Tag: resus

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: Traumatic Cardiac Arrest

Here’s the video from March 2018’s consultant education, on the theme of traumatic arrest.

It includes a case discussion of a gunshot wound to the chest in a young women with cardiac arrest, a talk on the management of traumatic arrest and the utility of CPR, and finally a discussion on ED thoracotomy.

The quality’s not great and we lost the AV halfway through, so I’ve patched in a PowerPoint presentation of the second part.

There’s also a video from the Alfred procedures course on thoracotomy- please don’t distribute this further, as it’s released to candidates on the course only.

Hope you enjoy, please post any comments or questions and we’ll attempt to answer them.

Thanks.

Further reading:

EMCrit

EMRAP – the quiet chest in trauma

ANZCOR guidelines

St Emlyn’s – CPR in TCA?

Pericardiocentesis in Cardiac Tamponade

Cliff Read recently put out a great post on this issue.

The take home points:

  1. Perform when refractory shock with evidence of tamponade physiology on ECHO:

A large effusion with a ‘little invisible man using the RV as a trampoline”

  1. Remove only small volumes of blood at a time (e.g. 30mls), aiming for a SBP of 90 mmHg.

The danger is overshooting the BP, resulting in hypertension and extension of the dissection which can be fatal.

  1. Avoid intubation if possible until a surgeon is ready to cut – positive pressures lead to worsening tamponade physiology (although mitigated by pericardiocentesis).
  2. Other options include intubation under local anaesthesia, allow the patient to breathe spontaneously through the tube, or preloading with fluid, using cautious doses of induction agent, and ventilating with low pressures & zero PEEP.
  3. CPR is futile in arrested patient.
  4. CPR leads to lower MAP and diastolic pressures, therefore worsening coronary perfusion. Only relief of tamponade will provide a chance of recovery.
  5. Patients requiring transport should be accompanied by a clinician able to perform pericardiocentesis in the event of deterioration en route.

The kit:

The approach:

There are several approaches – subxiphoid, left parasternal, apical. Go where the most blood is.

Thanks,

Stacy

 

If they arrest To intubate or not to intubate?

CPR or no CPR?

How to transfer – physician escort or just send in an ambulance on lights and sirens?

 

 

LUCAS CPR

The Lucas device performs mechanical CPR and can free up staff for other tasks during a cardiac arrest.

MICA Ambulance Victoria crew may bring the device in if an arrest is in progress; Alternately ED staff can ask for the device from CCU.

Review the relatively simple operation and setup of the device so you don’t have to figure it out under pressure.

 

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

enFlow fluid warmer

Both Footscray and Sunshine campuses currently use the enFlow fluid warmer. It is relatively easy to set-up and can quickly heat fluids (blood/crystalloid) to 40 degrees celsius.

Indications:

  1. hypothermia – active warming
  2. massive transfusion – prevention of coagulopathy

Contraindications:

  1. hyperthermia

Device set-up (manufacturer video – 3min)

Key points

  1. warmer cartridges are single patient use only
  2. the cartridge can be considered an extension of the drip line and hence must be primed to avoid air embolism
  3. note the helpful arrow on the cartridge to indicate direction of flow
  4. extension tubing can be added to the cartridge for difficult ergonomic situations but will carry a risk of heat loss distal to the warmer.

The warmer is found in the resus storeroom at Footscray, and the warmer cartridge and arm-pad near the bottom left of the shelves on the back wall.

warmer cartridge storeroom