Tag: RSI

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:

 

Procedures for consultant education

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

CT6 femoral splint

SAM pelvic splint

 

Pre-Oxygenation Update

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

 

 

 

 

RSI: The Hypoxic RSI

https://www.youtube.com/watch?v=kOaPo_d1Jso

How not to kill your hypoxic patient.

Key Points:

  • Pre-Oxygenate with CPAP/BVM+PEEP
  • Sit up
  • Use Ap-Ox
  • Roc rocks
  • 1st pass success is critical
  • Ventilate during apnoea

 

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