To Vent or Not To Vent

I don't see why a patient would not be taken on a vent.

I use the settings prescribed by MD as required by my protocols. Its not been a problem.
 
medic417 said:
If you are not willing to become educated then sadly you should stay with those barbaric lung poppers. A real vent is a wonderful tool when used properly but can quickly become deadly when handled incorrectly.
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On this thread, It was stated that the RT has either 2.5 x the medic's education, or one year's clinical experience before being cut loose to prescribe vent settings. I feel that the paltry amount of education and inservices for medics are inadequate to allow for standing orders for changing vent settings. A couple of paragraphs in a medic text, an hour or two inservice, and four to five vent jobs during orientation is not adequate.

At my old hospital, we used the hospital's vent settings, and we would put the pt on our vent first thing, before changing drips or anything else. This way, there was some time onscene to see if the pt does well on our vent and at those settings or not. At my current per diem IFT job, we have RT's set up our vents for us, and also ride with us if it's more than a routine vent transfer/discharge.
 
re

Definately agree that we don't receive anywhere near enough training on vent management. As in like zero.... Unless a provider takes the initiative to become skilled in their use. And by use I mean setting changes and set up. For IFT where you just babysit a vent set up by the receiving facility per your protocols is another story, at that point you need to know how to trouble shoot alarms and check a plateau pressure. I definately fall in the not enough education group, but do also take the initiative to learn. The various RT forums have been helpful along with Ardsnet. Unfortunately I've yet to see ventilatory management come into the curriculum changes............... So until then OJT is best we seem to get.
 
As someone who has been a user and supplier, I would always go to the vendor for support on how to use the device. Sales is based on building and maintaining relationships, which means they should provide support through post-sales education. If they don't, they risk being a non-entity the next time a purchase is in the works. Also, a vendor/supplier HATES having a device not being used or used inadequately such that the device becomes tainted or labeled as being too difficult to use. Therefore, I would lean on the vendor/supplier to provide as many inservices as possible until you feel comfortable using the device. Its in their best interests to be there.

My practice is to do an initial inservice, then repeat it later on to capture the "advanced" aspects of the device. It also corrects any bad practice that crept into "normal" use during initial deployment.
 
there are some great youtube lessons about vent management as well as vast resources for continuing education in the area of vent management. one of the things that sets paramedics apart from the rest of the medical community, which may be a bad thing, is the amount of learning we are expected to do OTJ and in our own time outside of formal education. it is your duty to find the information that you do not know and learn it.

start here, the AncientScholar, youtube vids which break down simply the theory and operation concerns of mechanical ventilation.
 
re

Thanks for the youtube link. Somehow I haven't stumbled across him yet!
 
46Young said:
The autovent is barbaric.
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Barbaric, yes, but it is versatile, and in a setting where you're manpower-limited, having an autovent is far preferable to having to juggle compressions, defibrillation, pharmacology, access, and ventilations with only one or two people.

In my opinion, an IFT patient on a vent should be on a portable ventilator, with the settings re-checked by me, continuous tracking of the patient's oxygenation/tube placement, and continuous capnography. That being said, sometimes we need to use BVMs, which should be monitored to the same standard.

Can anyone help me with understanding how to set up ventilators? I am familiar with Autovents and the like, but I am kind of lost on the more advanced ones. Pretty much all I know is that we want to see tidal volume appropriate enough to begin to cause chest rise, see appropriate square capnography waveforms, keep end-tidal CO2 between 35 and 45 in most cases, and keep oxygen saturations >95%. I know I'm missing a lot of important stuff, but I can't for the life of me figure it out.
 
Rocketmedic40 said:
Can anyone help me with understanding how to set up ventilators?
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see my post above. takes about 3 hours to get through all the vids, but in the end you will feel much more confidant in your abilities. also talk with the RTs and MDs about the topics he goes over.

I watched 2-3 sections per day, took some tidbits to the ED and had the doc and RT further explain them.
 
re

There are multiple strategies of vent setups based on patients. Check out the various RT forums and more importantly check out Ardsnet for their strategies
 
To help you out more, the basic settings you will be concerned about the most are tidal volume (6-8mL/kg for adult), breaths per min, mode (A/C or SIMV) - volume or pressure, PEEP, I/E ratio, and FiO2.
 
but it is versatile,
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Compared to what precisely?

and in a setting where you're manpower-limited, having an autovent is far preferable
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...if you don't mind your patient winding up with bilateral chest tubes. LOL
 
I am familiar with Autovents and the like, but I am kind of lost on the more advanced ones.
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If you'd like, all animosity between the two of us aside, I can try to put you in touch with one of the ventilator sales reps I've met through speaking at conferences and such. They could likely hook you up with their counterpart in your area. It's a great way to learn (including CEUs most likely) and chances are good you'll lunch out of the deal.

If you just have specific questions, you're always welcome to PM me.
 
That would be great. I'd love to learn...and thanks, USAF.
 
18G said:
To help you out more, the basic settings you will be concerned about the most are tidal volume (6-8mL/kg for adult), breaths per min, mode (A/C or SIMV) - volume or pressure, PEEP, I/E ratio, and FiO2.
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That's a lot more complicated then I remember! Back to the books for me. The tidal volume, rate, PEEP, and pressure are familiarish. I/E, FiO2, and mode are strange.
 
re

Oops meant to also note for a crash course go to --- emcrit.com ---and watch his 2 videos on ventilatory management. The Dr. Wiengart (sp) is very adept at explaining his material in ways that are understandable to all with any kind of advanced medical background
 
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