If your patient is supposed to have tidal volumes of 500mls

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usalsfyre

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...and only 250ml is being delivered by the vent because your bumping your max pressure, wouldn't be prudent to either bag your patient or at least up your pressure limit while you troubleshoot? Rather than make your patient have the appearance of a guppy out of water and spike their CO2 through the roof?

I swear, some of the "providers" I run into....
 
Id go with bagging while I troubleshoot. Depending on how high their pressure is I may up the limit, just depends on what Im seeing.
 
Moved them to my vent, bumped the pressure limit from 35 to 60, which yielded PIPs in the 55 range, aggressive suctioning and a neb brought them down to 40 or so.

The RRT looked clueless when I mentioned that the delivered volumes were no where near the set volumes. I'm not sure how some folks make it through licensure.
 
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You have more "fun" in IFT than I do in 911. Where do you find these people?
 
I know the answer!

Push "Silence Alarm" button until alarms are silent. Repeat as often as necessary. Much success!
 
usalsfyre said:
Moved them to my vent, bumped the pressure limit from 35 to 60, which yielded PIPs in the 55 range, aggressive suctioning and a neb brought them down to 40 or so.

The RRT looked clueless when I mentioned that the delivered volumes were no where near the set volumes. I'm not sure how some folks make it through licensure.
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I expected this is how you handled it. My first thought with high pressure and lack of delivered volume was suction needed.

I had more pucker moment patients doing CCT than I ever did on 911 calls.
 
Smash said:
I know the answer!

Push "Silence Alarm" button until alarms are silent. Repeat as often as necessary. Much success!
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See? Anybody can be a nurse! All that schooling and you're letting the secrets out!
 
Lol 5 minutes of listening to Dr. Weingart and you would know that. Bloody brilliant that man is
 
abckidsmom said:
See? Anybody can be a nurse! All that schooling and you're letting the secrets out!
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Nah, I just have to drive a Philips MRx at work, so 70% of my time on calls is spent pushing the "Silence Alarms" button because: the patient coughed; the patient scratched himself; the patient breathed; the patient had a pulse (strangely it never lets me know if they don't have a pulse); the rig went over a bump; the rig didn't go over a bump; the heart rate was over 70; the heart rate was under 68; a breeze blew in the window; the driver turned the aircon on; a butterfly flapped it's wings in the Amazon basin; it is Tuesday, or because it is another day of the week that ends in a "y"

So I am well versed at the "Silence Alarms, ignore alleged problem" routine.

I really love the Philips MRx
 
abckidsmom said:
See? Anybody can be a nurse! All that schooling and you're letting the secrets out!
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I love the fact that we can silence all alarms but still have lethal arrhythmia alarms go off on our monitors :)

Our crappy little vents don't have alarms they just make that sound you get when you blow air past a blade of grass in between your hands if it doesn't like what's happening.

On the note of RRTs I heard a brilliant rant by one in the ER the other day about how his counterparts at SNFs seem to have no idea what they are doing even though they passed the same exams and have the same degree that he has.
 
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Smash said:
Nah, I just have to drive a Philips MRx at work, so 70% of my time on calls is spent pushing the "Silence Alarms" button because: the patient coughed; the patient scratched himself; the patient breathed; the patient had a pulse (strangely it never lets me know if they don't have a pulse); the rig went over a bump; the rig didn't go over a bump; the heart rate was over 70; the heart rate was under 68; a breeze blew in the window; the driver turned the aircon on; a butterfly flapped it's wings in the Amazon basin; it is Tuesday, or because it is another day of the week that ends in a "y"

So I am well versed at the "Silence Alarms, ignore alleged problem" routine.

I really love the Philips MRx
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Lol I hear that smash. We run MRx here also. Just had a rep come by last week and upgrade the software in ours. Seemed to help a little. The newest MRx that they brought by wasnt to bad though, had some nice tweeks and upgrades
 
Which Vents ya running NV? Were running the LTV 1200 here
 
Corky said:
Lol I hear that smash. We run MRx here also. Just had a rep come by last week and upgrade the software in ours. Seemed to help a little. The newest MRx that they brought by wasnt to bad though, had some nice tweeks and upgrades
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I like the MRx. We are getting the software update this month as well so I'm looking forward to seeing how that works out. Anything you noticed they changed that you like?

Corky said:
Which Vents ya running NV? Were running the LTV 1200 here
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Our flight teams run the LTV 1000 or 1200 I can't remember which, I think it's the 1000 but they may have been upgraded recently.

Our ground units have the stupid little "avocado" autovent things, I don't remember the exact brand and model, with the preset rate/tidal volumes. They work well for arrests and someone who has no respiratory drive whatsoever but their usefulness pretty much ends there. We have to sedate people quite a bit post-intubation or coach vent-dependent patients quite a bit about how they work before we swap them over to our vent to keep them from fighting the vent.
 
We have the Phillips too. When we're not silencing alarms, we're calibrating the nbp and etco2 modules. What a racket!
 
usalsfyre said:
...and only 250ml is being delivered by the vent because your bumping your max pressure, wouldn't be prudent to either bag your patient or at least up your pressure limit while you troubleshoot? Rather than make your patient have the appearance of a guppy out of water and spike their CO2 through the roof?

I swear, some of the "providers" I run into....
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If your pt is popping the high pressure limit and only getting 1/2 of the dialed in Vt delivered, you need to be figuring out why that's happening. It's usually pretty straight forward. Start at the lungs and work your way back. If they're spasming then give a neb. If they're full of fluid, suction. If the tube's bent, straighten it. If the flow rate is set too high, lower it. If the pt is breathing against the vent, sedate them. If you're running out of oxygen, change tanks. 9 times out of 10 it is that simple.
 
Just remember that the high pressure alarm is only sensing the pressure within the vent circut and NOT what is in the airways. Silence the alarms and check a plateau pressure before doing anything else. Within range and your golden over 30 and you need to make some adjustments.
 
abckidsmom said:
We have the Phillips too. When we're not silencing alarms, we're calibrating the nbp and etco2 modules. What a racket!
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That thing needs an event mute button! I don't know why anyone would want that noise going off!
 
Solution for any monitor made by phillips

1. Unplug it from the wall
2. Throw it in the deepest body of water you can find
3. Watch it sink to the bottom
4. Forget you ever used it (which is like trying to forget being molested as a child, but you have to start somewhere.)
5. Buy a monitor from any other company to replace it
6. Forget phillips even makes monitors
 
MSDeltaFlt said:
If your pt is popping the high pressure limit and only getting 1/2 of the dialed in Vt delivered, you need to be figuring out why that's happening. It's usually pretty straight forward. Start at the lungs and work your way back. If they're spasming then give a neb. If they're full of fluid, suction. If the tube's bent, straighten it. If the flow rate is set too high, lower it. If the pt is breathing against the vent, sedate them. If you're running out of oxygen, change tanks. 9 times out of 10 it is that simple.
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Exactly what we did, we simply allowed higher pressures while we did it.
 
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