Needle decompression in crashing status asthmaticus

[VentMedic]

WOW. Talk about high flow ! :shock:

No it isn't compared to the 280 l/m the ICU vents can do. The Respironics Vision BiPAP maxs at 240 L/m. That is why we giggle when EMS wants us to switch to their 15 L models.

[VentMedic]

You have never worked in the asthma booth in the peds ER of Jacobi hospital in the Bronx. It is quite an experience. It is basically a regular room that they knocked the front wall out of. There are hard plastic chairs along each side with an oxygen port for each chair. As the name implies, this is where all the asthmatics go. The residents are assigned to the asthma booth for one hour during each shift, any more and you would have some strung out residents. You would see 10-12 pt/hr at minimum. After your hour you would come out with the shakes from all of the albuterol you inhaled. But hey, at least you weren't wheezing.

Actually that is exactly why I and all the RRTs in the departments I work with take precautions. Long term exposure has now been documented. The same from the days when we were running large amounts of Pentamidine and Ribavirin. We also do all the inductions AFB specimens. Flolan and nitric are also something that requires precautions.

In the Peds side of the ED we can set up 10 continuous nebs in the holding and run 8 more in the front section as singles. Yeah we're pretty large also with a huge children's hospital. We also have the HIV and TB section for the kids.

Risk management and workmen's comp insurances have already issued the bulletins. We may not be covered for certain exposures since we have strict P&Ps that have been enforced since the mid 80s when several of our RRTs unfortunately became headlines due to exposure to TB. We can run over 35 different gases and medications on our patients. We treat each one with the same respect whether it is Flolan or Albuterol.

Your own health is not something to take chances with and when you have RN, RRT, MD or whatever behind your name, you should know better.

Sorry for the lecture but our residents hear something similar to this on their first day in our hospital. We want to set good examples for a long career.

[Mateo_1387]

No it isn't compared to the 280 l/m the ICU vents can do. The Respironics Vision BiPAP maxs at 240 L/m. That is why we giggle when EMS wants us to switch to their 15 L models.

15 L/m is a joke compared to 240 L/m. Exposure to 60 L/m of contaminated gas being expelled is not a joke.

Just for the sake of conversation and learning, would 60 L/m still be considered high flow because the flow rate of 60 L/m will be higher than the minute volume of a patient?

Also, would 15 L/m be considered high flow for a patient with a minute volume less than 15 L/m, since normal minute volume is approximately 5-8 L/m?

At a minute volume greater than 15 L/m, a delivery system that is set at 15 L/m would now be a low flow system, right?

Thanks.

Matt

[VentMedic]

15 L/m is a joke compared to 240 L/m. Exposure to 60 L/m of contaminated gas being expelled is not a joke.

Just for the sake of conversation and learning, would 60 L/m still be considered high flow because the flow rate of 60 L/m will be higher than the minute volume of a patient?

Also, would 15 L/m be considered high flow for a patient with a minute volume less than 15 L/m, since normal minute volume is approximately 5-8 L/m?

At a minute volume greater than 15 L/m, a delivery system that is set at 15 L/m would now be a low flow system, right?

Thanks.

Matt

This might get a little confusing since both are L/M.

Minute volume is a "volume measurement" as to how much is moved in 1 minute.

And, when we talk about L/M for flow, we are talking speed.

And when we get into ventilators or your more effective CPAP machines, we are running off of the 50 psi outlet and not the stepped down liter flow.

If your mask or ventilator cannot meet the needs of your inspiratory volume and speed, it is not a "high flow" device by technical definition.

A NRBM is in true definition not a high flow device since it actually restricts what a patient can intake for demand. A venturi device or hi-flo aerosol are high flow because of air entrainment.

So yes your 15 L/M example is correct.

Some transport ventilators just don't have the flow and the demand valve responsiveness, thus increase work of breathing because the patient must work to meet their own demand. A high tech finely tuned precision ICU ventilator knows what the patient wants before the patient does.

When choosing a transport ventilator, one must look at it like cars. Power, speed, responsiveness, gas economy, handling, price, options and of course sleek design are all factors that must beconsidered. Earlier in this thread I posted a link that compared these factors for 15 transport ventilators.

Most vents will offer the same modes but it is how each ventilator can keep up in delivering those modes to meet the patient's needs that is the deciding factor.

Per curse's comment on teeing in a neb on a transport vent, yes it is possible but one must be mindful of your total flow as it will increase VT. We prefer using MDIs in many patients as the dosage can be acheived quickly.

Many of the transport ventilators are also homecare or LTC ventilators. These patients may require nebs as part of their maintenance.

The Pulmonetics LTV is a good example and is a very popular CCT and Flight vent. It was also the vent of choice for Christopher Reeve.