CCT: Vent. Transports Gone Wrong. Air or Ground

AeroClinician

AeroClinician

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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?
 
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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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.
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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.
 
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
 
DrankTheKoolaid said:
Only issue for me is the 2hour portable battery on the LTV1200 not living up to its 2 hour claim.
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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.
 
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.
 
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?
Click to expand...

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

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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Love complex patients like this. Makes you think and really use your critical thinking abilities.
 
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?
 
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.
 
Page 179 of the MD EMS provider protocols, most certainly a BLS skill.
 
DEmedic said:
Page 179 of the protocols? Page one hundred and seventy nine? Seriously?
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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....
 
I think hes trying to say thats a long protocol book.
 
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"
 
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"
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The whole thing is well over 400 pages.
 
Halothane said:
The whole thing is well over 400 pages.
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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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