This is probably a question I should know the answer to but it has slipped my mind. What would be BLS care for a patient experiencing a problem with home equipment such as a respirator or other piece of equipment that can't be moved into the ambulance and is causing a serious issue (e.g. airway compromise)?
Trach Problems
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I'm confused, what are you asking? What kind of problem is the patient experiencing? If it comes down to ventilating a patient then you would use a BVM. A BVM is the simplest form of manual ventilation.
I guess I'm asking how we are supposed to handle the equipment. Scenario: Dispatched to a respiratory problem, upon arrival pt. is on artificial ventilation at home via ventilator (pt. in an ICU type setting in the home), nurse is not on scene and other caregivers aren't sure about use of the equipment but it is now causing the pt. a respiratory problem. What would be BLS care for that scenario? Can we disconnect the vent and switch to a BVM without being trained to operate the vent.? What about other types of equipment?
That's what I was thinking, can't go wrong with ABC, ALS, and when all else fails call med control. I was just wondering if I missed something and there was something I should do because I'm not going to mess with equipment a pt. is relying on even to take over with a BVM because who knows at that point what is the actual problem and what is worse.
KEVD18
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your thinking is like a scatter plot. make it linear.
is the ventilator they are on currently working? no? then disconnect it and go with what works, a bvm. you dont need to know how to work the vent. your not using the vent. quite the opposite in fact, so the operation of the vent is irrelevant.
id say als is a given.
unless your required to do so by state/county/municipality or service rules, why call med control? you dont need a doctors permission to ventilate a patient. they cant breathe, you breath for them. we dont carry any advanced airways or respiratory drugs. we dont do advanced procedures. we ventilate and screw for the H. let the medics worry about the rest of it.
is the ventilator they are on currently working? no? then disconnect it and go with what works, a bvm. you dont need to know how to work the vent. your not using the vent. quite the opposite in fact, so the operation of the vent is irrelevant.
id say als is a given.
unless your required to do so by state/county/municipality or service rules, why call med control? you dont need a doctors permission to ventilate a patient. they cant breathe, you breath for them. we dont carry any advanced airways or respiratory drugs. we dont do advanced procedures. we ventilate and screw for the H. let the medics worry about the rest of it.
Ok, well let me give you a case study of one of the frequent flyers for my BLS service before I became ALS.
We would regularly get dispatched to an elderly gentleman who was on a very advanced home ventilator. The man was fully with it, but was vent dependent through a tracheostomy. The patient would regularly develop lung infections which would require an ED visit due to respiratory difficulty.
Due to a slight language barrier with the patients wife, sometimes the call would come in as an undefined medical emergency which only gets a BLS response in New Jersey (BLS transport with ALS flycar). Often, we would get there and realize that the patient needed to be transported to the hospital. Our procedure was as follows:
1) Crank up the O2 settings from 4LPM to 10LPM through the vent. (usually there is a hospital style oxygen controller on many commercial vents, and it is obvious in many home vents).
2) Call for an Advanced Life Support unit.
3) Prepare a BVM with 10LPM of oxygen (Remember, with COPDrs you don't want to blast them with oxygen)
4) Manually disconnect the vent from the patients trach tube and bag WITH THE PATIENT. This is the most difficult part as many ventilator patients you will find at home have a fairly significant respiratory drive of their own and are merely "assisted" by the vent. The vent is set either at a predictable and consistent rate (that you as a human will never be able to provide!) or on a negative-pressure sensor which senses when the patient starts to breath in and thus assists the breath by firing off. A neat trick that I use is to have the patient tap me, or whomever is bagging, on the leg or arm whenever he wants a breath. Presto!
If the reason that you have to transport the patient is NON respiratory related, I would argue that transporting a patient that uses a vent with no acute respiratory distress is a BLS call. At a BLS level, ventilations are no biggie, and as long as you keep providing ventilations for the patient, ALS should not be needed. Just make sure to call the ER and let them know to have a vent ready! Otherwise you'll have some pissed off nurses at two in the morning (when this stuff ALWAYS seems to happen). All the best,
Jersey
We would regularly get dispatched to an elderly gentleman who was on a very advanced home ventilator. The man was fully with it, but was vent dependent through a tracheostomy. The patient would regularly develop lung infections which would require an ED visit due to respiratory difficulty.
Due to a slight language barrier with the patients wife, sometimes the call would come in as an undefined medical emergency which only gets a BLS response in New Jersey (BLS transport with ALS flycar). Often, we would get there and realize that the patient needed to be transported to the hospital. Our procedure was as follows:
1) Crank up the O2 settings from 4LPM to 10LPM through the vent. (usually there is a hospital style oxygen controller on many commercial vents, and it is obvious in many home vents).
2) Call for an Advanced Life Support unit.
3) Prepare a BVM with 10LPM of oxygen (Remember, with COPDrs you don't want to blast them with oxygen)
4) Manually disconnect the vent from the patients trach tube and bag WITH THE PATIENT. This is the most difficult part as many ventilator patients you will find at home have a fairly significant respiratory drive of their own and are merely "assisted" by the vent. The vent is set either at a predictable and consistent rate (that you as a human will never be able to provide!) or on a negative-pressure sensor which senses when the patient starts to breath in and thus assists the breath by firing off. A neat trick that I use is to have the patient tap me, or whomever is bagging, on the leg or arm whenever he wants a breath. Presto!
If the reason that you have to transport the patient is NON respiratory related, I would argue that transporting a patient that uses a vent with no acute respiratory distress is a BLS call. At a BLS level, ventilations are no biggie, and as long as you keep providing ventilations for the patient, ALS should not be needed. Just make sure to call the ER and let them know to have a vent ready! Otherwise you'll have some pissed off nurses at two in the morning (when this stuff ALWAYS seems to happen). All the best,
Jersey
KEVD18
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As informative as that graphic was, I'm not sure as to what point you are making.
10LPM is more than adequate for a COPD patient in respiratory distress, and using an additional 5LPM over a long transport time of up to an hour is something that can have a significant impact on the patients respiratory drive.
If you have an issue with a post, for all means say it! None of us are experts, and I love hearing different opinions as they consistently add to my knowledge. Posting a stick figure banging his head against the wall however does not add to my, the original poster, or any other readers knowledge.
10LPM is more than adequate for a COPD patient in respiratory distress, and using an additional 5LPM over a long transport time of up to an hour is something that can have a significant impact on the patients respiratory drive.
If you have an issue with a post, for all means say it! None of us are experts, and I love hearing different opinions as they consistently add to my knowledge. Posting a stick figure banging his head against the wall however does not add to my, the original poster, or any other readers knowledge.
reaper
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Hehe, I caught that too!
daedalus
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Uh, what would ALS do for this patient that you cannot? And why could you not disconnect the vent? Assess the patients LOC, lung sounds, pulse oximetry, vital signs, and affect. Pull the vent off and soft cath suction the trach. Hook your BVM up with 100% O2 and reassess the patient, and transport with parents and Hx.
When you get back to station after the call, learn about the condition that put the pt on the vent, learn about home care vents, and read up on assessment and common respiratory conditions. Than next time you get a call, teach everybody what you already know and you will look like a real professional.
When you get back to station after the call, learn about the condition that put the pt on the vent, learn about home care vents, and read up on assessment and common respiratory conditions. Than next time you get a call, teach everybody what you already know and you will look like a real professional.
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KEVD18
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at least once a month, someone comes here and posts something regarding overloading copd patients with o2 and how its a guaranteed way to kill them.
then, people who actually read the data on the matter answer back with the facts regarding conversion of respiratory drive, how long it takes, how much oxygen, the real dangers etc etc.
then uninformed people try to justify their position with several versions of "well thats what i was taught".
then the informed people try to answer that with stats and so on and so on. it rapidly deteriorates into a big mess.
id rather repeatedly bang my head against the wal until im rendered unconscious than do that again. if you stick around here for any period of time, you'll see that gif pops up from time to time. thats what it means. id rather repeatedly bang my head against the wall until im rendered unconscious than do this again.
although i must say that your the first person to bring up this topic that will admit that ten lpm is ok. usually we get the standard party line of "never under any circumstances administer anything more than 4lpm".
then, people who actually read the data on the matter answer back with the facts regarding conversion of respiratory drive, how long it takes, how much oxygen, the real dangers etc etc.
then uninformed people try to justify their position with several versions of "well thats what i was taught".
then the informed people try to answer that with stats and so on and so on. it rapidly deteriorates into a big mess.
id rather repeatedly bang my head against the wal until im rendered unconscious than do that again. if you stick around here for any period of time, you'll see that gif pops up from time to time. thats what it means. id rather repeatedly bang my head against the wall until im rendered unconscious than do this again.
although i must say that your the first person to bring up this topic that will admit that ten lpm is ok. usually we get the standard party line of "never under any circumstances administer anything more than 4lpm".
KEVD18
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basics in mass cant suction anything past the stoma of a strach. only medics can deep suction.
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Wow, reading this thread you'd think that we were a community of jerks. Even my response sounded mean.
It really all comes down to the ABCs, especially at the BLS level. I'd go with 15 LPMs because that's what I've been taught, but I'm sure 10 LPM would work just fine. For the record, I believe that this should be an ALS call, as all DIB should be. In our system it would be classified as an ALS call with a BLS unit also dispatched for support.
It really all comes down to the ABCs, especially at the BLS level. I'd go with 15 LPMs because that's what I've been taught, but I'm sure 10 LPM would work just fine. For the record, I believe that this should be an ALS call, as all DIB should be. In our system it would be classified as an ALS call with a BLS unit also dispatched for support.
daedalus
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I had a new EMT on my rig last month who stopped me with his hands as I went to put a mask on a patient. The patient called 911 for difficulty breathing, and was a CHFer and COPDer. He told me I would kill the patient with the oxygen.
daedalus
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I dont think I can but I do it allllll the time. Many patients would be not breathing by the time I got to the ER if I did not.
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I can remember how horrified I was the first time I had to do it. Then the patient took the suction from my hand and did it himself. It sounded like I was killing the guy.
KEVD18
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i can neither confirm nor deny that i may or may not do the same.
i will say that i dont make a public record of my operations outside of scope. whenever i write something it will always be per protocols.
what happens in the back of my truck or your truck or anybody elses truck may differ slightly or greatly from the prescribed treatment algorithms.
10LPM may indeed be enough for a pt. who is not compromised except for a malfunctioning vent, depending on what sort of a mix they were on when the vent was working.
The reference to switching to hypoxic drive and inhibiting breathing, as you may have gathered, garners signifigant skepticism at this site (and among educated providers everywhere). The notion that COPD'rs can't tolerate high flow 02 is just not supported by evidence, and basically is wrong (according to me).
That said, even if you do end up inhibiting their respiratory drive (unlikely) - if you are ventilating with a BVM: Who cares? You are their respiratory drive now. You're breathing for them.
If the COPD pt. is not breathing adequately or in resp. distress - give them high flow O2. If they are being adequately oxygenated by a vent using a room air mix, it's probably OK to withold the highest flow 02.
for more:
http://emtlife.com/showthread.php?t=4225&highlight=hypoxic+drive
Really, if I'm ventilating by BVM I'm going to crank the O2 all the way up just to make sure, COPD or not. Even a transport time of an hour isn't going to have any major impact, and it's much worse to find out you were ventilating insufficiently.
The reference to switching to hypoxic drive and inhibiting breathing, as you may have gathered, garners signifigant skepticism at this site (and among educated providers everywhere). The notion that COPD'rs can't tolerate high flow 02 is just not supported by evidence, and basically is wrong (according to me).
That said, even if you do end up inhibiting their respiratory drive (unlikely) - if you are ventilating with a BVM: Who cares? You are their respiratory drive now. You're breathing for them.
If the COPD pt. is not breathing adequately or in resp. distress - give them high flow O2. If they are being adequately oxygenated by a vent using a room air mix, it's probably OK to withold the highest flow 02.
for more:
http://emtlife.com/showthread.php?t=4225&highlight=hypoxic+drive
Really, if I'm ventilating by BVM I'm going to crank the O2 all the way up just to make sure, COPD or not. Even a transport time of an hour isn't going to have any major impact, and it's much worse to find out you were ventilating insufficiently.
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