As part of an airway workshop we ran this pre-session learning suite of talks covering standard rapid sequence induction, as well as RSI in special situations.
Intubation: overview (43min)
Intubation in trauma (18min)
Intubation in shock (17min)
Intubation in asthma (24min)
Intubation curveballs: laryngospasm (18min)
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:
Hi guys.
Here are some videos relating to the procedures we covered during the consultant education this month.
Enjoy!
Stacy
I-gel 2nd generation supraglottic airway
Surgical Airway – Scalpel
RIC line
MAC line
Humeral IO
Thanks to Dr Martin Bicket
August 2017
(29 min)
Thanks to Dr Stacy Turner
August 2017
(43min)
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
A great discussion on pre-oxygenation in the ED and pre-hospital environments, from the PHARM podcast.
Check out the show notes and references here.
Key Points:
A BVM (with PEEP valve) will provide better pre-oxygenation than a NRBM (non-rebreather) AS LONG AS THERE IS A GOOD SEAL.
Adding nasal cannulae may worsen pre-oxygenation a little, likely more than offset by the additional benefit of apnoeic oxygenation.
For me, the problem with a BVM is that the airway practitioner isn’t solely focused on achieving a good seal during pre-oxygenation. They’re doing other things – prepping the eam/patient/equipment etc. Therefore, I’d suggest NRBM and NPs as routine, especially for more inexperienced practitioners. If using a BVM (with PEEP valve), the airway practitioners sole focus needs to be on maintaining a seal.
Also, remember to sit the patient up and use CPAP if necessary.
Thanks,
Stacy
How not to kill your hypoxic patient.
Key Points:
Show Notes:
Pre-oxygenation
Preoxygenation, Reoxygenation and Deoxygenation – EMCrit
Covers Pre-oxygenation with CPAP in the hypoxic patient – watch the 2 videos
Preoxygenation and Prevention of Desaturation During Emergency Airway Management article by Scott Weingart and Rich Levitan – a must read
RebelEM – a nice summary and explanation of the above paper
http://lifeinthefastlane.com/ccc/preoxygenation/ – LITFL’s overview
The problem with the BVM for pre-oxygenation – Nick Crimes
Positioning
Levitan’s ear-to-sternal notch positioning
Find out about ramping here and here (EMUpdates)
See also the PreOx, ReOx paper by Weingart & Levitan
Apnoeic oxygenation
NO DESAT! – Rich Levitan
PulmCrit – an in-depth discussion by Josh Farkas, including the THRIVE study
http://lifeinthefastlane.com/ccc/apnoeic-oxygenation/ – LITFL’s overview
Apnoeic oxygen relies on an open airway, so we have to maintain a jaw thrust.
NCs buy you more time, in normal, obese and hypoxic patients.
High-flow NC would be even better, but are complicated because getting a BVM seal over them is not possible
DSI – Delayed Sequence Intubation
The Website – EMCrit
The Paper – no longer FOAM, but you can find it here
http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/ – LITFL’s comprehensive overview
Rocuronium vs Suxamethonium
Video from Reuben Strayer from EMUpdates
Apnoeic Ventilation
Video from EMCrit
See also the PreOx, ReOx paper by Weingart & Levitan
Recent paper on using the Hamilton Ventilator for this (VAPOX)
1st Pass Intubation
The importance of 1st pass success, by Cliff Reid, and how to do it, by LITFL
Awake Intubation
Airway topicalisation and awake intubation, by EMCrit, and KSI here and here, by EMUpdates
Thanks,
Stacy