Thursday, February 27, 2014

ASV & ABGS: Adjusting %Min Vol Based on Arterial Blood Gases


Adjust %Min Vol setting during ASV in regards to ABG analysis

I often get asked how do I adjust my settings during Adaptive Support Ventilation based on my arterial blood gas (ABG) results.
 Above is a snap shot of a flow chart from my new ASV guide I'm currently working on. 
This chart provides a brief overview of adjusting the percent minute volume setting based on ABG results, the guide will provide more details. 

RELATED LINKS


Monday, February 3, 2014

A Synopsis of Strategies in Difficult Intra-Operative Ventilation


Image from: http://www.esicm.org

“Strategies in Difficult Intra-Operative Ventilation” was a continuing education course originally presented at the 2012 American Academy of Anesthesiologist convention. 

Now the course is available online through the ASA website for continuing education units. I would not recommend this course for the ICU practitioner because it overviews strategies that we practice daily or weekly, however for the anesthesia provider that is not familiar with lung protective strategies the course may be beneficial. 

Below is a synopsis of the course and a hyperlink to the website. 

Wednesday, January 22, 2014

Updated Adaptive Support Ventilation (ASV) Book Coming

ASV Least WOB Screen Identifying Safety Rules

Yes, I made a mistake my first ASV guide was a basic synopsis and protocol of Adaptive Support Ventilation.

This frustrated you (my readers), so I decided to take it off Amazon and work on a more in-depth version.

So please be patient, this guide will be available soon.




Tuesday, January 7, 2014

What the Sales Guy Won't Tell You. Why You Won't Save $200,000 in Anesthetic Agent

In a previous post "How to Save $200,000 in Anesthetic Agent" I demonstrated how one anesthesia department could save close to a quarter of a million dollars by changing efficiency. I presented this many times using a mathematical modeling tool (Anesthesia Agent Analysis. S. Richey & R. Hazlett)  a colleague and myself created. 

Anesthesia Companies have used this same modeling in their marketing and device claims in regards to saving anesthetic agent. 

Example 1: Draeger Medicals "Low Flow Wizard" 
This is a decision support tool to help practitioners feel comfortable with using low to minimal flow anesthesia. 




Example 2: GE Healthcare's "ecoFlow"
This is GE's product to compete with & similar to the Low Flow Wizard (Draeger's was released first).

ecoFlow




However, these tools are not novel. 

Dr. James H. Philip, the creator of "Gas Man" [1] has been a advocate, and teacher of minimal flow & closed system anesthesia for almost two decades. 
Dr. Philips software & courses demonstrate that one can provide minimal flow anesthesia using any modern day anesthesia delivery system, not just the Draeger Apollo or GE Avance with ecoFlow. 

The key factor in minimal flow anesthesia is patient safety, which translates to patient monitoring, which is not accomplished by the Low Flow Wizard or ecoFlow. These tools only look at the anesthesia device (gas uptake & system leaks) not hemodynamic status, metabolic demand, SpO2, EtCo2, rebreathed gas, etc. 

Additionally, the medical device companies marketing claims provide a false prediction of actual cost savings related to decreased anesthetic agent usage. 

In the following post I will present why you will not obtain these savings.

Thursday, December 5, 2013

Why I Do Not use Draeger Ventilator Simulators



I get asked often why do I not use other simulators in my videos.
Specifically the Draeger ventilator simulators.
It is very simple, they cannot perform the functions I need to teach modes of ventilation & pulmonary mechanics as demonstrated in the video. 

Saturday, November 16, 2013

Adaptive Pressure Control Ventilation Video Series




After finishing my videos on the mathematical models of PC-CMV, I decided to create videos on Adaptive Pressure Control (APC) ventilation.

These videos compare and contrast between APC, VC, & PC during changes in pulmonary dynamics & various patient conditions/ interactions.

Tuesday, November 12, 2013

Incorporating Proportional Assist into Ventilator Protocols

Image 1: PAV+ Work of Breathing bar. 


PAV+ may be used for the initial mode of ventilation during the acute phase of mechanical ventilation. However, from my experience I have had the most success and efficiency with PAV+ utilizing the mode to rest patients after a failed spontaneous breathing trial. After reviewing the literature it is still unclear the best way to wean or liberate a patient from PAV+. However, a traditional T-piece trail has been supported by many peer reviewed journals, so at my institution we still use a 30 minute to one hour T-Piece trial to screen patients for extubation.
How to incorporate PAV+

Tuesday, November 5, 2013

The Fastest Ambulance on TED


Whats in your pockets? Are you a Prepper or Macgyver?

In a previous post (The RT Hoarder) I mention that I carry very little on me when I'm at work. 
Yes, I believe in being prepared, however I try to practice the "Macgyver" philosophy [1], versus the "Dooms Day Prepper" mentality [2].

This post presents my Everyday Carry (EDC) [3] from when I first started in the field of respiratory therapy to what I carry now. I will describe "what is in my pockets" and why, also notice the progression throughout the years.

What items do I get rid of & what do I always need to practice the profession?

EDC as a RT student & new graduate.