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 2014 2

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 2014 3

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 2014 4

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. 2014 5

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 2014 6

7. AutoVent 3000 Contraindications Children who have not reached their 9 th birthday THIS APPLIES TO BOTH “CHRONICALLY VENTILATED” AND “SCENE OF AN EMERGENCY” PATIENTS Patient is in Cardiac Arrest If patient is “bucking the tube” 2014 7

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 8 2014

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 9 2014

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 2014 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 11 2014

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 12 2014

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 13 2014

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 2014 14

15. AutoVent 3000 Things to Remember (Continued) Have two ALS providers check and verify the ventilator settings Any acutely ill or injured breathing patient at the “scene of an emergency” shall be manually ventilated NOTE: This is referring to patients who are not chronically ventilated. 15 2014

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 2014 16

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 2014 17

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 2014 18

19. AutoVent 3000 AutoVent 3000 Tutorial (9:25 min) AutoVent 3000 Tutorial Instructor Demo Practice 2014 19

20. 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 2014 20 King Vision Laryngoscope

21. 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 2014 21

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 2014 22

23. King Vision Laryngoscope General Technique Not the same as with direct laryngoscopy Three fingers and slide into place 23 2014

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 24 2014

25. King Vision Laryngoscope Technique for Channeled Blade Insert tip of blade into Vallecula and gently lift until vocal chords come into view 25 2014

26. King Vision Laryngoscope Technique for Non-Channeled Blade Insert tip of blade and lift epiglottis until vocal chords come into view 26 2014

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 2014 27

28. King Vision Laryngoscope King Vision In-Service Guide (2 min) King Vision In-Service Guide Instructor Demo Practice 2014 28

29. LUCAS Chest Compression System 29 2014

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 30 2014

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 31 2014 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 32 2014

33. LUCAS Chest Compression System Allows for one person to be a dedicated scribe This will improve the accuracy of the patient data 33 2014

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 34 2014

35. LUCAS Chest Compression System LUCAS Demo (13:08 min) LUCAS Demo LUCAS vs. Manual CPR (4:37 min) LUCAS vs. Manual CPR Instructor Demo Practice 2014 35

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 9 th birthday Pt bucking the tube (in respiratory distress) 36 2014

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 37 2014

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 38 2014