Pulmonary Fibrosis and use of CPAP

[tniuqs]

scratrat:

Amiodarone (long term usage) can lead to PF complications, the PFTs that Ventmedic is refering are called DLCO (diffusion limited carbon monoxide testing) always wondered how good that test was for the patient?

TALC Lung a completly different story, IV drug abusers with bad "cuts" from those concerned "dealers" that use talcum (sp) powder is used and with devistating results, as the lungs are an excellent "filters" The CXRays are "signature" as they look like a freakin snowstorm. I doubt in this 90 year old patient that this was tangible possibility.......that said.... I have come to the conclusion that one should "expect the unexpected".

cheers

[VentMedic]

I don't know about the long term effects of DLCO. For the patients, they may only get checked once or twice/yr. The RTs in PFT lab have to keep their machines in cal and do frequent staff normals. My COHb will go up to 3.0+ after 4 checks on myself to do a staff normal. Other worries for RTs and PF/other; long term exposure to pentamidine, ribavirin, various antibiotics, nitric oxide (esp at 50+ ppm), flolan, other nebulized Prostacyclins, morphine and of course the old standards; albuterol, mucomyst etc.

We take precautions to keep nurses and family from being exposed. We are always telling the nurse to sit further away from the pt or keep the isolation door closed for his/her own safety when we're running these drugs in the ICU.

For the EMS teams, I will always voice my concerns for them when they do interfacility transports with some of the above drugs running on the pt. Precautions must be observed especially in close quarters.

In the 80s, when doing 24 pentamidines 3x/wk, I was checked by spirometry weekly. I was younger then.....

[tniuqs]

Ventmedic:

I SOO hear you!

I got sick myself was on BIPAP for 3 days in 94 in my own IC, P02sa of 48, on 10 of PEEP, and Fio2 of 1.0 for 36 hours.

NOT fun times, a mycoplasma pneumonia (maybe?) so I wonder where I picked that up....fishing?

I couldn't work for 2 months. Let me tell you that just trying to get even short term disability was a freaken nightmare, no compensation at all, the MDs said it was pointless even applying for Workmans Comp. So many times the RTs are the forgotten as the very "Hi risk exposed" health providers (s) SARs was another example too.

But, I think you forgot one situation....CT Scan. NO mr. RT, the radiation is low level.....like 3 times a shift?

Ok then, why are you (mr/ms Xray) dude standing behind leaded glass, 4 inches forking thick!

I always asked where is my Lead Hat? but the Xray folks thought I was joking...sheesh. In case you ask it took 3 years to get a transport Vent in ER, and most RTs (at that time) said it was not worth the time in set up, TILL one died of a Brain Tumor!

sorry off topic Dean, but please heed Ventmedics cautions ALL, RTs are NOT just Oxygen boys.

cheers

[VentMedic]

Sorry to hear you had to experience this first hand. At least you now can give a first hand account of CPAP vs BIPAP.

Impressive settings...

For Peds ER we have strict policy when giving nebs to kids...5 ft rule/mask. Pertussis got a couple of our staff one year. They too couldn't collect benefits.

I remember being so concerned while working in PICU about mycoplasma that the nurses and RTs were drawing each others blood to check for it. We had two kids on vents with it.

r/o TB; guilty until proven innocent.

I worked in NICU with 10 - 20 morning xrays...scatter. I hated to see our rad badge readings each month.

Now I occasionally do bronchoscopies...4 - 5 / day with flouro. I really look forward to the pulmonologist having a resident with him/her to learn the forceps.

As I get older, MRI transports don't appeal to me either if the vent isn't in service.

Thank goodness for students and nurses

Back to CPAP and different pulmonary diseases; Sometimes we have to re-educate the ER physicians what CPAP/BIPAP is used for and its limitations. Like Albuterol, it is sometimes thought of as the universal cure-all.

I have not examined too many prehospital CPAP machines so maybe you could help me out on this one.

With the hospitals' Respironics Vision (love this machine), the higher you go on FiO2 the lower the flow curve. Are the prehospital machines essentially flow generators with a manual PEEP valve?

[scratrat]

VENTMEDIC :

Again, thanks for the great posts.

I am not sure how many different devices there are for pre-hospital use. I can tell you I've used two different types. Both were CPAP though and not BiPAP.

1./ Had a set valve to deliver 10 mmHg PEEP and always delivered 100% FiO2.

2./ Can set anywhere from 0-?? mmHG PEEP. We are instructed not to exceed 10. Also, you can adjust the FiO2 from 0-100%.

I guess it's all medical director dependant.

[VentMedic]

scratrat,

Thanks for the info.

One more question if you don't mind...

How long on average do you or your co-workers usually take to set-up CPAP on a pt? Is the head gear usually with the mask as a complete set?

[scratrat]

Shouldn't take any longer than 2-3 minutes start to finish. The ones' I've dealt with anyway. You basically have the power device that plugs directly into the wall of the ambulance, the tube goingfrom the device to the pt, the mask, a PEEP valve that goes on the mask, or some don't have that valve if it's an adjustable machine, and then the strap. That's all there is to it.

I recently moved down south and have been presented with a new device. I have never used it yet in the field, but I have put in together in training. The one I had up where I used to work, I could put that together in under 2 minutes.