too unstable to bag??

[divinewind_007]

ok...got dispatched to the local ER for a emergency transfer to level 1 trauma center. got over there to the icu and they asked if we had a portable vent. we dont carry portable vents...i dont know of any service within 100 mile radius of nashville that does. so they said they were going to call someone else because they were too unstable to bag. 5 minutes later after we had left they called back and said they redid her blood gases and she was now stable enough to be bagged. i have never heard of someone being too unstable to bag, and futhermore in my opinion if they were that unstable they should have been flown. it is 45 minutes running emergency to this hospital or 10-15 min flight time. :wacko: but anyway we transported her fine. no probs. in route. she had a stroke previoulsy and was basically going down hill. white count was up and she had spiked a temp. thats why she was sent out. so what do yuns think...have you ever heard of someone too unstable to bag??

 

[Jon]

Were you a BLS or ALS service? (and are you a BLS or ALS provider?)

Vents have many settings Assist, Assist/control then settings like PEEP, tidal volumes, cycle times, sighs, etc.... a good portable vent duplicates many of the functions of the "bedside" vent.

An AutoVent 2000/3000 IS NOT A VENT. It is a BVM on a Timer. It has no settings other than breaths per minute and tidal volume.... and is barbaric, in that it forces air in every X seconds.... no chance for a patient to control the respirations by taking their own breaths.

Bagging someone for 45 minutes is CRAZY.... All tidal volumes and rates are "guestimates" (if that) by the care provider. It also will cause a hand cramp. And what if the provider "forgets" to ventilate a few times... or displaces the tube because they aren't paying 110% attention to ventilating the patient???

If you are transporting vent patients a lot from the hospital - see if you can get a vent for the transport rig. See if the hospital might be willing to have a portable vent availible for your use for vent transports.... it can't hurt.

 

[divinewind_007]

Were you a BLS or ALS service? (and are you a BLS or ALS provider?)

Vents have many settings Assist, Assist/control then settings like PEEP, tidal volumes, cycle times, sighs, etc.... a good portable vent duplicates many of the functions of the "bedside" vent.

An AutoVent 2000/3000 IS NOT A VENT. It is a BVM on a Timer. It has no settings other than breaths per minute and tidal volume.... and is barbaric, in that it forces air in every X seconds.... no chance for a patient to control the respirations by taking their own breaths.

Bagging someone for 45 minutes is CRAZY.... All tidal volumes and rates are "guestimates" (if that) by the care provider. It also will cause a hand cramp. And what if the provider "forgets" to ventilate a few times... or displaces the tube because they aren't paying 110% attention to ventilating the patient???

If you are transporting vent patients a lot from the hospital - see if you can get a vent for the transport rig. See if the hospital might be willing to have a portable vent availible for your use for vent transports.... it can't hurt.

yes, were a als service. around this area nobody buys portable vents. the other service i work for doesnt have them and when we transport by ground to the nearest level 1 trauma center we have a hour and 30 minute transport. we send a extra person to help with ventilations. but none of the counties around here will buy any...too much money they say. i know the benefits of having a vent...but a vent and bagging someone actually does the same thing...correct? so tecinally...can you be too unstable to bag?

 

[ffemt8978]

Bagging someone for 45 minutes is CRAZY.... All tidal volumes and rates are "guestimates" (if that) by the care provider. It also will cause a hand cramp. And what if the provider "forgets" to ventilate a few times... or displaces the tube because they aren't paying 110% attention to ventilating the patient???

Come to my neck of the woods. Bagging someone for 45 minutes in not all that uncommon, given our transport times. I agree with your assessment about the possible complications of bagging for that long, but the alternative would be to transport a corpse.

 

[TTLWHKR]

Just 45 minutes? That's all? BWAAAHAHAHAHA...

Try doing that in a wooden box on wheels, pulled by an ATV, for three hours.

 

[MMiz]

Around here that patient would have been taken by a Critical Care team.

We have BLS, ALS, and Critical Care teams. It's either a MICU/Critical Care unit, the name depends on the service. Critical Care Paramedics go though the University of Maryland-Baltimore Critical Care Critical Care Transport program.

In my one county we have probably more than five private services that could offer the service. I know it's not the same everywhere.

 

[coloradoemt]

Ok everyone... I am sure divinewind knows about the different levels of transport. What the question is, ---------> has anyone ever heard of someone being to unstable to bag???? <-------- I am curious as well as I have never heard of it but then again I only have 6 months in Critical care and in the ED.

 

[MMiz]

I got off track quite a bit on that one. I mean to say that the patient would have gone via Critical Care simply of the extended transport time.

I'm not sure how long is too long, but I would think that any patient that requires bagging for transport would be put on a vent of some kind.

 

[Jon]

Around here... many ALS providers have "autovents" - simple timer devices for codes, etc. Very nice if you are working a code with 2 or 3 people.

Some transport companies try to pass an AutoVent off as a vent... others have REAL vents.

My company has both ALS and SCTU (Specialty Care Transport Unit) rigs. The SCTU is a "nurse truck" or Critical Care transport rig... PHRN as the provider. They have some advanced stuff they get to play with (A-lines, etc). New Jersey also requires that all ALS transports in NJ are done by a RN I think the vent is kept on all units (ALS/SCTU) and all our rigs are certified as ALS rigs in PA, and SCTU rigs in NJ.

Jon

 

[TTLWHKR]

I've never bagged anyone on an interfacility transfer, any service I've worked for has always used some type of auto vent.

 

[divinewind_007]

I got off track quite a bit on that one. I mean to say that the patient would have gone via Critical Care simply of the extended transport time.

I'm not sure how long is too long, but I would think that any patient that requires bagging for transport would be put on a vent of some kind.

we dont have critical care trucks around here. actually..i dont think the state of tennesse recognizes critical care paramedics...at least the last time we checked they hadnt. and most people just wont spend that kind of money on a vent. our knoxville service has one vent there but we are in the nashville area and we dont have one. but i dont know of any county services having them...actually our knoxville service is the only private i know of having them. all the other private services down here barely have trucks that would start. luckily this service actually buys us good equipment otherwise i would not have left my county service. the pay is not too bad neither.