Mechanical Ventilation Vid 1

Hello, everyone, and welcome to mechanical ventilation one on one.

My name is Kwabena.

This presentation is meant to provide some basic education on

ventilator management, so let's get into it.

What is the ventilator?

First and foremost, it is a machine one of this

useful work in this case, respiratory work in a bit

more detail.

It's a flow generate and pressure regulating, microprocessor controlled, electrically

powered usually machine.

Many types of ventilators exist, and we will introduce a

few of them.

But on Lee, talk about one class of ventilators.

Home ventilators are those used for chronically ventilated patients.

We rarely see these in our facility.

However, If you were to work in ST Amant, Riverview

or Deer Lodge, you would have encountered one of these

before a tw some point.

Those shown in the image here are the Philips trilogy

and the Puritan Bennett 5 60.

Those are probably the most commonly used ventilators that you

see for chronically ventilated patients below the um, home ventilators

are the hospital ventilators.

Most of you are familiar with these, um, these air

used for critically ill patients.

So let's jump into what exactly these hospital ventilators are,

how they're separated within the hospital ventilators.

There's further subdivision into bedside ventilators and transport ventilators.

Bedside ventilators are predominantly font of the I.

C U setting transport ventilators, as the name implies air

used for transport or short term ventilation.

This is what most nurses in the E.

D are used to see him, at least the same

hospital. Some hospitals actually have bedside ventilators in their resource

rooms. They may also be seen in the heart cath

lab. Due to the short term, the short term nature

off patients being there by our discussion today will primarily

focus on transport ventilators.

Because this discussion is about the emergency department.

While we have both of these in the facility, it

may interest you to know that even among the transport

ventilators, there is a slight differentiation between among the Hamilton

ventilated Hamilton ventilators.

We use the T.

One is an inter facility ventilator, and the C one

is an intra facility ventilator.

This is the reason you see into facility transport exclusively

with the T one Ventilators, which comes with the usually

has a red case, and I think there's some with

the black case and as well for the purposes of

this discussion, please consider both of these ventilators as the

same. Their functionality and inner workings will not differ from

a nursing perspective.

So now that we've kind of differentiated some off the

ventilators, let's do a little quiz to see how what

you remember.

So follow along.

And if you have to pause the video, pause it

and try to answer the question.

So the first question is, ventilators are always electrically powered.

True or false, Answer is false.

Question number two.

The inner workings between a C one and the T

one are exactly the same.

That is true.

Remember that the inter facility and intra facility ventilators Onley

different where they're used and how robustly they're built.

The molds that they they offer, um, the extra features

that they offer.

Actually, all the same, the Hamilton G five ventilator can

be used as a transport ventilator.

False. And the predominant reason for this is that Hamilton

G five ventilator has a battery that lasts only for

a very short period of time.

So you cannot go far with that ventilator at all

moving on.

So why do we ventilate there?

Ventilation attempts to correct one of these respond to failure

or impending respiratory failure.

This can be separated into the following three situations.

Inability to maintain an airway, decreased oxygenation or increased carbon

dioxide retention.

But before going on, let's briefly see how the respiratory

system works.

If we're to risk to understand what respiratory failure actually

is, we will start off with a basic description off

some respiratory anatomy and physiology.

Don't now I would I would how I would like

to go through this and describe all of the anatomy,

but there is a short video here that I think

that's a much better job of doing that than I

do. So I would ask all of you to go

on YouTube and type in US Moses dot or GE

and go through the respiratory anatomy and physiology video.

Feel free to pause this and come back.

So that was a brief description or discussion office party,

anatomy and physiology.

An excellent video bars, Moses or GE.

In addition to that, I think it is worthwhile to

know that other parts of the respecting system not talk

about in the video is the chest wall.

This is particularly important when we talk about ventilation due

to the effects off lung mechanics before we go into

that know that this consists of the sternum, ribs and

cartilage that when I say that I mean the chest

wall. The chest wall, um, also consists off seven true

ribs, 3 to 10 false ribs, which are ribs 3

to 10, not the number of ribs, but does the

placement of them and to floating ribs.

Now let's discuss some mechanics mechanics as the video.

As the video mentioned, inspiration is achieved when the diaphragm

contracts moved down and the chest wall moves up and

out to create a negative pressure in the chest cavity.

The reverse causes expiration.

Why is this important compliance?

And that's the biggest reason that we run into a

lot of alarms and we'll discuss this later on.

In this discussion, compliance is defined us.

The amount of volume over the amount of pressure so

is measured in Emil's per centimeters of water.

Not only do we need to take into account the

lung tissue when ventilating, we also need to consider the

effect of the chest, wall and abdomen, for that matter.

So in this discussion, let's take a look at a

new example, a patient with a B M I of

45 centimeters per kilogram.

We'll have significantly less compliance compared to a patient with

a B M I off 20 centimeters per kilogram.

Therefore, with inappropriately set volumes, you can expect more high

pressure alarms and low expire many volumes or low minute

volume alarms.

That is why compliance becomes so important because it actually

is what will provide as the feedback to the ventilator.

I hope that that that makes sense.

If you don't get that, please rewind the video and

watch that part of it.

And here it's a summary off the path off oxygen

and carbon dioxide from the mouth to hemoglobin.

Keep in mind that while ventilating, our goal is to

achieve improved oxygenation and ventilation.

And this is the passion.

This is what ventilators have to mimic with complicated algorithms,

which create molds and measure parameters.

My first, why do you even need to know this?

This is a study from 2000 and 12 and describes

the length of times patients and a tertiary hospital in

a tertiary hospital.

Emergency department can expect to remain in the e.

D. Prior to being transferred to the I c u.

This means for the length of time it is for

this length of time.

It is up to the emergency department nurse, the RT

and physician to provide that care similar to what will

be provided in the i.

C u.

Realistically, just by way of numbers, the eating nurse will

have the most interaction with the patient.

Therefore, it is only logical that the eating nurse have

a grasp off every aspect of care that the patient

is receiving, especially with the when it comes to the

ventilator. Now, if you look at the study, it says

the patients receiving mechanical ventilation exclusively had a medium length

of state off 4.6 hours in the e d.

And this was this was this was look for emergency

departments in Toronto that they looked at.

It also says that emergency department to I C.

U times less than two hours have been associated with

shorter days on the ventilator and then I see you,

which makes sense because the amount of time that a

patient spends away from the I C.

U. When they need to be a nice you will

mean the further deteriorate.

Usually from a ventilation standpoint, it means a longer period

of time where they are not on settings that they

may need to be on that being lung protective strategy

a R D s protocol, maybe requiring to be prone,

whatever the case is, alarms may also not be addressed

appropriately. I've seen Barnabus Hospital we saw, on average, off

20 ventilated patients monthly in our emergency department from May

2019 to August 2020.

A little bit of math there.

That leads to 92 hours of exposure to ventilators every

month in the emergency department.

Now, if you had 92 hours off exposure to a

ventilator every month and did not know how to use

that ventilator or even how to troubleshoot that ventilator, I

think that would be a problem.

So I coined this term convent safe.

What events safe means the wall responded to.

The therapy will continue to maintain a minimum Q two

h van checks schedule.

We still do need emergency department nurses to be safe

around ventilators.

And with that safety, what that is referring to is

understanding ventilator and the basics of ventilation, the alarms and

troubleshooting and interventions what to do when something goes wrong,

because that's exactly when most people will panic.

If we had a stable ventilator, we wouldn't have to

be having this course.

However, we all know our patients always change course, always

deteriorate, and we need to be able to respond to

that. This is the first half off this video.

Now let's take a look at a quiz.

Mechanical Ventilation Vid 1

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