New Ems equipment training - Montgomery County, Maryland

New Ems equipment training - Montgomery County, Maryland

New EMS Equipment Training AutoVent 3000 King Vision Video Laryngoscopy LUCAS CPR 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 2014 Goals ALS Providers To become proficient with the use and set-up

of the AutoVent 3000, King Vision Laryngoscope, and LUCAS Chest Compression System 2 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 2014 Outline 3 AutoVent 3000 Indications Point of origin could be from anywhere:

2014 Chronically Ventilated Patients Long term facility Home Outpatient setting Hospital AND Reason for transport isnt a respiratory problem

4 AutoVent 3000 PEEP less than or = to 10 cmH2O Peak pressures are less than or = to 30 2014 Indications (Continued) Patients ventilator settings are: AND No changes in the patients normal ventilator settings are required during the transport.

5 AutoVent 3000 Indications A non-chronically ventilated patient who is in respiratory arrest. 2014 Scene of An Emergency Ventilated Patient A SECOND PROVIDER (ALS or BLS) IS REQUIRED TO ASSIST WITH PATIENT CARE 6

AutoVent 3000 THIS APPLIES TO BOTH CHRONICALLY VENTILATED AND SCENE OF AN EMERGENCY PATIENTS 2014 Contraindications Children who have not reached their 9th birthday Patient is in Cardiac Arrest If patient is bucking the tube 7

AutoVent 3000 The patient could be regaining consciousness The patient is in respiratory distress 2014 What does it mean if the patient is Bucking the Tube? 8 AutoVent 3000 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 2014 Signs of respiratory distress in a ventilated patient 9 AutoVent 3000 Select Breaths Per Minute (BPM) Select WHITE Adult setting

2014 How To Use the AutoVent 3000 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 10

AutoVent 3000 What is PEEP? Constant pressure that keeps the alveoli open Increases the volume of gas remaining in the lungs at the end of expiration 2014 Positive End Expiratory Pressure Improves gas exchange Average healthy adult has PEEP of 5 11

AutoVent 3000 Destination 2014 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 12

AutoVent 3000 Paramedics ONLY CRT-I can only transport chronically vented patient if the patient has his own vent and the pts care provider manages the vent during transport 2014 Who can use the AutoVent? 13 AutoVent 3000 Things to Remember Maintain situational awareness when managing the

AV3000 2014 Always treat the PATIENT ALWAYS default to what you know USE THE BVM IF PROBLEMS ARISE WITH THE VENTILATOR 14 AutoVent 3000 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 2014 Things to Remember (Continued) NOTE: This is referring to patients who are not chronically ventilated. 15 AutoVent 3000 Only hand tighten the fittings

2014 Things to Remember (Continued) 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 16 AutoVent 3000 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 2014 Things to Remember (Continued) 17 AutoVent 3000 Autovents are on M712, M715, M703 and PE732 Restocking

Email Jon Fiedler at [email protected] 2014 They will not be placed on any additional units Troubleshooting/Broken Unit Contact EMSDO 18 AutoVent 3000 Instructor Demo

2014 AutoVent 3000 Tutorial (9:25 min) Practice 19 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 2014 King Vision Laryngoscope 20 King Vision Laryngoscope 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 2014 General Info: Kit includes (1) Digital Display (3) Channeled Blades (1) Non-Channeled Blade Will be placed on AFRAs and chase cars/medic units 21 King Vision Laryngoscope

Kit $927.00 (Display and 4 blades) Replacement blades $24.39 (channeled and non-channeled) Restocking 2014 Cost Initial blades will be purchased by the EMS Section Additional restocking done through normal Boundtree ordering process 22

King Vision Laryngoscope Not the same as with direct laryngoscopy Three fingers and slide into place 2014 General Technique 23 King Vision Laryngoscope Does not require stylet Size equivalent to a 3 Mac More popular choice

2014 Channeled Blades Non-Channeled Blades Useful in patient with small anatomy, or other circumstances where you need more room to work. Requires stylet or bougie 24 King Vision Laryngoscope Insert tip of blade into Vallecula and gently lift until vocal chords come into view

2014 Technique for Channeled Blade 25 King Vision Laryngoscope Insert tip of blade and lift epiglottis until vocal chords come into view 2014 Technique for Non-Channeled Blade 26

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 2014 King Vision Laryngoscope 27 King Vision Laryngoscope

Instructor Demo 2014 King Vision In-Service Guide (2 min) Practice 28 2014 LUCAS Chest Compression System

29 LUCAS Chest Compression System Transport conditions Provider fatigue Variability in the experience level of the provider 2014 Provides consistent CPR independent of: Based on the international guidelines for CPR 30

LUCAS Chest Compression System Age Limits None, as long as the patient fits 2014 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 31 Should Fit Probably Not

LUCAS Chest Compression System BE SURE TO PAUSE THE LUCAS EVERY 2 MINUTES TO REASSESS 2014 Set at 102 compressions per minute Can defibrillate while in use 32 Allows for one person to be a dedicated scribe This will improve the accuracy of the patient

data 2014 LUCAS Chest Compression System 33 LUCAS Chest Compression System Ensure that the LP15 is in Paddles mode so that the CPR information can be recorded into CODESTAT 2014

IMPORTANT TO REMEMBER: 34 LUCAS Chest Compression System LUCAS vs. Manual CPR (4:37 min) 2014 LUCAS Demo (13:08 min) Instructor Demo Practice

35 Review Questions Autovent When you can match the patients own ventilator settings Peak pressures < than or = to 30 PEEP < or = 10 2014 When can we use the AutoVent? 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) 36 Review Questions King Vision 18 years old What is the main difference in stylet use between the 2 types of blades? 2014

What is the minimum age for use? 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 37 Review Questions LUCAS CPR Device Yes

What is the age limit for the LUCAS? 2014 Can you defibrillate while the LUCAS is on? 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 38

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