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New EMS Equipment T raining. AutoVent 3000 King Vision Video Laryngoscopy LUCAS CPR. Goals. 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

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new ems equipment t raining

New EMS Equipment Training

AutoVent 3000

King Vision Video Laryngoscopy

LUCAS CPR

goals
Goals
  • 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
  • ALS Providers – To become proficient with the use and set-up of the AutoVent 3000, King Vision Laryngoscope, and LUCAS Chest Compression System
outline
Outline
  • 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
autovent 3000
AutoVent 3000
  • Chronically Ventilated Patients
    • Indications
        • Point of origin could be from anywhere:
          • Long term facility
          • Home
          • Outpatient setting
          • Hospital
                  • AND
        • Reason for transport isn’t a respiratory problem
autovent 30001
AutoVent 3000
  • Indications (Continued)
    • Patient’s ventilator settings are:
      • PEEP less than or = to 10 cmH2O
      • Peak pressures are less than or = to 30
          • AND
    • No changes in the patients normal ventilator settings are required during the transport.
autovent 30002
AutoVent 3000
  • Scene of An Emergency Ventilated Patient
    • Indications
      • A non-chronically ventilated patient who is in respiratory arrest.
      • A SECOND PROVIDER (ALS or BLS) IS REQUIRED TO ASSIST WITH PATIENT CARE
autovent 30003
AutoVent 3000
  • Contraindications
    • Children who have not reached their 9th birthday
      • THIS APPLIES TO BOTH “CHRONICALLY VENTILATED” AND “SCENE OF AN EMERGENCY” PATIENTS
    • Patient is in Cardiac Arrest
    • If patient is “bucking the tube”
autovent 30004
AutoVent 3000
  • What does it mean if the patient is “Bucking the Tube?”
    • The patient could be regaining consciousness
    • The patient is in respiratory distress
autovent 30005
AutoVent 3000
  • Signs of respiratory distress in a ventilated patient
    • 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
autovent 30006
AutoVent 3000
  • How To Use the AutoVent 3000
      • Select Breaths Per Minute (BPM)
      • Select WHITE Adult setting
        • 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
autovent 30007
AutoVent 3000
  • What is PEEP?
    • Positive End Expiratory Pressure
      • Constant pressure that keeps the alveoli open
      • Increases the volume of gas remaining in the lungs at the end of expiration
        • Improves gas exchange
      • Average healthy adult has PEEP of 5
autovent 30008
AutoVent 3000
  • Destination
    • 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
autovent 30009
AutoVent 3000
  • Who can use the AutoVent?
    • 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
autovent 300010
AutoVent 3000
  • Things to Remember
    • Always treat the PATIENT
      • Maintain situational awareness when managing the AV3000
    • ALWAYS default to what you know – USE THE BVM IF PROBLEMS ARISE WITH THE VENTILATOR
autovent 300011
AutoVent 3000
  • Things to Remember (Continued)
      • Have two ALS providers check and verify the ventilator settings
      • Any acutely ill or injured breathingpatient at the “scene of an emergency” shall be manually ventilated
      • NOTE: This is referring to patients who are not chronically ventilated.
autovent 300012
AutoVent 3000
  • Things to Remember (Continued)
      • Only hand tighten the fittings
      • 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
autovent 300013
AutoVent 3000
  • Things to Remember (Continued)
      • 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
autovent 300014
AutoVent 3000
  • Autovents are on M712, M715, M703 and PE732
    • They will not be placed on any additional units
  • Restocking
    • Email Jon Fiedler at MCFRS.EMSSupplies@montgomerycountymd.gov
  • Troubleshooting/Broken Unit
    • Contact EMSDO
autovent 300015
AutoVent 3000
  • AutoVent 3000 Tutorial (9:25 min)
  • Instructor Demo
  • Practice
king vision laryngoscope
King Vision Laryngoscope
  • 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
king vision laryngoscope1
King Vision Laryngoscope
  • General Info:
    • 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
      • Kit includes
        • (1) Digital Display
        • (3) Channeled Blades
        • (1) Non-Channeled Blade
    • Will be placed on AFRA’s and chase cars/medic units
king vision laryngoscope2
King Vision Laryngoscope
  • Cost
    • Kit $927.00 (Display and 4 blades)
    • Replacement blades $24.39 (channeled and non-channeled)
  • Restocking
    • Initial blades will be purchased by the EMS Section
    • Additional restocking done through normal Boundtree ordering process
king vision laryngoscope3
King Vision Laryngoscope
  • General Technique
    • Not the same as with direct laryngoscopy
    • Three fingers and slide into place
king vision laryngoscope4
King Vision Laryngoscope
  • Channeled Blades
    • Does not require stylet
    • Size equivalent to a 3 Mac
    • More popular choice
  • Non-Channeled Blades
    • Useful in patient with small anatomy, or other circumstances where you need more room to work.
    • Requires stylet or bougie
king vision laryngoscope5
King Vision Laryngoscope
  • Technique for Channeled Blade
    • Insert tip of blade into Vallecula and gently lift until vocal chords come into view
king vision laryngoscope6
King Vision Laryngoscope
  • Technique for Non-Channeled Blade
    • Insert tip of blade and lift epiglottis until vocal chords come into view
king vision laryngoscope7
King Vision Laryngoscope
  • 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
king vision laryngoscope8
King Vision Laryngoscope
  • King Vision In-Service Guide (2 min)
  • Instructor Demo
  • Practice
lucas chest compression system1
LUCAS Chest Compression System
  • Provides consistent CPR independent of:
    • Transport conditions
    • Provider fatigue
    • Variability in the experience level of the provider
  • Based on the international guidelines for CPR
lucas chest compression system2
LUCAS Chest Compression System
  • Age Limits
    • None, as long as the patient fits
  • 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

Should Fit

Probably Not

lucas chest compression system3
LUCAS Chest Compression System
  • Set at 102 compressions per minute
  • Can defibrillate while in use
    • BE SURE TO PAUSE THE LUCAS EVERY 2 MINUTES TO REASSESS
lucas chest compression system4
LUCAS Chest Compression System
  • Allows for one person to be a dedicated scribe
    • This will improve the accuracy of the patient data
lucas chest compression system5
LUCAS Chest Compression System
  • IMPORTANT TO REMEMBER:
    • Ensure that the LP15 is in “Paddles” mode so that the CPR information can be recorded into CODESTAT
lucas chest compression system6
LUCAS Chest Compression System
  • LUCAS Demo (13:08 min)
  • LUCAS vs. Manual CPR (4:37 min)
  • Instructor Demo
  • Practice
review questions
Review Questions
  • Autovent
    • When can we use the AutoVent?
      • When you can match the patients own ventilator settings
        • Peak pressures < than or = to 30
        • PEEP < or = 10
    • 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)
review questions1
Review Questions
  • King Vision
    • What is the minimum age for use?
      • 18 years old
    • What is the main difference in stylet use between the 2 types of blades?
      • 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
review questions2
Review Questions
  • LUCAS CPR Device
    • Can you defibrillate while the LUCAS is on?
      • Yes
    • What is the age limit for the LUCAS?
      • 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