Vents used in 911 ?

[Arctickat]

You may have been introduced to CPAP.

Man, I wish I would have thought of that.

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

Carevent ALS (near the bottom of the page)

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

So can I consider that as an endorsement that the ALS is a good machine?

[VentMedic]

can I consider that as an endorsement that the ALS is a good machine?

The specs on it look better than some so it might be able to do decent CPAP and ventilate post code on an unresponsive patient.

The thing with ventilators, if the patient is trying to breathe spontaneously and the machine isn't sensitive enough or doesn't have the capability to meet flow demands, few 911 ALS or even some CCTs have the ability to provide adequate sedation.

In the hospital, we occasionally use the ParaPac portable ventilator for MRI.

http://www.smiths-medical.com/upload/products/PDF/Respiratory.pdf

(specs near the bottom - the specs for the Carevent are on the links above)

It is a little work horse and can achieve a decent flow but we often have to give a good dose of something to chill some patients. Luckily Diprivan (Propofol) is usually hanging. I have quizzed patients who have been transported many times which they prefer and it usually the LTV 1000 or 1200 with a real liking for the 1200.

The internal turbine in the LTV is hard to beat among the transport vents. I like the valving also for its responsiveness and ease of acceleration to meet the patient's demand. It is fairly rugged and handles the rough terrain of HEMS. The sleek design allows it to hug the curves to travel just about anywhere including cramped CT Scan rooms. Nice option package with can include a good monitor makes it versatile for CCT. It handles most critical care respiratory patients very well when taken for a long distance transport. Gas consumption gets decent mileage also. And, it was the ventilator choice of Superman. But, it is impractical for most 911 ALS unless they also do "real" CCT and have adequate training.

I'm spoiled. After growing up with Elder demand valves, it is time for some luxury.

BTW, my opinion of the Oxylator is that it is a Elder demand valve that they attempted to give some "thinking ability" to but the limited feedback data capabilities can fool it and the health care provider.

http://www.lifesavingsystemsinc.com/documentation/LSI-Oxylator-BPM%20Rate%20Changes%20&%20Indications%20EM-100,%20EMX.pdf

Edited October 9, 2009 by VentMedic

[kohlerrf]

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.

Im sorry you had a bad experience. From what you have said here it appears that you did not have a ventilator but instead you may have had a device delivering CPAP at too high a PEEP. With regard to "no moving the tube", currently our pt in respiratory arrest is often secured to a scoop with the "D" tank between their legs feeding the 3 ounce ventilator which is attached to side stream continuous capnography and the ballard then to the ET Tube. This simple assembly is then secured to the C Collar and tube placement is checked again, vent settings finalized and then the pt is moved. No one is bouncing around holding a BVM walking down stairs or in the back of the amb. the vent is fixed in place and moves with the pt only when the pt is moved.

[Arctickat]

The specs on it look better than some so it might be able to do decent CPAP and ventilate post code on an unresponsive patient.

The thing with ventilators, if the patient is trying to breathe spontaneously and the machine isn't sensitive enough or doesn't have the capability to meet flow demands, few 911 ALS or even some CCTs have the ability to provide adequate sedation.

I've had good luck with it in all aspects of care, it has a -5cm/H2O demand valve trigger for the spontaneously breathing patient, a nice variety of settings for the ventilator. and as a test I set the CPAP to the highest setting and it uses about 700 litres/hour. I'd have preferred one with separate respiratory rate and tidal volume controls, but there was a cost vs benefit issue in there. I'd have also preferred something a little lower than the 60cm/H2O pressure limit, but it's also not adjustable. 50 would have been my choice.

[FireMedic65]

Im sorry you had a bad experience. From what you have said here it appears that you did not have a ventilator but instead you may have had a device delivering CPAP at too high a PEEP. With regard to "no moving the tube", currently our pt in respiratory arrest is often secured to a scoop with the "D" tank between their legs feeding the 3 ounce ventilator which is attached to side stream continuous capnography and the ballard then to the ET Tube. This simple assembly is then secured to the C Collar and tube placement is checked again, vent settings finalized and then the pt is moved. No one is bouncing around holding a BVM walking down stairs or in the back of the amb. the vent is fixed in place and moves with the pt only when the pt is moved.

We tried all kinds of adjustments. Used the recommended specs in the directions. I just can't believe that none of us could figure it out. My guess is, it was broke.

That makes more sense when you explain it that way. A lot less movement with a vent.

[mobey]

few 911 ALS or even some CCTs have the ability to provide adequate sedation.

Vent: I am going to start a thread on prehospital sedation and would LOVE to hear your thoughts.

[flight-lp]

The specs on it look better than some so it might be able to do decent CPAP and ventilate post code on an unresponsive patient.

The thing with ventilators, if the patient is trying to breathe spontaneously and the machine isn't sensitive enough or doesn't have the capability to meet flow demands, few 911 ALS or even some CCTs have the ability to provide adequate sedation.

In the hospital, we occasionally use the ParaPac portable ventilator for MRI.

http://www.smiths-medical.com/upload/products/PDF/Respiratory.pdf

(specs near the bottom - the specs for the Carevent are on the links above)

It is a little work horse and can achieve a decent flow but we often have to give a good dose of something to chill some patients. Luckily Diprivan (Propofol) is usually hanging. I have quizzed patients who have been transported many times which they prefer and it usually the LTV 1000 or 1200 with a real liking for the 1200.

The internal turbine in the LTV is hard to beat among the transport vents. I like the valving also for its responsiveness and ease of acceleration to meet the patient's demand. It is fairly rugged and handles the rough terrain of HEMS. The sleek design allows it to hug the curves to travel just about anywhere including cramped CT Scan rooms. Nice option package with can include a good monitor makes it versatile for CCT. It handles most critical care respiratory patients very well when taken for a long distance transport. Gas consumption gets decent mileage also. And, it was the ventilator choice of Superman. But, it is impractical for most 911 ALS unless they also do "real" CCT and have adequate training.

I'm spoiled. After growing up with Elder demand valves, it is time for some luxury.

BTW, my opinion of the Oxylator is that it is a Elder demand valve that they attempted to give some "thinking ability" to but the limited feedback data capabilities can fool it and the health care provider.

http://www.lifesavingsystemsinc.com/documentation/LSI-Oxylator-BPM%20Rate%20Changes%20&%20Indications%20EM-100,%20EMX.pdf

Our recent feedback from pts. and family members also reflects these findings; they prefer the individuality of the LTV. Having used most models in both the ground and air environments, I find no equal to the LTV! We still use the Crossvent 2i and 4Plus in the air, and the Eagle 754 as a backup on the ground. They are nice and provide the multiple ventilatory modalities needed for most patient populations, but we still find ourselves needing more sedation and/or paralysis than with the LTV. Our regular ground MICU's carry the Carevent ATV and I actually find them completely inappropriate for the IFT environment. For resuscitation or the apnic pt. sure, but the lack of key components such intermittant ventilation, pressure support, and inspiratory time adjustment is problematic for the sedated ICU patient. I am a firm believer in bringing the vent to the patient and not the patient to the vent unless absolutely necessary. All too often I see sedated pts. getting inappropriately "snowed" with benzos or paralytics due to ineffective equipment or sheer ignorance of ventilatory strategies. A lot of medics freak and run to medications when they see a pt. try to overbreathe. Whether they can't because they are on a CMV only vent or stacking on A/C, a sound basic education on patient ventilation strategies is needed.