Is this important if we do not do interfacility transport?
Eventually, we will be using ventilators for almost everything where we currently use a BVM (Bag Valve Mask).
Because we humans are pathetic at bagging patients.
If you have not seen a doctor/nurse/respiratory therapist/paramedic/EMT basic bagging a patient at 60 breaths per minute, you have not been paying attention.
Since we seem to be resistant to education, the protocol writers are starting to make this something that is not corrected by education, but is prevented from happening by putting it in the hands of machines.
Needless to write, but this will have plenty of unintended consequences. The best way to avoid these unintended consequences (assuming that we do not magically develop excellent BVM skills, which would be the subject of other posts) is to be as familiar as possible with the use of transport ventilators and the kinds of problems that we can cause.
Original image credit.
The goal of medical care is to make things better, or to not make things worse.
The three most basic points, that apply just as much to BVM use as to ventilator use.
1. How to assess the patient for the cause of a sudden deterioration of the intubated patient. Everyone should know this. It is a part of every PALS/NRP class. If it is not, it was supposed to be. It should also be a part of every ACLS class, since these are some of the preventable causes of cardiac arrest.
DOPE – DOPE (or POET for the more politically correct) stands for Dislodged, Obstructed, Pneumothorax, Equipment failure. I have discussed these elsewhere.
2. Hypotension – Even in a trauma patient, hypotension is often resolved by correcting the ventilation, rather than by adding fluid to the blood vessels.
3. Waveform Capnography – Continuous waveform capnography should be mandatory for the movement of all intubated patients anywhere. The same is true for extraglottic devices (LMAs, CombiTubes, King Airways, et cetera).
CentreLearn Webinar: Automatic Transport Ventilators in EMS
Thursday, April 25, 2013 8:30 PM – 9:30 PM EDT
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 Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
Aufderheide TP, Lurie KG.
Crit Care Med. 2004 Sep;32(9 Suppl):S345-51.
PMID: 15508657 [PubMed – indexed for MEDLINE]
 Capnography Use Saves Lives AND Money
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