Lying for what? (venting a little...)

[VentMedic]

Out of curiosity, in the prehospital setting, what would then constitute "high flow O2?" In southern AZ, we can transport vented pts, but not initiate vents (too bad, cause it'd free up hands during a code).

Venturi masks are high flow.

People often confuse high flow and high FiO2. However, if flow is inadequate, high FiO2 may not be possible either as with NRBMs in some situations.

A transport ventilator may also not provide adequate flow depending on its entrainment system and demand valve. An ATV is almost useless on a hypoxic patient with a high MV requirement. You would need lots of sedation and paralytics to just keep them on that ventilator and then the chance of adequately oxygenating and/or ventilating them is slim at best. Some prehospital vents are just for ventilating post code nearly dead patients without a lot of lung disease processes complicating things.

People who are now trying CPAP in the field should also be aware of their device's flow limitations and understand the principles that make the device function with the flow available.

[brentoli]

Richard, I am honestly, not sure what our protocols are for O2 flow. I know we just go by what ever keeps the reservoir inflated.

[Arizonaffcep]

Why would the venturi masks be high flow? While we can transport these without issue, we don't use them prehospital.

[VentMedic]

Why would the venturi masks be high flow? While we can transport these without issue, we don't use them prehospital.

High flow systems deliver about 40l/min of gas through the mask, which is usually sufficient to meet the total respiratory demand. This ensures that the breathing pattern will not affect the Fio2. The masks contain venturi valves, which use the principle of jet mixing (Bernoulli effect). When oxygen passes through a narrow orifice it produces a high velocity stream that draws a constant proportion of room air through the base of the venturi valve. Air entrainment depends on the velocity of the jet (the size of orifice and oxygen flow rate) and the size of the valve ports. It can be accurately controlled to give inspired oxygen levels of 24-60%.

If you have been through the FF academy, Venturi and Bernoulli should be easy for you to understand.

[Arizonaffcep]

In reference to the venturi/Bernoulli effect, I've known how they work for much longer than I've been in fire/ems. Learned all about them dealing with protien skimmers and what not for salt water fish tanks...

That's interesting about the 40lpm...we aren't allowed to touch them once their set by RT or an RN at the hospital/SNF, whatever. As such, it's not gotten into much detail in classes here.

[VentMedic]

Here's a good link with an overview of O2 devices and the air entrainment formula.

http://www.virtual.yosemite.cc.ca.us/lylet...es%20Oxygen.doc

My favorite use of the venturi is with my wine aerating device for quicker decanting. :wink:

[JPINFV]

Admittedly, this is for ambulance folks, not SNF personnel, but...A quick survey here:

Per your local protocols, with a non rebreather mask, do you administer something like 10 to 15 liters per minute?

As for the nasal cannula, when used, 2 to 6 liters per minute?

Final question for the survey. Nasal cannula used when the patient cannot tolerate an NRB mask, or otherwise refuses a mask?

I guess I have to adjust the color on my analog broadcast TV, as "Smurf" blue, and "Blue Man Group" blue appear the same to me.

Option D. Orange County, CA does not have a written EMT-B protocol.

As per EMT-B class, and common sense, I use NRB at a high enough rate to keep the bag filled (hence common sense, but yes, at least 10 LPM), and 2-6 LPM for nasal cannula. I decide between a NC and NRB based off of my patient's presentation and have zero problem upping the oxygen dose as needed. To be honest, I don't believe in the "one size fits all, everyone gets a non-rebreather because oxygen is harmless" nonsense. No, not every patient needs oxygen. No, not everyone that needs supplemental oxygen needs a non-rebreather. No, oxygen is not harmless, even if it's pretty darn close (and no, I'm not referencing hypoxic driver either).