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.
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:
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.
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.