NEED HELP WITH PPV

[DwayneEMTP]

We used PPV or assisted ventilations in basic.

We may have asked for a BVM, but it was always an item, not an intervention, as opposed to PPV or assisted vents where you were expected to justify your rate, force and mixture.

Not that I don't agree with your logic Dust, just adding this tidbit of info in case it makes sense when others post...

Have a great day!

[JPINFV]

I'll also jump on board that my basic class used the term "positive pressure ventilation" for lecture and exams.

[VentMedic]

For those of you who use the terminology PPV or Positive Pressure Ventilation, can you explain why it is called that from the physiological definition?

[DwayneEMTP]

For those of you who use the terminology PPV or Positive Pressure Ventilation, can you explain why it is called that from the physiological definition?

I'm guessing you're not asking for yourself Vent...But do you mean why PPV as opposed to the normal physiological process?

[VentMedic]

I'm guessing you're not asking for yourself Vent...But do you mean why PPV as opposed to the normal physiological process?

Exactly how does PPV relate to the normal physiological process?

How much pressure are you delivering? What determines the amount of tidal volume delivered? What determines the amount of pressure? What unit is this pressure measured in? Why is the amount of pressure important? What is a pressure gradient? Negative pleural pressure? How does this relate to atmospheric pressure? What is the difference between passive and active exhalation?

Any scuba divers here?

For those considering prehospital CPAP, this whole PPV process is good to review.

[tskstorm]

So according to the textbook..if the breathing RATE or TIDAL volume is inadequate..then you do PPV with supp. O2.

If a normal rate is 12-24, (these numbers are very arbitrary, and there are different sets on normal rates.) Good tidal volume can be assessed by good bilateral chest rise. Keeping this in mind...

So keeping that in mind... whenever i do some practice tests and theres a question where a pt has a breathing rate of lets say...30 bpm...with good/equal tidal volume, i choose to do ppv with suppl. O2. But then i get marked WRONG?

The rate is slightly high, but could be the patients normal rate. Patient could have just ran up a flight of stairs. Had a screaming match with significant other. In your treatment of this patient, you can give supplemental oxygen, and if the patients condition deteriorates change your intervention to positive pressure ventilations with high concentration oxygen. To review in the little bit you did indicate in your post, the patient had full adequate chest rise and fall indicative of you saying "patient had good tidal volume." Something else to remember, you don't treat numbers(or monitors) and you treat the patient. There is nothing to indicate this patient that is Alert and Oriented, with good tidal volume needs positive pressure ventilations. Oh yea, and if you ever try to treat this patient in the field with positive pressure ventilations I hope you got a strong jaw, because your probably going to get swung at! Not many people will take kindly to being bagged if they are alert and oriented.

[AnthonyM83]

Because the NREMT teaches you that anybody with a respiratory rate outside of the accepted range probably needs to be bagged. It has nothing to do with medicine, it's painting by numbers. And your answers are coloring outside the lines.

This is aaaaall part of the game. You have to tell the NREMT what they want to hear, then forget all of it and do it the RIGHT way in the street.

It seemed that's what she was trying to do. She was trying to play that game and answer the question based on their technical rules, but she still got it wrong. Having been there, I know how frustrating it can be...

But agreed, we need to see the whole question to try and figure it out based on context. To see what they're getting at.

[VentMedic]

I hate cook book norms!

Every patient and every medical situation represents a different set of values. Yes, it is good to know what a 25 y/o, 75 kg, normal height male or female breathes, but there are some many physical elements that alter the "norm".

DKA: Kussmaul respirations, definitely not normal but the body will do its best in the breathing department until action is taken to correct the metabolic side.

Biot's respirations is another that the body will probably do okay until advanced intervention.

Obese people and people with pulmonary fibrosis will have a higher normal resting respiratory rate due to a decreased tidal volume. Their body is concerned about maintaining an overall normal minute volume.

Air trapping COPD patients may have a lower than norm rate.

These are the more obvious patients.

Quality and not necessary quantity is key in assessing respirations and the need for aggressive intervention.

And yes, for testing purposes you have to memorize but for practical purposes, the patient sets the norms. Understanding disease processes along with experience with enable you to know how much deviation from the norm and fatique or work of breathing can occur before intervention is required.

As for PPV, this term is used loosely in all professions.

Mouth to mouth and mouth to mask are the simplest forms of PPV. BVM and then some of the mechanical devices attached to masks that the AHA is promoting is the next level. The next step is attaching a Bag Valve to some adjunct airway that is supraglottic: LMA, King and in many instances, the Combitube. I rarely recommend attaching a mechanical device to a supraglottic device. Next, it is ventilation using the subglottic devices; ETT, trach and occasionally the Combitube.

I am mentioning the above because with each type of "power" used to perform PPV, the characteristics of ventilation change. Flow, tidal volume, resistance and distribution of gas within the lung fields can change with each different airway adjunct.

I am disappointed in the AHA's promotion of mechanical devices without elaborating on some basic principles. The resurgence of the Demand valve brings with it some concerns about "PPV".

[tniuqs]

Ventmedic: Your commentary is very true.

Many of my patients have never read the "Cook Book"

cheers

[surfersweety415]

Thankyou for all of your answers...

Basically, im trying to pass this NREMT-B exam..and im getting frustrated because they go by "textbook only". Believe me...im well aware that in the field everything changes...but right now im just trying to answer the questions in the way "they" want them to be answered so i can pass the test.

As far as PPV goes... In school, we only said "Positive Pressure Ventilations" and we werent allowed to just say "bag the pt". Again...is an example of "textbook" as opposed to what its like in the field.

Now...for testing purposes..in the book it states to adminster PPV with supp. O2 if the pt's breathing rate OR tidal volume is inadequate. It doesnt make sense to me to do that if the pt's breathing rate is only slightly above normal if he has good/equal tidal volume. In the question they will usually give you choices like..

The pt has a breathing rate of 32 bpm with good/equal tidal volume. What are your interventions?

A. nasal canula @ 6lpm

B. Nonrebreather @ 15lpm

C. PPV via BVM with supp. O2

D. insert oral airway.

So normally in the field you would choose B. but according to the book..it would be C.

So im not sure what to put on the actual exam....if i were to come across a question like that.