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If a patient can actually perform a reproducible FEV1, then you have a while to go before they need tubing. Like the original question asks about applying positive pressure on an asthmatic, tubing them and forcing more air in ain't gonna be much better unless you are really really deep in the...

At the moment the only way to provide Bilevel NIPPV (because BiPap is a brand name for a particular device providing a particular mode) is through a mechanical ventilator in non-invasive mode (LTV, Draegar, etc.). It will also consume a lot more oxygen resources that the CPAP devices. Up till...

In Ontario, Canada, patient care standards now include (since the 2003 SARS outbreak) the use of oxygen therapy masks that are outfitted with expiratory filters. These masks don't replace the PPE but provide an additional layer that traps exhaled particles at the patient level. Its interesting...

So how long will the transition be as I plan to dress all in black and crawl into the fetal position in the dark during this time...

Chimpie mentioned "maybe" follow up. this is essential. You can practice all you want but if you don't get the next chance, its all for naught. There are many articles on what to do when you fail interviews. Sending cards regardless is essential. It adds the personal tough so when they see...

The goal is to minimize barotrauma and volutrauma. 4-8 mL/kg ideal body weight in critical care. I don't understand how one could rationalize doubling or tripling tidal volumes for obese patients; their lungs aren't any bigger.

Some devices are better than others and you have to weigh the features with the benefits of any device. Of course you have to take studies and white papers with a grain of salt. Regarding the use of a low flow oxygen nipple to supply, these devices use venturis draw in room air to make up the...

I think you've got the right attitude in the way you approach your goals. Too many people focus on the SpO2 when using CPAP where the primary outcome would be the ETCO2. Using the Combo nasal cannula/ETCO2 is the best method of monitoring while increasing delivered FiO2. One could also...

I don't understand the need for paralysis if you have proper analgesia AND anaesthesia. I have seen far too many issues with mechanical ventilators and circuits where the patient's own spontaneous breaths saved them despite the efforts of the attending staff. Most patients require support, not...

I only have one (on my vocal chords that reads "If you can read this, you are too close").

Interesting post on LinkedIn (for those with accounts) this morning that sums up the views posted here: https://www.linkedin.com/today/post/article/20140505122803-20017018-but-you-asked-me-to-stare-at-your-tattoos?trk=tod-home-art-list-large_0

A lot of the US states allow CPAP to be used as a basic level skill. New York is in the process of introducing it now.

I've been told "Red Back" are amazing but have personally not tried them. My 5.11 ATAC's are incredibly comfortable and water tight as well. One of the most comfortable ones for my feet anyway.

I partake in these conversations to learn something about the industry and those within it. Some issues are technical, some professional and some cultural. I'm always trying to absorb, learn and go on from there without judgement...on a daily basis. Today I learned the word "décolleté". Its...

Give 'em lab coats or have them do the test in a more realistic setting like outside in the rain and mud with the patient covered in blood.

Sorry guys I have to disagree to some degree. The point of high fidelity scenarios comes to light when you take 10, 30, 50, 100 experienced practitioners and place them in a true life scenario and note if EVERYONE performed exactly the same way to the standards. The exact same scenario (that's...

To understand their training methods, you have to look at their safety culture and acceptance of failing during training. In healthcare, we are nervous about failing (human nature) and loath having those errors discussed in public, especially in front of classmates. HOWEVER, most medical...

Here's just one study I was able to dig up that discusses the topic: Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation. Authors: Weiler N; Heinrichs W; **** W Affiliation: Johannes Gutenberg University Medical School, Clinic of...

Gastric insufflation is also seen with CPAP use, which obviously occurs during spontaneous breathing in an increased pressure environment...but the explanations offered above about gas taking the path of least resistance is spot on.

My understanding was that the risk of air entering the esophagus and stomach lied around the 18 cmH2O mark, so moderate amounts of positive pressure support could lead to issues, even in the act of spontaneous breathing.