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Ventilators 101 – Part 1

Rob Orman, MD and Haney Mallemat, MD FAAEM
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21:36
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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02:05

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EM:RAP 2015 October Summary 928 KB - PDF

At its core, the ventilator is a simple device: a mechanical bellows. There are three questions to ask when dialing in the settings: target, trigger, and termination. Well, maybe more than three questions, but those will get you started.

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Sean G., M.D. -

Thank u this was an awesome segment and I would appreciate delving a bit deeper in the future, explaining the use of PEEP for recruitment and more on the use of pressure as the independent variable. I feel I understand the ventilators much better now. That being said...what advantage does AC have over SIMV w pressure support? I really see none. If u have a "tired" pt why not use SIMV with a matching to intrinsic resp rate(assessing the resp rate just prior to intubation, and adding a proper amt of pressure support. It would seem this would be safer for the patient to avoid breath stacking mainly....am I missing something? I mean I am assuming we are sedating the pt well, and his SIMV rate should be high enough to meet his ventilator needs, and with the added Pressure support if the pt does start to over breathe the vent he will receive the pressure support so that it is not taxing to do so and the vent will work to avoid breath stacking and alkalosis.

Brandon O. -

Hi guys. I'm afraid I have to quibble with one of the points here. Dr. Mallemat explains that in an assist control mode, breaths can be either patient- or vent-triggered (specifically flow or pressure triggered in one case, or time triggered in the other). If a patient-triggered breath occurs just before a vent-triggered breath, he says, the latter will stack on top of the former. This is not correct; in AC, a patient breath "resets" the timer, and the vent will allow the full time cycle (10 seconds in this example) until triggering the next breath. I'm sure Haney knows this and it was merely a bobble in communication!

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Vents, Scabies, and IV Fluid Cage Match Full episode audio for MD edition 256:28 min - 357 MB - M4AEM:RAP 2015 Octobre Résumé en Francais Français 65:06 min - 39 MB - MP3EM:RAP 2015 October Aussie Edition Australian 31:30 min - 43 MB - MP3EM:RAP 2015 Octubre Español 71:43 min - 38 MB - MP3EM:RAP 2015 October Canadian Edition Canadian 20:46 min - 16 MB - MP3EM:RAP 2015 Español Octubre 2015 1 MB - PDFEM:RAP 2015 October Board Review Answers 243 KB - PDFEM:RAP 2015 October Board Review Questions 343 KB - PDFEM:RAP 2015 October MP3 253 MB - ZIPEM:RAP 2015 October Summary 928 KB - PDF

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