Thanks to Dr Sheri Abramovic for this sensitive presentation about an incredibly difficult resuscitation case.
Thanks to Dr Sheri Abramovic for this sensitive presentation about an incredibly difficult resuscitation case.
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
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:
Then watch the following videos, together with the Initial Setup & Troubleshooting Guides below:
Initial ventilator settings, Western, Draft, Feb 2020
Initial Setup:
Troubleshooting:
Idiosyncracies of the Hamilton:
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:
Cliff Read recently put out a great post on this issue.
The take home points:
A large effusion with a ‘little invisible man using the RV as a trampoline”
The danger is overshooting the BP, resulting in hypertension and extension of the dissection which can be fatal.
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?
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.
Thanks Elliott Adamson for this presentation about the PEAPETT study.
Key points:
Those interested in acid-base balance should have a read of this post by Josh Farkas on the Emcrit website. It follows on nicely from my acid-base talk, and I’ve added it to the notes there too.
Another nail in the coffin for (ab)normal saline?
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:
Contraindications:
Device set-up (manufacturer video – 3min)
Key points
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.
A short talk on using the ASV mode on the Hamilton ventilator.
This is an intelligent ventilation mode exclusive to Hamilton, which works out the most efficient way to give a set minute volume (MV) to your patient.
Audio version also available