person with trach on vent

[tacitblue]

I wrote this as an email inservice not long ago:

I love your inservice. Perfect! Do you mind if I share this with some of the EMTs who work with RTs at my service? I will credit you (your handle, rather), of course.

 

[CAOX3]

I thought the original post was pretty benign.

Regardless, I think is a great topic for discussion. With more and more vent dependent patients being managed at home, chances are we will be crossing paths on a more regular basis.

The DOPE acronym is fantastic, thanks.

Now as EMTs does your area allow deep trachial suctioning or is that strictly an ALS skill?

 

[medicdan]

Now as EMTs does your area allow deep trachial suctioning or is that strictly an ALS skill?

In MA, it's a BLS skill for a basic working on an ALS truck, so performed under the order (and supervision) of a medic.

My default (if theres ever a problem) before immediately bagging a patient is to turn to FiO2 up on the vent-- and see if that corrects the problem. It's what we would do to a non-vented patient, who is on existing oxygen (turning up an n/c, switching to a NRB). From there, of course, transfer to a BVM while troubleshooting vent with staff/family, or preparing our vent with consultation of family/facility RT. RTs are generally an excellent resource, if available, I encourage you to take advantage of their wisdom and problem solving magic.

 

[ladyMj]

In MA, it's a BLS skill for a basic working on an ALS truck, so performed under the order (and supervision) of a medic.

My default (if theres ever a problem) before immediately bagging a patient is to turn to FiO2 up on the vent-- and see if that corrects the problem. It's what we would do to a non-vented patient, who is on existing oxygen (turning up an n/c, switching to a NRB). From there, of course, transfer to a BVM while troubleshooting vent with staff/family, or preparing our vent with consultation of family/facility RT. RTs are generally an excellent resource, if available, I encourage you to take advantage of their wisdom and problem solving magic.

Thank you I am trying to set up a day where I can shadow an RT. I can only read so much, so I would love to see resp. side in action;-) Thanks for a great idea! I am an LPN, but I going to see also if I can get into EMT work and eventually become a medic. I think the emergency side of care is intriguing, so I would love to pursue that avenue. I do have a client currently who has a trach and is vented, family is awesome, but I do have questions...but when you talk of worst case scenario...I like to be prepared and the family says 911 will be there in minutes and I am sure they will, but I just want to know exactly what to do in any event. You all have really given me some good info! I did leave a message for the NCM to see if I can spend a day with an RT, so we will see....wish me luck;-)

 

[squrt29batt12]

if you have ANY trouble with the trach patient on a vent, d/c the vent and bag with 100% o2 (i would make sure the cuff on the patient's tube is inflated if necessary). i would suggest that you NEVER, let me repeat, never, remove the patient's tube. you run the risk of causing a laryngospasm, and have yourself in a bucket of s**t

just make sure the patient is being oxygenated, administer high flow diesel and let the er physician and rrt deal with clearing the obstruction

 

[8jimi8]

if you have ANY trouble with the trach patient on a vent, d/c the vent and bag with 100% o2 (i would make sure the cuff on the patient's tube is inflated if necessary). i would suggest that you NEVER, let me repeat, never, remove the patient's tube. you run the risk of causing a laryngospasm, and have yourself in a bucket of s**t

just make sure the patient is being oxygenated, administer high flow diesel and let the er physician and rrt deal with clearing the obstruction

A trach insertion is below the vocal chords... Are you sure that is what you Meant to say? Are you talking about an ET tube?

 

[squrt29batt12]

You caught me in a brain fart, that's what I get for multitasking and half-reading the OP. For some reason I pictured the pt with an et, but it's actually a stubby trach tube, as you said below the larynx. Thank you for the heads up lol. Disregar:wacko:d my original post, wow

 

[usalsfyre]

just make sure the patient is being oxygenated, administer high flow diesel and let the er physician and rrt deal with clearing the obstruction

With a seriously obstructed trach, you won't be able to oxygenate the patient no matter what you do. Knowing how to replace a trach, or clear a mucous plug is literally a lifesaving skill.

"High flow diesel" very, very rarely a good treatment plan.

 

[squrt29batt12]

With a seriously obstructed trach, you won't be able to oxygenate the patient no matter what you do. Knowing how to replace a trach, or clear a mucous plug is literally a lifesaving skill.

"High flow diesel" very, very rarely a good treatment plan.

Of course always handle the ABCs even if it means having to remove/replace the trach IF you have poor compliance or the pt remains in resp distress, but where I live, transport times are 4-6min, and if I can properly oxygenate the pt, I will leave it to the specialists.