've seen_"



The whole thing is well over 400 pages.


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## NomadicMedic (Dec 14, 2013)

Halothane said:


> The whole thing is well over 400 pages.



That says something, doesn't it?

1. Toilet paper MUST hang in the proper orientation, with the flap in the "over the top position"

a. In the instance orientation is incorrect, BLS/ILS providers MUST contact medical control for permission to perform orientation change.

b. Paramedics may perform orientation change without a prior medical control contact, but must document exact times and radio SYSCOM when the correct orientation has been achieved.


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## Handsome Robb (Dec 14, 2013)

We just bought the ReVel vent. I'm looking forward to using it, does anyone here have any experience with it?

We aren't critical care but we routinely do vent transports and the current vent we use (haven't started using the ReVels yet) is a nightmare. It's the "ALS CareVent". Basically a demand valve with some RR tied to a set TV. Unless they're completely out every transport is a nightmare requiring lots of coaching and sedation. It's borderline cruel to transport these vent dependent patients who may only be on PS on this thing.


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## emt11 (Dec 15, 2013)

CANMAN said:


> Page 179 of the MD EMS provider protocols, most certainly a BLS skill.



Yea, I'd more than likely lose my license for doing something like that. In my state, even a medic can't replace a trach. It's monitor the airway(that they have left) and load and go.


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## Carlos Danger (Dec 15, 2013)

ExpatMedic0 said:


> I am about to start using the Oxylog 5000 plus. Anyone have experience with this? Anything I should be aware of (good or bad)?





Robb said:


> We just bought the ReVel vent. I'm looking forward to using it, does anyone here have any experience with it?



I have not used either one but have heard good things about both of them. Is it the Revel or the Revel Enve that does an APRV mode? 

Which modes do they do?


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## Christopher (Dec 17, 2013)

ExpatMedic0 said:


> I am about to start using the Oxylog 5000 plus. Anyone have experience with this? Anything I should be aware of (good or bad)?



The Aussies seem to rave about the Oxylog.


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## NomadicMedic (Dec 17, 2013)

Seems like it's rare that I was using an LTV1200 for a transport vent for CCT calls.


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## TransportJockey (Dec 17, 2013)

DEmedic said:


> Seems like it's rare that I was using an LTV1200 for a transport vent for CCT calls.



My evil empire has an LTV1200 for CCT calls as well. Our 911 trucks are getting the parapaqs for basically just hands free bagging


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## Aprz (Dec 17, 2013)

I'm just an EMT, ain't no expert on ventilators, but I am fascinated by them.

I've used the ReVel before (ie played with it, not used on a patient). I've seen it used at multiple companies in the San Francisco Bay Area. I've only seen the LTV once. ReVel is easy to use, has BiPAP, and it's light. Two most common issues I've seen with it is the screen turning off and trying to start BiPAP mode.

When the internal battery, T-battery, charge is low, the screen to the vent will turn off, which is obviously alarming to many who don't know about this feature. The ventilator will continue to work, the screen can be turned back on by pressing any button I believe, I just press the yellow silence/alarm button personally. It will alarm about the T-battery frequently when the power is low. The T-battery exist so you can transfer the external battery without interrupting the ventilator. Charging the gentilator by plugging it in to the wall is how you recharge the T-battery (has nothing to do with charging the external battery).

For BiPAP, you just need to connect the circuit and mask to the patient, and it'll start, but people are stumped cause it's not starting prior to applying it to the patient. You can also turn the knob from IPAP, EPAP, and ventilate. By selecting ventilate, it'll start without being connected to the patient, but immediately alarm and stop until you connect it to the patient.


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## Carlos Danger (Dec 17, 2013)

The LTV1200 is a solid vent. It's what I've used for most of my career. 

I think the newer vents mostly are just smaller and lighter; I don't think they actually do anything more than the 1200 in the way of modes or important settings. I'm sure they have some nice little features that the LTV doesn't, and are probably easier to use in some cases. By my understanding is that their primary advantage is less size and weight. Which is not an insignificant thing.

On the other hand I did hear about one including an inverse-ratio APRV-like mode; maybe that was the Revel Enve? Not sure.


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## Handsome Robb (Dec 17, 2013)

Halothane said:


> I have not used either one but have heard good things about both of them. Is it the Revel or the Revel Enve that does an APRV mode?
> 
> 
> 
> Which modes do they do?



AC, SIMV, CPAP+PS, NPPV. Then all sorts of different choices as far as volume/pressure control, pressure support, PRVC/VS.


http://www.carefusion.com/pdf/Respiratory/Ventilation/RC2880_Revel_Ventilator_Spec_Sheet.pdf


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## Aprz (Dec 17, 2013)

Not sure what APRV mode is. Wikipedia has a page dedicated to it though so I'll read that soon.


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## Medic2409 (Dec 25, 2013)

CCT, LDT>2 hours, using an EMV.  Something on the truck caused an overpressure of Oxygen to the vent, causing a catastrophic vent failure.  The vent effectively shut shut down and locked me out, leaving me unable to even give a manual breath.  I had to pop it off and start manually bagging while trying to figure out just what in the world went wrong.  Turns out we had a bad regulator at the main tank.  By completely shutting the vent off, disconnecting and bleeding the O2 supply line, removing a Christmas Tree, and re-connecting to the oxygen supply I was able to get the vent to function again.


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