VENTILATOR USE FOR INTUBATED PATIENTS
ALL LEVELS
Purpose
To establish guidelines for the use of O-TWO e500 portable ventilator by members of the Las Cruces Fire Department.
Policy
The guideline covers use of the LCFD portable ventilator for ventilation of intubated patients. The steps for setting up the ventilator and care instructions can be found in the OTWO-ESERIES-E500-User Guide located in File Center of Vector Solutions.
Procedure
1. Confirm the ET tube is properly placed, and patient is compliant with BVM ventilations.
2. Confirm ETCO2 is present via number and waveform to confirm tube is properly inserted.
a. EtCO2 preferred range is between 35-45mmHg
PARAMEDIC
Procedure
1. Assembly the vent circuit and power on the vent.
2. Calculate the appropriate ideal weight tidal volume
i. Estimate patient’s height in feet and inches. Then, subtract the feet by 1 and multiply by 100, then take the inches and multiply by 10, then add these two values, the result is the patent’s ideal tidal volume (TV)
1. EX: Pt estimated height is 5’ 9”; (5-1=4, 4x100=400) then (9x10= 90) 400+90 = 490.
2. EX: Pt estimated height is 5’11”; (5-1=4, 4x100=400) and (11x10=110) 400+110= 510.
ii. Round up or down based on lung compliance.
b. Use tidal volume supplied by medical staff if patient already on a ventilator.
i. Advise staff of the limitations of our ventilator.
3. Ventilation rate (Vr or RR) is preset by the vent at 10 bpm for adult or 20 bpm for children.
4. FiO2 should be set to 60%
a. Increase to 100% if O2 saturation remains below 90% after a few minutes of ventilation.
5. Set the PEEP to 5cmH20
6. Pmax is preset to 30cmH20 and Pmin is preset to 3cmH20
a. These are alarms when the pressure is too high assess lung compliance and breath stacking
7. Attach the ventilator to the patient, confirm all filters and connections are secure.
8. Evaluate for proper lung compliance and ventilation.
a. Visible chest rise
b. Confirm wave forms, both pressure and volume
i. Keep pressure waveform primary to monitor lung compliance, but assessing volume intermittently is recommended.
c. Appropriate EtCO2 values between 35 and 45mmHg
d. Appropriate SpO2 between 93 to 98%
9. Common complications to monitor for:
a. Displacement of ET tube
i. Stop ventilator, extubate and re-intubate.
b. Obstruction of ET or airways
i. Use suction to clear the tube
ii. Consider bronchodilators for COPD/Asthma
c. Pneumothorax
i. Needle decompression if pneumothorax shows signs of becoming a tension pneumothorax
d. Equipment failure
i. Discontinue the ventilator and switch to BVM
e. Breath stacking
i. Disconnect the ventilator circuit
ii. Squeeze the chest wall, if feasible
iii. Re-connect the ventilator circuit
f. Pressure Alarms
i. If the high pressure alarms sound assess wave form for breath stacking
ii. Assess for lung compliance or the DOPE complications
iii. Consider increasing Pmax as a last resort.
Notes: If at any time the ventilator is not providing adequate ventilations to the patient discontinue and initiate manual ventilation with BVM.
If patient is already on a ventilator and we are transporting, provide medical staff the features of our ventilator to determine the proper settings. It is preferable to use the facilities transport ventilator and have their RT or RN ride to the hospital.
Post-intubation sedation
1. Interfacility transfer patients may already be sedated. As long as the medications being used are in the Treatment Guidelines or the state Scope of Practice they can be monitored.
2. In cases where sedation is necessary to allow the patient to be pain free or more comfortable with the tube it is advisable to medicate the patient. The following medications can be used:
A. MIDAZOLAM 5 mg. IV/IO q 10 minutes as needed.
B. KETAMINE 0.5-1.0 mg/kg slow IV/IO q 5-15 minutes as needed and tolerated. Caution advised if increased intracranial pressure is an issue. Consider MIDAZOLAM.
C. FENTANYL 50-150 mcg IV/IO q 5 minutes as needed for pain.
Documentation
1. It is important to document final ventilator settings in the narrative of your report.
2. The following should be recorded if possible:
a. Tidal volume
b. Minute volume
c. Ventilator’s set rate
d. Ventilator actual rate
e. PEEP
f. FiO2
g. Peak pressures
ALL LEVELS
Purpose
To establish guidelines for the use of O-TWO e500 portable ventilator by members of the Las Cruces Fire Department.
Policy
The guideline covers use of the LCFD portable ventilator for ventilation of intubated patients. The steps for setting up the ventilator and care instructions can be found in the OTWO-ESERIES-E500-User Guide located in File Center of Vector Solutions.
Procedure
1. Confirm the ET tube is properly placed, and patient is compliant with BVM ventilations.
2. Confirm ETCO2 is present via number and waveform to confirm tube is properly inserted.
a. EtCO2 preferred range is between 35-45mmHg
PARAMEDIC
Procedure
1. Assembly the vent circuit and power on the vent.
2. Calculate the appropriate ideal weight tidal volume
i. Estimate patient’s height in feet and inches. Then, subtract the feet by 1 and multiply by 100, then take the inches and multiply by 10, then add these two values, the result is the patent’s ideal tidal volume (TV)
1. EX: Pt estimated height is 5’ 9”; (5-1=4, 4x100=400) then (9x10= 90) 400+90 = 490.
2. EX: Pt estimated height is 5’11”; (5-1=4, 4x100=400) and (11x10=110) 400+110= 510.
ii. Round up or down based on lung compliance.
b. Use tidal volume supplied by medical staff if patient already on a ventilator.
i. Advise staff of the limitations of our ventilator.
3. Ventilation rate (Vr or RR) is preset by the vent at 10 bpm for adult or 20 bpm for children.
4. FiO2 should be set to 60%
a. Increase to 100% if O2 saturation remains below 90% after a few minutes of ventilation.
5. Set the PEEP to 5cmH20
6. Pmax is preset to 30cmH20 and Pmin is preset to 3cmH20
a. These are alarms when the pressure is too high assess lung compliance and breath stacking
7. Attach the ventilator to the patient, confirm all filters and connections are secure.
8. Evaluate for proper lung compliance and ventilation.
a. Visible chest rise
b. Confirm wave forms, both pressure and volume
i. Keep pressure waveform primary to monitor lung compliance, but assessing volume intermittently is recommended.
c. Appropriate EtCO2 values between 35 and 45mmHg
d. Appropriate SpO2 between 93 to 98%
9. Common complications to monitor for:
a. Displacement of ET tube
i. Stop ventilator, extubate and re-intubate.
b. Obstruction of ET or airways
i. Use suction to clear the tube
ii. Consider bronchodilators for COPD/Asthma
c. Pneumothorax
i. Needle decompression if pneumothorax shows signs of becoming a tension pneumothorax
d. Equipment failure
i. Discontinue the ventilator and switch to BVM
e. Breath stacking
i. Disconnect the ventilator circuit
ii. Squeeze the chest wall, if feasible
iii. Re-connect the ventilator circuit
f. Pressure Alarms
i. If the high pressure alarms sound assess wave form for breath stacking
ii. Assess for lung compliance or the DOPE complications
iii. Consider increasing Pmax as a last resort.
Notes: If at any time the ventilator is not providing adequate ventilations to the patient discontinue and initiate manual ventilation with BVM.
If patient is already on a ventilator and we are transporting, provide medical staff the features of our ventilator to determine the proper settings. It is preferable to use the facilities transport ventilator and have their RT or RN ride to the hospital.
Post-intubation sedation
1. Interfacility transfer patients may already be sedated. As long as the medications being used are in the Treatment Guidelines or the state Scope of Practice they can be monitored.
2. In cases where sedation is necessary to allow the patient to be pain free or more comfortable with the tube it is advisable to medicate the patient. The following medications can be used:
A. MIDAZOLAM 5 mg. IV/IO q 10 minutes as needed.
B. KETAMINE 0.5-1.0 mg/kg slow IV/IO q 5-15 minutes as needed and tolerated. Caution advised if increased intracranial pressure is an issue. Consider MIDAZOLAM.
C. FENTANYL 50-150 mcg IV/IO q 5 minutes as needed for pain.
Documentation
1. It is important to document final ventilator settings in the narrative of your report.
2. The following should be recorded if possible:
a. Tidal volume
b. Minute volume
c. Ventilator’s set rate
d. Ventilator actual rate
e. PEEP
f. FiO2
g. Peak pressures