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Let's start with the scenario. You have a female patient in her 40s on mechanical ventilation for airway protection. After an acute change in condition, a stat CXR found a massive left tension pneumothorax. It was treated rapidly with chest needle decompression and chest tube placement. A...

Hmmm... let me post another Critical Care Vent scenario...

The above chart is used to keep their SpO2 within that 88-95% range. The take home message is that you will not hurt a patient with a high level of PEEP. Don't be afraid of high PEEPs. It's not going to cause a pneumothorax and it won't cause barotrauma. It reduces atelectrauma because the...

Usually, (if not following the above table) I will wean their FIO2 to 30-40 until I start decreasing their PEEP (unless there is a hemodynamic problem). If an A-line is available, I'll probably get a gas pretty frequently unless their SpO2 stays in the 95-100% range. I don't have a specific...

I like it a lot! Yeah it's an unforeseen issue with an LTV that I ran into that's not your typical situation. LESSON LEARNED: do not use the infant mode on the LTV. I'm not sure if it's standard of care to paralyze most peds vent patients. I know where I worked we never paralyzed unless...

Check out the options for PEEP and FIO2 as provided by ARDSNet

So guys as far as initial settings go for PCV in this four month old... Pressure Control: 10-15 cmH2O PEEP: 5 cmH2O Rate: 25-35/min Insp Time: 0.5-0.8 secs Sensitivity: 2 Lpm I:E (adjust rate and IT to 1:2) FIO2: 60% and weaned quickly to room air Target volumes 35-70 ml Target Minute...

Yep driving pressures are very important because they are responsible for the opening and closing of the alveoli---essentially they are to blame for atelectrauma that leads to acute lung injury. Very much the reason why I advocate for much higher PEEPs in adult patients. I'm not so sure the...

Haha unless you hang around Charlotte, NC I don't think we've met. Unfortunately I had to figure this all out in a trauma room as the sole RT

Traumatic Brain Injury :(

Good thinking on this... unfortunately this mode isn't available on this vent (LTV) and I'm not sure if it's role in pediatrics. To be honest, I've never worked with ASV. Typically, "driving pressures" refers to pressure control setting or the inspiratory work.

You definitely are moving in the right direction! So the answer to this would be to accept the fact that you have to stay in the PEDIATRIC size for the sake of the inspiratory time. Then switch to pressure control because guess what---it's just pressure. The tidal volume will be what it will...

Agreed! But unfortunately, I ran into this situation with an LTV...

That's an interesting thought that I admit, I have never thought to do!! Risky, but definitely feasible! Let's say this ventilator has a variety of different modes... there is a way :)

Let's say you just intubated a 4 month old child. You are preparing to place this patient on a ventilator that allows you to select patient size, such as infant, pediatric, or adult. You elect to place the patient in volume control per IBW under the INFANT size category. You notice that she has...

Are you referring to your scope of practice at this time or the patient's condition? I would feel much better about a surgical airway (even if it may accidentally be a trach) than a need cric. I feel that the space you're working with would make a surgical cric less than ideal, not considering...

You got that right. This chick is all about planning, as every RSI should be. There better be a really good reason to intubate her, and I'm sure any anesthesiologist would consider alternatives if possible.

Thinking about the direct laryngoscopy with this patient scares me due to the over bite. I probably would stick with a glidescope or airtraq for her if available.

Dang... well, my first instinct is to avoid intubation at all costs. NIV, BVM, whatever works till we get to the hospital. Intubation needed, no questions asked? Video initially with bougie insertion. Next step would be miller blade (due to small oral opening) with bougie insertion. Failed...

Glad you mentioned those guys... unfortunately, that is the only service I know of... honestly wish it were more common. Provided, of course, the RT has a medic background... which most of the flight therapists do.