coding a vented patient

[sjt9721, BSN, RN]

...I hear what your saying, I am not saying that you have to stop compressions to give breaths but giving a breath while a compression is being delivered will not go in or the compression will be altered. There still needs to be synchrony (proper timing) to maximize the effect of CPR.

-Smiley

Okay, now I'm getting you. I took your words to the extreme!

[SOMA]

Thanks, that is why a minimally experienced nurse should not take care of a vented patient in a code situation. chest compressions were done while the vent was still on. How much damage can that do

[cardiacRN2006, ADN, RN]

Thanks, that is why a minimally experienced nurse should not take care of a vented patient in a code situation. chest compressions were done while the vent was still on. How much damage can that do

Was there no RT in the room???

[XB9S, BSN, MSN, EdD, RN, APN]

Thanks, that is why a minimally experienced nurse should not take care of a vented patient in a code situation. chest compressions were done while the vent was still on. How much damage can that do

If the patient is in cardiac arrest in an ICU then they are pretty sick anyway and the chances of survival poor, how much damage can this do, I doubt that it will make a huge difference to the overall outcome.

From what I understood the rationale for taking off the vent is that most vents have pressure limits set and if you are doing chest compressions then you are increasing thoracic pressure and the vent will not deliver the ventilations because it will sense an obstruction so alarm.

By doing BVM ventilations you are better able to deliver the ventilations with the compressions as you are doing it manually therefore you are able to get some oxygenation.

So thinking about the reversible causes of cardiac arrest and hypoxia being one of them, then in order to exclude and treat reversible causes you must be able to ventilate adequately.

[joeyzstj, LPN]

One of the primary reasons that you shouldnt code someone on a ventilator is that with pressure and alarm limits being set on the vent it will discontinue delivering a breath once a pre-set pressure limit has been hit. As an example, if I have my Peak Airway pressure Alarm limit set at 60 cmH20, this tells the ventilator that if the pressure limit is reached to STOP trying to ventilate the patient and go into exhalation. If you think about it, when you are performing chest compressions the repeated pressure on the lungs is going to set the limit off almost every time subsequently causing the patient to no be ventilated. As someone else mentioned, asynchronous ventilation is often needed in a code with chest compressions. With an advance airway (et tube) you really dont need to pause while the person performing chest compression presses, but sometimes it is necessary to give breaths in an asynchronous manner depending on how easy it is to ventilate the patient. In my hospital and any other hospital I have been to we remove them and bag them with 100% FiO2.

Another VERY important reason this should be done in a code is due to the use of a RESCUE-POD that is placed on the ambu bag. Studies have shown that ventilation and compression can cause an entrapment of pressure/volume in the chest ultimately causing and increase in intrathoracic pressures and pressure on the great vessels. A rescue-pod helps to decrease intrathoracic pressures and ultimately improve survival rates of coding patients.

[RNJim22]

What is a "Rescue-pod?" I am unfamiliar with this.

Thanks,

Jim

[Cathlabnurse46]

One of the primary reasons that you shouldnt code someone on a ventilator is that with pressure and alarm limits being set on the vent it will discontinue delivering a breath once a pre-set pressure limit has been hit. As an example, if I have my Peak Airway pressure Alarm limit set at 60 cmH20, this tells the ventilator that if the pressure limit is reached to STOP trying to ventilate the patient and go into exhalation. If you think about it, when you are performing chest compressions the repeated pressure on the lungs is going to set the limit off almost every time subsequently causing the patient to no be ventilated. As someone else mentioned, asynchronous ventilation is often needed in a code with chest compressions. With an advance airway (et tube) you really dont need to pause while the person performing chest compression presses, but sometimes it is necessary to give breaths in an asynchronous manner depending on how easy it is to ventilate the patient. In my hospital and any other hospital I have been to we remove them and bag them with 100% FiO2.

Another VERY important reason this should be done in a code is due to the use of a RESCUE-POD that is placed on the ambu bag. Studies have shown that ventilation and compression can cause an entrapment of pressure/volume in the chest ultimately causing and increase in intrathoracic pressures and pressure on the great vessels. A rescue-pod helps to decrease intrathoracic pressures and ultimately improve survival rates of coding patients.

This is a great statement. In all of my years I have seen many changes from the AHA and ACC. I took my first ACLS class while still a nursing student in 1983 when getting my EMT. I became an ACLS instructor in 1985 after I graduated nursing school. SOOO many changes have occured over this time in how we did CPR and bagged a patient.

At one time we had to place MAST suits on patient in cardiac arrest and we bagged them DURRING compressions. The thought was that the increasing intra-thoracic of the compression/bagging would help circulated the blood by increasing the right venous pressures. Then the ACC and AHA changed the guideline again.

CO is reduced to about 25% durring compressions. It's not the "squeezing" of the heart per say that causes the CO, but the presure in the chest cavity. Too much pressure as resistance in the great vessels by over ventalation interfers with the blood flow. The ambu bags have a pressure releif valve to elimate this (you'll hear it if you compress while someone does compressions as a squeek or squeal).

A vent will alarm durring CPR because the CPR will:

1. trigger a high resp rate.... giving breaths with compression thinking the patieng is trying to breath (depending on the mode)

2. Hit a high pressure limit as the vent attemt to ventalated durring a compression and hit the limit setting.

3. It's FIO2 is preset.... we now need 100% FIO2.

It's a good question... this is how you learn.

[Cathlabnurse46]

Resuce pod would be a pressure relief value. Once you exceed too much pressue within the system... it "burps". Again, years ago we used these high flow mask hooked to O2 tanks that had a purge button to vent a patient... like you would see on a fire truck. They cause the patient to vomit b/c it force air into the stomach (they had no pressure releif... the cheeks would FLAP). By placing the valve on the BVM it helps to reduce the extra air from entering the stomach and over inflating the lungs.

Also, less then 5% of patient recover from codes, depending on the cause, rhythm and history.

[joeyzstj, LPN]

RESQPOD information:

http://www.advancedcirculatory.com/CET/resqproduct.htm

[APRN., DNP, RN, APRN, NP]

When bagging someone off the ventilator in any situation, always remember that the PEEP on the BVM needs to be set to the same PEEP that the ventilator was on.

[RRT2RN2CRNA]

Yes- I always take them off the vent and bag. You can't get good breaths in otherwise.

ALSO When you have a pt on a higher level of peep (8+) make sure you have a peep valve on the bag. If you don't know if you have one, ask your RT.

If the pt's on a high level of peep and you lose that peep when you take them off the vent, it'll just compound problems with oxygenation.

[RNNPICU, BSN, RN]

RTs take the pt off the vent and bag while someoneelse, RN or MD does compressions while that pts RN pushes the meds since they are the ones that know where the lines are.