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Is that a vent alarm I hear? What to do? Turn the alarm off? Fix the problem? Let's hear what Scott has to say?
Loved it! Thanks much! more vent mgmt stuff is always welcome and loved the "rolled their eyes" explanation....straight from the heart that was for sure. Had a recent Ludwigshafen Angina that I needed anesth to fiber optically incubate. Big guy, diprivan gtt did little to sedate even with dilaudid, fentanyl and Ativan so I ended up adding ketamine gtt. He had to be transferred. He sat in my Ed for hours no prob, but during transfer in 15 min he went Brady then a systole, the took off vent suctioned mucous bagged, CPR and returned. By the time he arrived back he looked like a rose. The tube was checked with the fiber optic no occlusion tube position perfect. No pmh but arthritis in this 50 year old who developed the Ludwigshafen from a dental abscess. We put him back on the transport vent and he left. We gave some glycopyrolate to dry him out. They left again. 15 min later etco2 shot to 80s Brady a systole and back again, this time tube not obstructed and required 2rounds epi and CPR while bagging to get roc with now bp in the 70s placed on phenyl periph and now air transported 1 hour different vent no issues. Is there some way the ambulance vent may have oxygenated but not ventilated? Seems the guy only got hypercapneic when on the one vent. Lungs were clear and no rad
Sean, sounds like the same situation. High pressure and the vent is not delivering the full breath.
CORRECTION:Somehow during the piece, I stated you need 200 ml/hr to get to the alveloi to fully oxygenate. Of course I mean 200 ml/min.
Scot the only problem with that answer is the pt was vented on our vent just fine for about 6 hours, when in transit by ground they had problems almost immediately, air transport did not have problems. Now possibly their PIP limit in the ambulance may have been set too low, I have never had that problem with them before so have never asked what its set at, I know ours are 40-60 typically. I will check with that amb company to see if they use a standard setting, and what it is, but also if that was the case I would have expected the paramedics to tell me the vent started alarming, but they didn't say that, just the ETCO2 began to climb rapidly.
very weird then; may be a vent malfunction.
We'll see my partner had taken over the case on the code which occurred at shift change and he called the ambulance co to suggest they take a look at that vent as it may be the problem. Btw I referred him to this podcast and I gotta say emrap has greatly enhanced our practice and both he(Dr Megna) and myself really enjoy your sections. The whole program is excellent but clearly when u bust knowledge into our heads we r better for it, though one day we may make a class action lawsuit against emrap for CTE similar to the NFL....
Ahhhh, learning is good....Off to work
The day after I listened to this lecture I had intubated a COPD pt. and was placing a Pre-Sep cath in a patient with septic shock due to probable MRSA pneumonia. The vent started alarming, the pt. placed on bagged ventilation and the plateau pressure was 20 while the PIP was high. The tube was in good position and by suctioning the pt. and giving more beta 2 agonists the alarm stopped. In addition we used the flush NS method through the distal port of the catheter. U/S showed the "whiting out" of the RV prior to levophed being started. All these tips from EMRAP have been tremendously useful! Thank you!
THE PODCAST IS NOT AVAILABLE ANYMORE WHAT HAPPENED? !!
Amazing segment Thanks Scott .... learning is good.... :)
Fantastic talk! Quick question, what do u do when the Pco2 is consistently high? How do u adjust the ventilator
tolerate it if the pt is stacking; if not creep up on the resp rate
What you do matters.