Tag: anaesthetics

ASV (Adaptive Support Ventilation) with the Hamilton Ventilator

Here is a video I produced for Adult Retrieval Victoria on Hamilton’s proprietary intelligent ventilation mode, ASV, using the Hamilton T1 Ventilator, but it’s applicable to our Hamilton C1.

Please do not distribute, as these videos are AV property.

 

ASV takes into account the patient’s respiratory mechanics, which are measured breath-by-breath by the proximal flow sensor. ASV ensures optimal ventilation for each patient during passive ventilation but also has automatic adjustment in spontaneously breathing and weaning patients.

In passive patients, ASV is a volume-targeted pressure controlled mode with automatic adjustment of inspiratory pressure, respiratory rate, and inspiratory/expiratory time ratio. Maximum tidal volume is controlled by setting a maximum inspiratory pressure. Expiratory time is determined according to the expiratory time constant in order to prevent dynamic hyperinflation.

 

Watch the following video, together with the Initial Setup (Page 2) & Troubleshooting Guides below:

Initial ventilator settings, Western, Draft, Feb 2020
 Ventilator problems algorithm, Hamilton, Version 5, May 2018

 

 

Hamilton Ventilator Education

Here are some videos I produced for Adult Retrieval Victoria, using the Hamilton T1 Ventilator, but all are applicable to our Hamilton C1.

Please do not distribute, as these videos are AV property.

 

To begin please watch the videos linked below produced by Hamilton to familiarize yourself with the Hamilton T1:

Device Overview

Setup and Preop Checks

User Interface

Basic ventilator settings

Alarm Management

 

Then watch the following videos, together with the Initial Setup & Troubleshooting Guides below:

Initial ventilator settings, Western, Draft, Feb 2020
 Ventilator problems algorithm, Hamilton, Version 5, May 2018

 

 

 

Initial Setup:

Troubleshooting:

Idiosyncracies of the Hamilton:

 

Central venous catheterisation (CVC)

Here are some resources that I’ve found useful.

  1. How to scrub. This is often done badly in ED – there’s no excuse for this. Please make sure that the insertion site, the patient and the bed are all covered by drapes.
  2. Blind insertion. This is not recommended. There is a ton of evidence supporting the use of ultrasound.
  3. Ultrasound-guided insertion:
  4. How to confirm line placement and avoid complications.
  5. Using an angiocath instead of the needle to avoid inadvertent displacement outside of the lumen of the vein.
  6. Where should the tip sit?
  7. Setting up the transducer.
  8. Which ports to use?:
    • distal port (usu ~ 16-gauge lumen): the largest lumen; used for CVP monitoring, emergency access, blood products
    • medial and distal port (smaller lumens, more chance of extravasation): used for everything else
    • don’t run anything else with inotropes/pressor
    • radiocontrast media (RCM) – CAN go through the CVC – any port ≥ 18-gauge – check CVC type and max flow rate; discuss with radiology

After all of this, you should be a line guru!

download

Thanks,

Stacy

Ventilation

An overview of the mechanics of ventilation, using the initial ventilator protocol with the Hamilton ventilator and using the troubleshooting algorithm when encountering difficulties.

Summary:

– Use low pressures, low volumes (lung protective ventilation strategy)

– Optimise expiratory time if obstructive

– Titrate FiO2, then titrate PEEP to FiO2

If problems:

– Look at Compliance & Resistance and follow the Deteriorating Ventilated Patient algorithm

– If in doubt, disconnect from the vent, allow to expire, then bag

RSI: Pre-Ox and Ap-Ox for RSI

Scott Weingart from EMCrit on pre-ox and ap-ox for the emergency RSI.

Fits in well with the talks on safe RSI and hypoxic RSI by me.

Summary:

  • Non-hypoxic patient:
    • Pre-ox and Ap-Ox:
      • Non rebreather mask (NRBM) and Nasal cannula (NC), both @ 15L/min
      • or
      • any of the options below
  • Hypoxic patient:
    • Pre-ox and Ap-Ox:
      • Bag-valve-mask (BVM)+PEEP (≤15cmH2O) and NC, both @ 15L/min
      • or
      • ventilator CPAP and NC @ 15L/min
      • and 
      • consider gentle ventilation with BVM+PEEP or ventilator during apnoea