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New EMS Equipment T raining

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

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  1. New EMS Equipment Training AutoVent 3000 King Vision Video Laryngoscopy LUCAS CPR

  2. 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

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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”

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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

  19. AutoVent 3000 • AutoVent 3000 Tutorial (9:25 min) • Instructor Demo • Practice

  20. 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

  21. 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

  22. 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

  23. King Vision Laryngoscope • General Technique • Not the same as with direct laryngoscopy • Three fingers and slide into place

  24. 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

  25. King Vision Laryngoscope • Technique for Channeled Blade • Insert tip of blade into Vallecula and gently lift until vocal chords come into view

  26. King Vision Laryngoscope • Technique for Non-Channeled Blade • Insert tip of blade and lift epiglottis until vocal chords come into view

  27. 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

  28. King Vision Laryngoscope • King Vision In-Service Guide (2 min) • Instructor Demo • Practice

  29. LUCAS Chest Compression System

  30. 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

  31. 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

  32. 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

  33. LUCAS Chest Compression System • Allows for one person to be a dedicated scribe • This will improve the accuracy of the patient data

  34. 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

  35. LUCAS Chest Compression System • LUCAS Demo (13:08 min) • LUCAS vs. Manual CPR (4:37 min) • Instructor Demo • Practice

  36. 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)

  37. 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

  38. 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

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