Tag: respiratory

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:

 

SMS teaching: Pneumothorax

May 2017

Thanks to Dr John Loy

 

(29min)

 

Discussion points:

  1. The majority of large pneumothoraces managed this year have ultimately required intervention
  2. Non-intervention in one case has also generated further dialogue with the Respiratory unit regarding management of these patients
  3. An upcoming multi-centre trial co-ordinated via Monash may further inform our practice
  4. In the meantime discussion with the respiratory or thoracics team on the day regarding large stable pneumothoraces will ensure timely follow-up

Yuen’s yap 5/4/17 – Decision-making, dyspnoea, paediatrics, virtual fracture clinic

Summary of registrar teaching 5/4/2017
For DEMTs Ruth Hew and Terence Yuen

Congratulations

To Lucy Selleck and Alyza Gossat for passing the primary exam and Steven Lee and Deb Maher for passing the fellowship exam written component.

 

To DEMT Terence and Jenny Yuen for arrival of their son Archer.

 

Decision making under pressure

Registrar Amar Winayak presented a case of inferior STEMI with cardiogenic shock and discussed its time critical decision points. Of note:

  1. there are numerous means to gain circulatory access (peripheral IV, intra-osseous, central venous), each with pros and cons – be familiar with all modes as you may need to try all
  2. don’t forget external jugular veins for peripheral access
  3. ED must initiate STEMI calls to cardiology early and advocate appropriately for each individual patient

Dyspnoea in ED

Consultant Keith Nallaratnam presented a few cases of dyspnoea in ED which highlighted:

  1. thrombolysis in submassive PE is a thorny and complex issue without clear scientific consensus, but thrombolysis probably has minimal major risk and should be considered
  2. a new anticoagulation treatment protocol for PE is likely to appear for Western health soon which will suggest unfractionated heparin rather than low-molecular weight heparin (clexane/enoxaparin)
  3. bedside ECHO is a very useful test in ED for diagnosis of PE (right ventricular distension/strain) and pericardial effusion

Virtual fracture clinic

Senior physiotherapist Narelle Watson presented on the incoming Virtual Fracture Clinic which begins April 18th and is a new intermediary triage process between ED and the orthopaedic fracture clinic.

  1. Ward clerks are still to make fracture clinic appointments but patients will now receive a phone call from the virtual fracture clinic practitioners informing them of the next clinical step
  2. Clinical practice should not change because of this new process
  3. Please ensure notes are complete including patient social information like occupation, handedness, primary language and correct phone number as well as any discussions with orthopaedic teams
  4. patients should be given an information sheet abou the fracture clinic which will be available

Paediatrics

Consultant David Krieser presented a series of excellent cases highlighting, amongst other things, fixation error, open disclosure and cannulation in children.

His tips for cannulation include

  1. remove the end of the cannula and flush with saline as it reduces the pressure differential and makes it more likely for you to see venous flashback
  2. veins are better felt than seen
  3. consider the use of butterfly or broken needles in venepuncture

Wednesday Registrar Training 22.03.2017

PALLIATIVE CARE – DR ADRIAN DABSCHEK

Limited presence at Footscray, but phone consultations available

DEMENTIA

  • admission to Aged Care predicts decline

Difficult Discussions Towards End-of-Life 

  • practice the conversation
  • understand the patient’s and family background..”the patient’s journey”

ANTI-EMETICS IN PALLIATIVE CARE SETTING (beware of side effects f used in normal ED setting)
Cyclizine – incombination with dexamethaosine for raised ICP

Haloperidol – high doses often used, combined anti-psychotic effects, effective in renal failure

Ondansetron – effective in chemotherapy and radiotherapy induced N + V

Olanzepine – chemotherapy induced N + V, also antianxiety, 2.5-5mg nocte

CANCER PAIN

Physiology – inflammation vs neuropathic pain

Long acting opiates – breakthrough doses are 1/6 of long acting dose

Rotate opiods to reduce tolerance: Morphine -> oxycodone -> hydromorphone

Fentanyl patches – good for stable cancer pain, fentanyl syringe driver in renal failure

SMART CLINIC – Footscray weekly, open to non-cancer patients, Sunshine twice weekly (oncology patients)

 

COPD BUNDLE OF CARE – Dr Lexi Gerber

 

LFA-COPD-X-doc_V3.02_0815_WEB

DKA – Dr Tamarind Reynolds

hyperkalaemia

hypothermia

difficult IV access

intubation and ventilation challenges

management of shock

 

 

Thrombolysis in PEA arrest and PE

Thrombolysis in PEA with confirmed PE

 

Thanks Elliott Adamson for this presentation about the PEAPETT study.

Key points:

  1. Suggests that thrombolysis with tPA in PEA arrest with confirmed PE has benefit
  2. Logically contrasts with other studies of thrombolysis in PEA arrest (all causes) which does not appear to show particular benefit
  3. Despite minimal proven benefit of thrombolysis in PEA arrest where cause is unclear, consideration of thrombolysis is still important (reversible causes – 4Hs and 4Ts) particularly in younger patients where overall outcome likely to be better