03/21/2020
Timely and important
・・・
With an increase in COVID19 intubation and ventilator discussions, I wanted to revisit this topic.
VENT ALARMS:
What do you do when the VENT alarm goes off? Many times it's not serious, nor needs intervention. But be cautious... ALARM FATIGUE is real and what happens when your patient starts to CRASH ON THE VENT?
Think "DOPE-AAA"
1. DISLODGED/DISCONNECTED: evaluated ETT and oral exam. Look at circuit & tubing connections. May need to reintubate.
2. OBSTRUCTION: secretions and plugging. Mucus plugs can kill. Have suction ready. .
3. PNEUMO/PLEURAL EFFUSION: listen for breath sounds, ultrasound/cxr. Clinical diagnosis = finger thoracostomy/NCD.
4. EQUIPMENT: any equipment failure, vent/power failure, cuff leaks etc.
5. ASPIRATION: consider on the differential.
6. ASTHMA (bronchospasm): treat in usual fashion-->O2, inline nebs, epi, magnesium, ketamine, steroids, fluids, terbutaline
7. ANAPHYLAXIS: treat in usual fashion.
COVID19: proper PPE is needed. Negative pressure rooms if available. Thick and copious secretions have been documented. Have primary and backup sucks available. Know where the difficult intubation kit is. Have a bougie and surgical airway equipment ready. .
KEY: great advice given to me, if unsure why patient is crashing or cardiac arrest, REMOVE patient from vent and bag them. Take the ventilator out of the equation.
D.O.P.E.-AAA
RTs are your friends! .
FIGHT ALARM FATIGUE! . 📸straitstimes.com