New EMS Equipment Training Auto Vent 3000 King

New EMS Equipment Training Auto. Vent 3000 King Vision Video Laryngoscopy LUCAS CPR

• BLS Providers - To become familiar with the use and set-up of the Auto. Vent 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 Auto. Vent 3000, King Vision Laryngoscope, and LUCAS Chest Compression System 2

• Auto. Vent 3000 • Chronic vs. Scene of an Emergency Ventilated Patients • You. Tube Videos • Instructor demo • Practice • King Vision Laryngoscope • General Information • You. Tube Videos • Instructor demo • Practice • LUCAS CPR Device • You Tube Videos • Instructor Demo • Practice 2014 Outline 3

Auto. Vent 3000 • Indications • Point of origin could be from anywhere: • • 2014 • Chronically Ventilated Patients Long term facility Home Outpatient setting Hospital • AND • Reason for transport isn’t a respiratory problem 4

Auto. Vent 3000 • PEEP less than or = to 10 cm. H 2 O • Peak pressures are less than or = to 30 2014 • Indications (Continued) • Patient’s ventilator settings are: • AND • No changes in the patients normal ventilator settings are required during the transport. 5

Auto. Vent 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

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

Auto. Vent 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

Auto. Vent 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

Auto. Vent 3000 • Select Breaths Per Minute (BPM) • Select WHITE Adult setting 2014 • How To Use the Auto. Vent 3000 • We will not be using the orange CHILD setting • Select Tidal Volume • 8 m. L per kg (or whatever the patient setting is) • Select PEEP setting • Match patient setting • Disposable valve • Max setting of 10 10

Auto. Vent 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

Auto. Vent 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

Auto. Vent 3000 • 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 2014 • Who can use the Auto. Vent? 13

Auto. Vent 3000 • Things to Remember • Maintain situational awareness when managing the AV 3000 2014 • Always treat the PATIENT • ALWAYS default to what you know – USE THE BVM IF PROBLEMS ARISE WITH THE VENTILATOR 14

Auto. Vent 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

Auto. Vent 3000 • Only hand tighten the fittings 2014 • Things to Remember (Continued) • Use a full size D portable oxygen cylinder – AV 3000 machines consume a portable O 2 cylinder within 23 minutes. • Will not run if the oxygen tank has less than 200 L 16

Auto. Vent 3000 • When switching a chronically ventilated patient over to the Auto. Vent 3000: • Monitor/trend for ONE minute to ensure that the patient tolerates and accepts the ventilator 2014 • Things to Remember (Continued) • High pressure alarm activates and dumps oxygen at 45 -55 cm H 2 O & Barotrauma occurs at 60 cm H 2 O • THERE IS NO LOW PRESSURE ALARM 17

Auto. Vent 3000 • Autovents are on M 712, M 715, M 703 and PE 732 • Restocking • Email Jon Fiedler at MCFRS. EMSSupplies@montgomerycountymd. gov 2014 • They will not be placed on any additional units • Troubleshooting/Broken Unit • Contact EMSDO 18

Auto. Vent 3000 • Instructor Demo 2014 • Auto. Vent 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 AFRA’s 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 LP 15 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 Auto. Vent? • What is the minimum age to use the Auto. Vent? • 9 years old • What are the 3 contraindications for the Auto. Vent use? • Cardiac arrest • Pt not reached 9 th 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