new ems equipment training autovent 3000 king vision video laryngoscopy lucas cpr
TRANSCRIPT
New EMS Equipment TrainingAutoVent 3000
King Vision Video Laryngoscopy
LUCAS CPR
Goals• BLS Providers - To become familiar with the use and set-up of
the AutoVent 3000, King Vision Laryngoscope, and proficient with the LUCAS Chest Compression System
• ALS Providers – To become proficient with the use and set-up of the AutoVent 3000, King Vision Laryngoscope, and LUCAS Chest Compression System
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Outline• AutoVent 3000
• Chronic vs. Scene of an Emergency Ventilated Patients• YouTube Videos• Instructor demo• Practice
• King Vision Laryngoscope• General Information• YouTube Videos• Instructor demo• Practice
• LUCAS CPR Device• You Tube Videos• Instructor Demo• Practice
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AutoVent 3000
• Chronically Ventilated Patients • Indications
• Point of origin could be from anywhere:• Long term facility• Home• Outpatient setting• Hospital
• AND• Reason for transport isn’t a respiratory problem
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AutoVent 3000
• Indications (Continued)
• Patient’s ventilator settings are:• PEEP less than or = to 10 cmH2O• Peak pressures are less than or = to 30
• AND• No changes in the patients normal ventilator
settings are required during the transport.
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AutoVent 3000
• Scene of An Emergency Ventilated Patient• Indications
• A non-chronically ventilated patient who is in respiratory arrest.
• A SECOND PROVIDER (ALS or BLS) IS REQUIRED TO ASSIST WITH PATIENT CARE
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AutoVent 3000
• Contraindications • Children who have not reached their 9th birthday
• THIS APPLIES TO BOTH “CHRONICALLY VENTILATED” AND “SCENE OF AN EMERGENCY” PATIENTS
• Patient is in Cardiac Arrest• If patient is “bucking the tube”
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AutoVent 3000
• What does it mean if the patient is “Bucking the Tube?”• The patient could be regaining consciousness• The patient is in respiratory distress
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AutoVent 3000
• Signs of respiratory distress in a ventilated patient• Increased secretions from tracheostomy site (mucous
plug)• Hypoxia, cyanosis, or decreased oxygen saturation levels• Increased work of breathing• Altered mental status due to hypoxia• Agitation and anxiety
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AutoVent 3000
• How To Use the AutoVent 3000• Select Breaths Per Minute (BPM)• Select WHITE Adult setting
• We will not be using the orange CHILD setting
• Select Tidal Volume• 8mL per kg (or whatever the patient setting is)
• Select PEEP setting• Match patient setting• Disposable valve• Max setting of 10
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AutoVent 3000
• What is PEEP?• Positive End Expiratory Pressure
• Constant pressure that keeps the alveoli open• Increases the volume of gas remaining in the lungs
at the end of expiration • Improves gas exchange
• Average healthy adult has PEEP of 5
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AutoVent 3000
• Destination• Closest appropriate hospital
• Cleaning• Must be cleaned after EVERY use
• Clean with Cavicide• On Boundtree website• Tubing is disposable but remaining equipment needs to be
cleaned
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AutoVent 3000
• Who can use the AutoVent?• Paramedics ONLY• CRT-I can only transport chronically vented patient
if the patient has his own vent and the pt’s care provider manages the vent during transport
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AutoVent 3000
• Things to Remember• Always treat the PATIENT
• Maintain situational awareness when managing the AV3000
• ALWAYS default to what you know – USE THE BVM IF PROBLEMS ARISE WITH THE VENTILATOR
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AutoVent 3000
• Things to Remember (Continued)• Have two ALS providers check and verify the
ventilator settings• Any acutely ill or injured breathing patient at the
“scene of an emergency” shall be manually ventilated
• NOTE: This is referring to patients who are not chronically ventilated.
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AutoVent 3000
• Things to Remember (Continued)
• Only hand tighten the fittings
• Use a full size D portable oxygen cylinder – AV3000 machines consume a portable O2 cylinder within 23 minutes.
• Will not run if the oxygen tank has less than 200L
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AutoVent 3000
• Things to Remember (Continued)• When switching a chronically ventilated patient
over to the AutoVent 3000:• Monitor/trend for ONE minute to ensure that the patient
tolerates and accepts the ventilator
• High pressure alarm activates and dumps oxygen at 45-55cm H2O & Barotrauma occurs at 60cm H2O
• THERE IS NO LOW PRESSURE ALARM
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AutoVent 3000
• Autovents are on M712, M715, M703 and PE732• They will not be placed on any additional units
• Restocking• Email Jon Fiedler at
• Troubleshooting/Broken Unit• Contact EMSDO
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AutoVent 3000• AutoVent 3000 Tutorial (9:25 min)
• Instructor Demo
• Practice
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• Why are we implementing this?• VL is a tool proven to improve first pass success• The EMS Management wants to ensure that providers
have the latest technology and that every attempt is being made to make your job easier and safer
• Data from Howard County was overwhelming• Initial success rate for ALL intubations was 68%• After implementing VL, success rate increased to
95% on the FIRST ATTEMPT
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King Vision Laryngoscope
King Vision Laryngoscope
• General Info:• 90 minute continuous use
• 3 AAA batteries• Be sure to put ribbon under the first battery
• Motion Activated• 60 second shut-off
• 57 Kits On Order• Kit includes
• (1) Digital Display • (3) Channeled Blades• (1) Non-Channeled Blade
• Will be placed on AFRA’s and chase cars/medic units
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King Vision Laryngoscope
• Cost• Kit $927.00 (Display and 4 blades)• Replacement blades $24.39 (channeled and non-channeled)
• Restocking• Initial blades will be purchased by the EMS Section• Additional restocking done through normal Boundtree ordering
process
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King Vision Laryngoscope
• General Technique• Not the same as with direct laryngoscopy• Three fingers and slide into place
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King Vision Laryngoscope
• Channeled Blades• Does not require stylet• Size equivalent to a 3 Mac• More popular choice
• Non-Channeled Blades• Useful in patient with small anatomy, or other circumstances
where you need more room to work. • Requires stylet or bougie
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King Vision Laryngoscope
• Technique for Channeled Blade• Insert tip of blade into Vallecula and gently lift until vocal chords
come into view
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King Vision Laryngoscope
• Technique for Non-Channeled Blade• Insert tip of blade and lift epiglottis until vocal chords come into
view
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King Vision Laryngoscope
• Things to Remember• Only to be used with patients who are 18 years
and older
• Continue to use capnography and all of your standard tube confirmation tools
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King Vision Laryngoscope
• King Vision In-Service Guide (2 min)
• Instructor Demo
• Practice
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LUCAS Chest Compression System
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LUCAS Chest Compression System
• Provides consistent CPR independent of:• Transport conditions• Provider fatigue• Variability in the experience level of the provider
• Based on the international guidelines for CPR
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LUCAS Chest Compression System
• Age Limits• None, as long as the patient fits
• Size Limits• Alarm will sound if plunger is too low
• This means that the patient is too small• If plunger cannot lower, patient is too big
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Should Fit Probably Not
LUCAS Chest Compression System
• Set at 102 compressions per minute• Can defibrillate while in use
• BE SURE TO PAUSE THE LUCAS EVERY 2 MINUTES TO REASSESS
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LUCAS Chest Compression System
• Allows for one person to be a dedicated scribe• This will improve the accuracy of the patient
data
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LUCAS Chest Compression System
• IMPORTANT TO REMEMBER:• Ensure that the LP15 is in “Paddles” mode so that
the CPR information can be recorded into CODESTAT
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LUCAS Chest Compression System
• LUCAS Demo (13:08 min)
• LUCAS vs. Manual CPR (4:37 min)
• Instructor Demo
• Practice
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Review Questions
• Autovent• When can we use the AutoVent?
• When you can match the patients own ventilator settings• Peak pressures < than or = to 30• PEEP < or = 10
• What is the minimum age to use the AutoVent?• 9 years old
• What are the 3 contraindications for the AutoVent use?• Cardiac arrest• Pt not reached 9th birthday• Pt bucking the tube (in respiratory distress)
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Review Questions
• King Vision• What is the minimum age for use?
• 18 years old
• What is the main difference in stylet use between the 2 types of blades?
• Channeled Blade – does not require stylet• Non-Channeled Blade – requires stylet
• Describe the hand technique for use of the King Vision• Hold handle with three fingers • Gently lift when entering the vallecula or lifting the epiglottis
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Review Questions
• LUCAS CPR Device• Can you defibrillate while the LUCAS is on?
• Yes• What is the age limit for the LUCAS?
• None, as long as the patient fits• How often do you reassess the patient while using the LUCAS?
• Every 2 minutes• Do you need to pause the LUCAS to reassess the patient?
• Yes
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