Without using the internet find the following info.....

[BLSBoy]

The total capacity of air in your BVM.
The tidal volume needed to adequately ventilate an adult weighing 80kg
The tidal volume needed to adequately ventilate a child weighing 30kg
The tidal volume needed to adequately ventilate an infant weighing 5kg


Then tell me how hard you would need to squeeze each BVM.
Next, tell me how hard you are currently squeezing each BVM.

Are you currently over, under or ventilating each pt?

What can under ventilating do?
What can over ventilating do?

Why is that important in the long run?

Yea, I had a kick *** Advanced Airway Class yesterday.
But a lot of it was going over things we SHOULD have learned as EMTs.
EMS education system FAIL. <_<

 

[BLSBoy]

52 views and no bites?
C'mon. Every CFR, EMT, and Medic should be doing this!
Use the net.
THIS WILL SURPRISE YOU!

 

[Shishkabob]

Avg adult is 7ml/kg.
I am trying to remember back to PALS, but I believe pedis are 3-5ml/kg?
EDIT Numero 2: I fail at reading comprehension.

 

[VentMedic]

Oh oh, I can answer these two without any problem!


What can under ventilating do?
What can over ventilating do?

1: Hypoxia / hypoxemia followed by death!
2: Pneumothorax followed by death!

Read the question carefully?

What happens when you over ventilate which brought about some changes in the CPR guidelines?

hint: There are at least two major issues.

 

[Shishkabob]

Gah, stupid reading. Who does that any more? I just look at the first word and the question mark and go fro there!

Under ventilating can lead to respiratory acidosis.

Over ventilating can lead to the opposite: alkalosis.




Or were you looking for a different answer?

 

[Lifeguards For Life]

The total capacity of air in your BVM.
The tidal volume needed to adequately ventilate an adult weighing 80kg
The tidal volume needed to adequately ventilate a child weighing 30kg
The tidal volume needed to adequately ventilate an infant weighing 5kg


Then tell me how hard you would need to squeeze each BVM.
Next, tell me how hard you are currently squeezing each BVM.

Are you currently over, under or ventilating each pt?

What can under ventilating do?
What can over ventilating do?

Why is that important in the long run?

Yea, I had a kick *** Advanced Airway Class yesterday.
But a lot of it was going over things we SHOULD have learned as EMTs.
EMS education system FAIL. <_<

Adult BVM- 1700cc
ped BVM-470 cc
reservoir- 2700 cc

The ARDS network recomends patients be ventilated with 6cc of air for every kg; 5cc per kg in peds
80kg patient- 480cc
30kg patient- 180cc
5 kg infant 25 cc

 

[BLSBoy]

Follow up questions...
knowing how many ccs are in each BVM, and knowing how much it takes to correctly ventilate each pt catagory, are you over, under, or ventilating each type of pt correctly?

SHARE this info. -_-

 

[Lifeguards For Life]

Follow up questions...
knowing how many ccs are in each BVM, and knowing how much it takes to correctly ventilate each pt catagory, are you over, under, or ventilating each type of pt correctly?

SHARE this info. -_-

close. with a typical adult i usually squeeze the bag about 1/3 the way. I have not yet managed the airway of a child though i have done compressions in ped codes

 

[Shishkabob]

Did your class say that ventilating till you see "adequate" chest rise is no longer acceptable?


/me hides from Vent

 

[VentMedic]

Or were you looking for a different answer?

Over ventilating: decreased venous return and coronary perfusion pressures

 

[Shishkabob]

Gah, I was still focusing on oxygenation and not ventilation volume. Darnit.


I obviously fail at comprehending what's being asked of me tonight.

 

[BLSBoy]

You still get partial credit.

 

[VentMedic]

The ARDS network recomends patients be ventilated with 6cc of air for every kg; 5cc per kg in peds
80kg patient- 480cc
30kg patient- 180cc
5 kg infant 25 cc

These are not recommendations for a patient that does not have a definitive diagnosis of ARDS.

I wouldn't institute an ARDS protocol in the field. We only institute it with a definitive diagnosis. Then, to make up for the low VTs we run serious PEEP levels with mega pressors and some buffer like Tham available. A central line is also a necessity. The patient may also have to be heavily sedated and given a paralytic to prevent any over breathing. We also will go up to a Rate of 35 if necessary.

Even when running the ARDS protocol in a progressive ICU, it is not often we take a patient down to 6 cc/kg.

http://www.ardsnet.org/

Acute Respiratory Distress Syndrome (ARDS) is a severe, often fatal, inflammatory disease of the lung characterized by the sudden onset of pulmonary edema and respiratory failure, usually in the setting of other acute medical conditions resulting from local (e.g. pneumonia) or distant (e.g. multiple trauma) injury.

Acute Lung Injury (ALI) is a term used to describe patients with a milder form of ARDS.

We will do preventive measures by not over ventilating with high pressures or excessive volumes except for organ procurement we may still do 15 cc/kg. Some post op patients may also get the bigger volumes providing they have a normal CXR and their Peak Inspiratory Pressures and Plateau Pressures are not high.

 

[Lifeguards For Life]

"Oxygenation and ventilation: Once the position and seal are obtained, "bagging" can commence. The rate of ventilation for an adult is 10-12 breaths per minute or, approximately 1 bag squeeze every 5-6 seconds.4 The bag should be depressed for a full 1-2 seconds and then released. Chest rise should be seen with adequate tidal volumes, approximately 6-7 cc/kg or 400-600 mL.4,7 Appropriate oxygenation and ventilation should be reflected by pulse oximetry readings. Providers have a tendency to hyperventilate patients.9 The emergency medicine literature has demonstrated that hyperventilation can be harmful by increasing intra-thoracic pressure, which decreases venous blood to the heart and subsequently decreases cerebral and coronary perfusion pressures.10 Be mindful of the potential harmful effects of hyperventilation when bagging your patient."
-American college Emergency Physicians
http://www.acep.org/publications.aspx?LinkIdentifier=id&id=40992&fid=3430&Mo=No&taxid=112591

 

[VentMedic]

"Oxygenation and ventilation: Once the position and seal are obtained, "bagging" can commence. The rate of ventilation for an adult is 10-12 breaths per minute or, approximately 1 bag squeeze every 5-6 seconds.4 The bag should be depressed for a full 1-2 seconds and then released. Chest rise should be seen with adequate tidal volumes, approximately 6-7 cc/kg or 400-600 mL.4,7 Appropriate oxygenation and ventilation should be reflected by pulse oximetry readings. Providers have a tendency to hyperventilate patients.9 The emergency medicine literature has demonstrated that hyperventilation can be harmful by increasing intra-thoracic pressure, which decreases venous blood to the heart and subsequently decreases cerebral and coronary perfusion pressures.10 Be mindful of the potential harmful effects of hyperventilation when bagging your patient."
-American college Emergency Physicians
http://www.acep.org/publications.aspx?LinkIdentifier=id&id=40992&fid=3430&Mo=No&taxid=112591

None of the references were from ARDSnet which is a whole protocol that some flight and CCT teams must follow if it has been initiated in the hospital. It should not be confused with the basic priniciples of preventing over ventilation at the BLS level or resuscitation phase. The ARDS protocol would not be used in resuscitation.

At 6 - 7 cc/kg you should see some chest rise but unless you have the proper equipment, you will never know exactly how much you are giving. The terms "big breaths" have been removed from CPR.

 

[Lifeguards For Life]

None of the references were from ARDSnet which is a whole protocol that some flight and CCT teams must follow if it has been initiated in the hospital. It should not be confused with the basic priniciples of preventing over ventilation at the BLS level or resuscitation phase. The ARDS protocol would not be used in resuscitation.

At 6 - 7 cc/kg you should see some chest rise but unless you have the proper equipment, you will never know exactly how much you are giving. The terms "big breaths" have been removed from CPR.

http://journals.lww.com/anesthesiol...lume_Lower_than_6_ml_kg_Enhances_Lung.26.aspx

"LIMITATION of tidal volume (VT) to 6 ml/kg predicted body weight (PBW) and of end-inspiratory plateau pressure (PPLAT) to a maximum of 30 cm H2O represents the standard for mechanical ventilation of patients with acute respiratory distress syndrome (ARDS)"

I can not re locate which website i read off of that quoted 6-7 as being from th ARDS network.

 

[Lifeguards For Life]

PEEP level not an issue for patients with ARDS
Nursing, Nov 2004

* 1
* 2
* Next

Clinical outcomes are about the same for patients with acute lung injury and acute respiratory distress syndrome who receive high or low levels of positive end-expiratory pressure (PEEP), according to a recent study.

Researchers randomly assigned 549 patients to receive mechanical ventilation with high (average 13 cm H2O) or low (average 8 cm H2O) levels of PEEP The tidal volume goal was 6 ml/kg of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm H2O. Higher levels of PEEP may improve oxygenation, but also may cause lung injury. Among patients in the low-PEEP group, 24.9% died, compared with 27.5% of those in the high-PEEP group.
Most RecentHealth Care Articles

* State Legislators Try to Preempt Federal Healthcare Reform
* Healthcare Roundup: Aetna Slammed by Senate Committee, $600M for Community...
* Senate Deal on Public Option Would Expand Medicare
* Debate Over Value-Based Purchasing by Medicare Continues
* Industry Has Influence In Reform Bill's Research Institute
* More »

Source: "Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome," The New England Journal of Medicine, R. Brower, et al., The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, July 22, 2004.
Copyright Springhouse Corporation Nov 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

 

[VentMedic]

The ARDS protocol basics are on the link I posted earlier but here is the specifics concerning the mechanical ventilation.

http://www.ardsnet.org/system/files/6mlcardsmall_2008update_final_JULY2008.pdf

There are also numerous links to studies on the website.

http://www.ardsnet.org


In the field you will not know if the patient is in ARDS. You will not know if the Plateau Pressure if above 30.

This is a very complex protocol that will not be initiated by BLS or even ALS on any field scene. The guidelines for basic resuscitation should be followed. The word ARDS is often misunderstood and overused before a diagnosis can be made.

 

[Lifeguards For Life]

The ARDS protocol basics are on the link I posted earlier but here is the specifics concerning the mechanical ventilation.

http://www.ardsnet.org/system/files/6mlcardsmall_2008update_final_JULY2008.pdf

There are also numerous links to studies on the website.

http://www.ardsnet.org


In the field you will not know if the patient is in ARDS. You will not know if the Plateau Pressure if above 30.

This is a very complex protocol that will not be initiated by BLS or even ALS on any field scene. The guidelines for basic resuscitation should be followed. The word ARDS is often misunderstood and overused before a diagnosis can be made.

you win vent, i made a mistake. but if i am bagging a patient in the field is 6-7cc/kg an acceptable tidal volume?(not that it could be accurately measured in the field)

 

[VentMedic]

you win vent, i made a mistake. but if i am bagging a patient in the field is 6-7cc/kg an acceptable tidal volume?(not that it could be accurately measured in the field)

As long as you can see some chest rise and hear breath sounds with the stethoscope.

Many people overuse the term ARDS even in the hospitals.

However, I thought you might to read a little more as to how the ARDS protocol is used by Flight teams.

http://www.ems1.com/ems-products/ambulances/articles/387343-Breathing-Life-into-ARDS/

It is an interesting topic and now with the H1N1, flu associated ARDS, it is a very, very deadly condition.