If your patient is supposed to have tidal volumes of 500mls

[usalsfyre]

Just remember that the high pressure alarm is only sensing the pressure within the vent circut and NOT what is in the airways. Silence the alarms and check a plateau pressure before doing anything else. Within range and your golden over 30 and you need to make some adjustments.

Unfortunately, one of the shortcomings of our vent is the inability to check a pPlat.

 

[MSDeltaFlt]

Exactly what we did, we simply allowed higher pressures while we did it.

How much higher? Pts do have limits as do providers. What was the pts? What was yours? There's a big difference between working a vent and managing it. Falls in line with the philosophy of giving pain meds and treating pain. Both are vastly different.

 

[Aidey]

1. Unplug it from the wall
2. Throw it in the deepest body of water you can find
3. Watch it sink to the bottom
4. Forget you ever used it (which is like trying to forget being molested as a child, but you have to start somewhere.)
5. Buy a monitor from any other company to replace it
6. Forget phillips even makes monitors

Tell us how you really feel, lol!

 

[Veneficus]

Tell us how you really feel, lol!

For free, I really should start charging for my knowledge and experience.

I worked at a hospital that was a phillips testing center for 4 years. I have dealt with everything from their latest CT to the portable monitors.

The CTs are great, but they need to get out of the portable monitor market. The only thing worse than the monitors is the support for them.

They make things that don't work or aren't practical then charge for the fix. (I suspect it is the end user that found the problem, not the company)

 

[usalsfyre]

How much higher? Pts do have limits as do providers. What was the pts? What was yours? There's a big difference between working a vent and managing it. Falls in line with the philosophy of giving pain meds and treating pain. Both are vastly different.

Not quite sure what your getting at here. The patient had been under ventilating for an unknown amount of time, probably at least one hour. The pressure upon increasing the Pmax was around 55cmH2O, he stayed at this level for less than five minutes while we treated the underlying issues when it dropped back to where it had been prior to the distress starting, however the patient was very fatigued on our arrival and I didn't feel we were doing him any good continuing to deliver inadequate tidal volumes. I wasn't suggesting by any means he be allowed to "hang out" at vastly higher airway pressures for the transport.

I agree completely there is a huge difference between managing a vent (or a patient for that matter) and simply pushing buttons.

 

[MSDeltaFlt]

Not quite sure what your getting at here. The patient had been under ventilating for an unknown amount of time, probably at least one hour. The pressure upon increasing the Pmax was around 55cmH2O, he stayed at this level for less than five minutes while we treated the underlying issues when it dropped back to where it had been prior to the distress starting, however the patient was very fatigued on our arrival and I didn't feel we were doing him any good continuing to deliver inadequate tidal volumes. I wasn't suggesting by any means he be allowed to "hang out" at vastly higher airway pressures for the transport.

I agree completely there is a huge difference between managing a vent (or a patient for that matter) and simply pushing buttons.

PIP's around 30, I don't worry TOO much over. Depends on pt condition/diagnosis, flow rate, tube size, etc. However, 55 is definitely beyond my comfort level as is yours apparently. That's what I was getting at. Good job on troubleshooting since pts PIP's returned to baseline pretty quickly. No real need in telling me what the problem was because you fixed it. Good job.

 

[KellyBracket]

It's the only button I can find on every piece of equipment in the ED...

Seriously, though, it's not all about the tidal volumes. Are you familiar with terms like "ARDS-net protocol," "permissive hypercapnea," or "lung-protective ventilation?" It's pretty interesting stuff, but it'll probably seem crazy if you haven't heard about it before.

The idea is this - it's all about the oxygen, especially in stiff, damaged lungs. If the pressures are getting too high, you bring down the tidal volumes to protect the lungs from the trauma. You let the CO2 drift up, while fiddling with other things to keep the PaO2 acceptable.

Occasionally, the vent alarms should make you think. Far more often, of course, you should just hit the damn silence button!

Edit: I managed to skip a number of posts the first time I read the thread - I think it's pretty clear people have heard of ARDS-net!

 

[DrankTheKoolaid]

Lol yup I made flash cards of ArdsNet protocols for all our rigs as reference

 

[jjesusfreak01]

I know the answer!

Push "Silence Alarm" button until alarms are silent. Repeat as often as necessary. Much success!

I did this today, tons of fun. Granted, my medic fixed the vent problems, but I still pushed the silence button!

 

[18G]

Thought this was a good read and relevant to the discussion for troubleshooting high vent pressures.

http://lifeinthefastlane.com/2010/07/pulmonary-puzzle-014/

 

[DrankTheKoolaid]

Yup excellent blog he has. Thats were i found the crapton of podcasts i listen to. He also has great printable ardsnet cheat sheets