using a bvm on a conscious pt.?

[JPINFV]

And this is where I gloat that my EMT-B class only cost $120 including books.

[VentMedic]

Here's an EMT class in the Miami area for almost $3000.

http://www.barry.edu/emt/whyBarry.htm

Barry University is a an excellent but expensive school and I still have not figured out why the started teaching an EMT class even for adult continuing education. Miami is full of expensive EMT and Medic Mills that may be slightly more or slightly less than this program. The only possible reason has to be to attract young people to the other programs.

[firedoc5]

Yes, on occasion I've had to use one. Like what has already been posted, if it can be tolerated and it is helping. An RT friend of mine showed me how to do it correctly though. Especially if you're assisting ventilation you have to watch them as they inspire on their own and not to interfere with what respirations they are making on their own.

One specific time was on a transfer where the patient was on a vent and it stopped working about an hour outside St.Louis. The patient was alert enough for us to ask him if he was getting enough air and he would respond. The RT with us and I took turns bagging him. By the time we got to the hosp. we had little blisters on the tips of our fingers from the friction on the bag. It's not something you want to do for an extended time.

[Leener77]

Coming from NJ where we were a BLS service with ALS intercept, I know that you don't have much to work with especially if ALS isn't available. If you have a somewhat new EMT or one that hasn't had some of the more advanced classes (or maybe just one that is completely clueless and lacking any form or common sense), like AMLS for example, they may not understand the etiology behind certain illnesses or diseases and therefore not know how to treat them. Basic class usually only gives you a certain number parameter to work with and unless you have an instructor that is able and willing to go beyond what is in the book and explain things in further detail.......a basic isn't of much use to a PT like the one explained in the scenario.

ALS was needed in the call, unfortunately they weren't available. It's a good thing this PT didn't go completely in the crapper during transport. Hopefully the crew was competent enough to know what to do had had that happened !!

I'm a basic myself and I wholeheartedly agree that the EMT-B class barely begins to scratch the surface of prehospital care. It's a good start as far as the basics go and is a necessary stepping stone to furthering education in the field. I've been a basic for several years now and simply have stayed this way mainly because I was staying home with the kiddos while the hubby worked on his career. Now that his is settled, I can move on to bigger and better things with mine I plan on going to medic school soon and am really looking forward to it! :thumbleft:

[firedoc5]

Coming from NJ where we were a BLS service with ALS intercept, I know that you don't have much to work with especially if ALS isn't available. If you have a somewhat new EMT or one that hasn't had some of the more advanced classes (or maybe just one that is completely clueless and lacking any form or common sense), like AMLS for example, they may not understand the etiology behind certain illnesses or diseases and therefore not know how to treat them. Basic class usually only gives you a certain number parameter to work with and unless you have an instructor that is able and willing to go beyond what is in the book and explain things in further detail.......a basic isn't of much use to a PT like the one explained in the scenario.

ALS was needed in the call, unfortunately they weren't available. It's a good thing this PT didn't go completely in the crapper during transport. Hopefully the crew was competent enough to know what to do had had that happened !!

I'm a basic myself and I wholeheartedly agree that the EMT-B class barely begins to scratch the surface of prehospital care. It's a good start as far as the basics go and is a necessary stepping stone to furthering education in the field. I've been a basic for several years now and simply have stayed this way mainly because I was staying home with the kiddos while the hubby worked on his career. Now that his is settled, I can move on to bigger and better things with mine I plan on going to medic school soon and am really looking forward to it! :thumbleft:

KEWL. Good for you.

[bigj1130]

Yes you can bag a conscious patient. However, I believe it is truly an art to effectively bag a conscious patient. In my opinion you have to have the complete trust of your patient, you have to be well versed in why you actually are bagging this patient( physiology etc.) Then I think finally you need to ask yourself if it will make the patient better. If you know that your patient is having a respiratory event and their breathing is ineffective, what can you do to make him/her better. Regardless of your skill level you have tools that can make your patient better, or at least not let him get worse. If NRBM made him better, then fine. In your case it didn't sound like NRBM made him better. You then have to move on to your next tool, the BVM. The positive pressure from a BVM can help the situation you described in your patient presentation just like the change in position from supine to semi-fowlers. This is just my opinion and personally I am a big proponent for Assisting ventilations in an ineffectively breathing patient so it may seemed a little biased

[Chief1C]

The hard ones to keep up with are the ones who are responsive enough to fight you, but are breathing so fast and so shallow that it's not productive. If you can talk to them, while you bag, esp the ones who are just hyperventilating, I think that helps to breathe with them. As long as they are getting oxygen, maintaining a sat that is acceptable, and you are holding a resuscitator; bag till they fight it; or you reach a goal.

[VentMedic]

The hard ones to keep up with are the ones who are responsive enough to fight you, but are breathing so fast and so shallow that it's not productive. If you can talk to them, while you bag, esp the ones who are just hyperventilating, I think that helps to breathe with them. As long as they are getting oxygen, maintaining a sat that is acceptable, and you are holding a resuscitator; bag till they fight it; or you reach a goal.

If the patient is truly "hyperventilating" I would probably not bag them. They are blowing down their PaCO2. Of course, one may not know that unless they can do an ABG. Rapid respiratory rates may also skew ETCO2 by sidesteam capnography.

If the patient is tachypneic, understanding the reason for the rapid respiratory rate will determine the best method to assist either by supplemental O2, BVM or pharmacology. If the cause is fever, pain or severe V/Q mismatching, you may make little head way with a BVM and actually increase work of breathing.

With the standard BVM, the patient is only getting the oxygen if the timing is good between the opening of the valve and the pt's inspiratory effort or clear airway if unconscious. If you are assisting a patient that is breathing rapid and shallow, they may be ineffective in opening the valve between the breaths you are giving them. If their mentation is off, they may think you are actually trying to suffocate them when they have their face pressed into a piece of plastic with little or no air moving when they want it.

[Asysin2leads]

Here's an EMT class in the Miami area for almost $3000.

http://www.barry.edu/emt/whyBarry.htm

Barry University is a an excellent but expensive school and I still have not figured out why the started teaching an EMT class even for adult continuing education. Miami is full of expensive EMT and Medic Mills that may be slightly more or slightly less than this program. The only possible reason has to be to attract young people to the other programs.

Sorry, Barry, $2,500 is too much for a basic class. I wouldn't take my EMT class at Harvard for $2,500 dollars.

[VentMedic]

Sorry, Barry, $2,500 is too much for a basic class. I wouldn't take my EMT class at Harvard for $2,500 dollars.

For some, that will be the closest they will get to a Barry U education.

Excellent BSN program at Barry. Good Masters in Cardiovascular Perfusion but it took a while for it to get accredited.