Vents used in 911 ?

[kohlerrf]

My service is totaly ground based and for several reasons we are bringing into service a disposable 1 patient use oxygen powered pressure ventilator. We average 20 cardiac arrests a month and add to that, a number of RSI's. There are some very good advantages for the patient as well as the paramedic in their use not the least of which is that once the vent is set NOBODY TOUCHES THE TUBE EVER untill the doc in the hospital after you transfer the patient. The Vent we use is called the "VAR" or Vortran Automatic Resuscitator. Although I know this brand is used in Air Medical Services often, does anyone have any experiance using it in a ground based system for 911 patients?

[chbare]

I can feel Vent's presence. Unfortunately, you can really screw somebody up with a ventilator. I am not familiar with this specific ventilator; however, I suspect it may actually be safer to bag these patients in many cases rather than attach a rudimentary device without the benefit of pressures or graphics.

Take care,

chbare.

[VentMedic]

the least of which is that once the vent is set NOBODY TOUCHES THE TUBE EVER untill the doc in the hospital after you transfer the patient. The Vent we use is called the "VAR" or Vortran Automatic Resuscitator.

That is cause for some concern. A ventilator still needs to be assessed as this is just a piece of plastic with O2 powering it and no monitoring capabilities except for manometer which could care less where it is getting its pressure measurement from.

Although I know this brand is used in Air Medical Services often, does anyone have any experiance using it in a ground based system for 911 patients?

Not if they do IFT or critical care patients.

This ventilator, and I use that term "loosely", is good for ventilating the living dead post code. It frees up your hands but that doesn't mean you do not monitor the airway. It is an automated BVM and should not be used on IFTs for patients requiring more precise monitoring and settings with some options.

For those of you who don't know what a VAR is:

http://www.floteco2.com/htm/Products/B-VOR_Automatic_Resuscitator.htm

Unfortunately for 911 EMS, an ATV may be all the education, training and budget will probably allow for.

However, one needs to know a little something about the pulmonary system to make these little ATVs work as well as they can for the patient. The generic settings I've seen in some of the protocols are...well.......okay I'm at a lost for words.

I am not familiar with this specific ventilator; however, I suspect it may actually be safer to bag these patients in many cases rather than attach a rudimentary device without the benefit of pressures or graphics.

Take care,

chbare.

If one understands the settings they have chosen for THAT patient and physically monitors the patient closely, the ATV has benefits over the bag for not causing flutuations in pH by varying the CO2 with irregular bagging or drastic changes in hemodynamic status with over zealous bagging. It is now recommended by the AHA for those reasons since counting while bagging with consistency for rate/volume is a difficult skill in an emergency for some. And, it does free up the hands but the ventilator should not be forgotten when it comes to continous assessment.

kohlerrf

I saw you post on the H1N1/Ventolin thread. Don't forget to put a good filter on this VAR to keep from getting aerosolized particles coming at you from the patient's lungs.

Edited October 9, 2009 by VentMedic

[kohlerrf]

That is cause for some concern. A ventilator still needs to be assessed as this is just a piece of plastic with O2 powering it and no monitoring capabilities except for manometer which could care less where it is getting its pressure measurement from.

Not if they do IFT or critical care patients.

This ventilator, and I use that term "loosely", is good for ventilating the living dead post code. It frees up your hands but that doesn't mean you do not monitor the airway. It is an automated BVM and should not be used on IFTs for patients requiring more precise monitoring and settings with some options.

For those of you who don't know what a VAR is:

http://www.floteco2.com/htm/Products/B-VOR_Automatic_Resuscitator.htm

Unfortunately for 911 EMS, an ATV may be all the education, training and budget will probably allow for.

However, one needs to know a little something about the pulmonary system to make these little ATVs work as well as they can for the patient. The generic settings I've seen in some of the protocols are...well.......okay I'm at a lost for words.

I agree. This is not a fire and forget nor did I mean so sophomoric as to imply such a thing. As a matter of fact our documentation has to include trending of Sa02 and EtCo2 readings along with "graphical" waveform capnograph during the time the pt is on the vent as well as the corrections we make to coordinate the two. Vents are dangerous so are defibrillator's. I think the assumption should be that the practitioner is properly trained to use the equipment before they are allowed too. In addition, I agree this brand is not designed for long term transport of the critically ill with multiple co-morbidity's. It would be ludicrous to assume that this $75 piece of plastic replaces an actual Vent. We are using perhaps for 30 Min's during extrication from the home and transport to the hospital. it provides constant ventilation while maneuvering the patient around a tight corner and up a flight of stairs to the amb. removing the 3rd man who may have to drop the BVM for a moment while you turn a carry has proved to be advantageous in reducing the movement of the tube prehospital. It also facilitates having less people involved in touching moving and caring for the pt. As you said this can free up hands but it also focuses responsibility.

[FireMedic65]

We had a demo vent at work. It was meant for BLS use. After reading directions, 4 medics could not figure it out. It wasn't "complicated" is was just confusing. There were settings, where the directions said "set and go". Do not change certain settings. All it did was blow continuously. I even attached it to myself. I let it breath in for me, but I had to tear it off since I could not exhale.

Equipment like this scares me. People are going to get hurt or worse. Using a vent should not be taken so carefree as these companies want you to use them.

As far as "no one touches the tube". I DO NOT agree with this. If you mean, it's in place with bi-lateral lung sounds, no epigastric sounds, etc etc and you don't adjust it, fine. But if you are in a moving ambulance, bagging the patient, you will bounce around. I prefer the person bagging, to hold the tube manually, even with a device securing it.

[Arctickat]

All it did was blow continuously. I even attached it to myself. I let it breath in for me, but I had to tear it off since I could not exhale

I'm not being facetious, I'm just wondering, was it a ventilator with CPAP capabilities? In my service we use the Carevent ALS+/CPAP http://www.otwo.com/prod_atv.htm

Since it is all I've ever used I'd be interested in getting input from others who have an informed opinion.....Vent?

Edited October 9, 2009 by Arctickat

[RavEMTGun]

This looks mighty useful for rescue situations where bagging the patient is very difficult, much less regular bagging. Sometimes bagging is even a hindrance to extrication (think confined space, MVC entrapment, high angle, wilderness).

[VentMedic]

All it did was blow continuously. I even attached it to myself. I let it breath in for me, but I had to tear it off since I could not exhale.

You may have been introduced to CPAP.

Here are a few I've seen in use with a couple of agencies or have heard being used.

Carevent BLS

http://www.otwo.com/prod_hhar.htm

Carevent ALS (near the bottom of the page)

http://www.otwo.com/prod_atv.htm

Autovent 2000

http://www.buyemp.com/product/1020801.html

Autovent 3000

https://www.med-worldwide.com/prod/allied-autovent-3000-al-l461-113

[FireMedic65]

It was none of those. The package said something like rescue vent on it.

Now that you mention it though, there was also a demo CPAP as well. That was meant for the BLS. Sorry, my misake there.

The vent looked a lot like a breathing treatment set up, only it attached to an ETT. There was no control box. The settings were set right on the device itself, o2 powered. I was quite confused. I wish I could remember the name of it.

Edited October 9, 2009 by FireMedic65

[JakeEMTP]

We don't use a vent per se, However we use an oxylator. I have only had to use this device once but it worked like a dream. I actually started running a code by myself when I was on the QRV (Quick Response Vehicle) using the Auto Pulse, Oxylator and a EJ, while I waited for the ambulance crew. Logistics being what they are, I just happened to be around the corner when the call came in.

Anyway, I have not used it enough to really form an opinion. All I know is the one time I did the device did what it was supposed to do.

http://www.lifesavingsystemsinc.com/em100.htm