Scenario - For students

StCEMT

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Explain please!


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Expand on your thoughts. Respiratory distress/failure has a cause. What do you think the cause is? And to echo Nomad, what is your reasoning for the BVM?

This is a good place to learn from others, throw stuff out there and learn from folks like Nomad who have been at this for a while.
 

Jackson dunn

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Reading earlier posts on this thread, p.e. Makes more sense to me. Age, smoker, birth control.The resp rate accompanied by delayed cap refill made me jump to o2 via bvm. I was thinking inadequate tidal volume.


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VentMonkey

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You would use a BVM to help slow the fast respirations, you need to pace her. Into a better rate.
By "pace" I imagine you're referring to synchronizing the patients ventilations with yours (BVM).

If so, how and why do you want to do this? Is this really necessary? What if this is a compensatory mechanism on behalf of the patients body mechanics based off of their underlying condition? Is it still feasible and conducive to a positive outcome (our ultimate goal)?

Short of complete and total paralysis, or allowing the patient to hypoventilate into near apnea, I don't know how realistically effective it is to think we can slow the fast respiratory rate with our ventilations. So again, please explain:)...
 
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NomadicMedic

NomadicMedic

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Just FYI, she had no history of smoking or birth control use.

Reading earlier posts on this thread, p.e. Makes more sense to me. Age, smoker, birth control.The resp rate accompanied by delayed cap refill made me jump to o2 via bvm. I was thinking inadequate tidal volume.


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VentMonkey

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I'm pretty sure the post was implying TCP.
CAL: Alright ma'am, every time this shocks you, I need you to take a breath.
Right, so perhaps she needs to clarify, and/ or use proper terminology.

When I think pace I think TCP as well, but the way she responded leads me to believe her treatment indicates aggressive BLS airway management via timing BVM ventilations with the patients (something I find less, and less conducive to actually protecting the patients airway).

Again, I'll allow her to clarify remembering this is for students so I was throwing some questions regarding her choice of patient, and airway management her way.
 

StCEMT

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I knew what was meant (ventilation timing), I remember being told about that in EMT school. That being said, I have never personally done it.
 

VentMonkey

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I knew what was meant (ventilation timing), I remember being told about that in EMT school. That being said, I have never personally done it.
So I just had a pretty good discussion today with an RT at our base about the advantages of PCV vs. a more "vent-controlled" mode (e.g., A/C and SIMV) in, say, metabolically deranged patients.

Without derailing too much, and taking away from the valued approach students bring, I would like to see, and know what the rationale would be for a basic (BLS) approach to aggressively managing said patients airway, and why or why not.

At every prehospital-level a provider can do a lot of harm, so why not learn and discuss rationale here?
 

CWATT

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...why do you want to do this? Is this really necessary? What if this is a compensatory mechanism on behalf of the patients body mechanics based off of their underlying condition? Is it still feasible and conducive to a positive outcome (our ultimate goal)?
Another question to ask yourself is: what conditions cause tachypnea? Which of these requires manual BVM and why?
 

VentMonkey

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Another question to ask yourself is: what conditions cause tachypnea? Which of these requires manual BVM and why?
A better question is:

Is this solely tachypnea, or is there hypoventilation present as well?
 

VentMonkey

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@VentMonkey I think the idea is that it makes them consciously focus on their breathing and then in turn helping them slow down.
If they're "conscious" enough to focus on their breathing there's no need to aggressively protect their airway, period. Passive oxygenation, and/ or coaching techniques work just fine.

Knowing when to be proactive vs. reactive is often not really covered in a ~120 hour course.

Basically they're either aware that they're actively, and purposefully hyperventilating, or they aren't. The latter should put your clinical feelers up.

Again, differentials, and experience can sharpen this approach, but without it you may fall into the "they're full of sh-t" trap all too common with newer providers.
 
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