ventilators vs ambubag

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This is just one of those things that I never thought about until it happened. When someone is on a vent,at what point do you just use the ambubag? When the sats drop in the 30s? Or when they stop breathing?confusing,because technically air will still be going in them even if they stop breathing?

My situation today is that I had a child who is being weaned from the vent. He is on a mist collar with 30% o2. All of a sudden his sats drop to the 30s and he turned blue. After checking to see his trach was in, I immediately put him on the vent.Mom says I should have used the ambubag. I'm thinking you only use the ambubag when some isn't breathing at all.(he was still breathing) who is right?

Afetr I put him on the vent he went to the high 90s immediately.

Also,please no one bash me or make me feel ashamed,as I'm on this site to learn.

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I would have suctioned and bagged him. If I have a pt on the vent whos sats drop, tube is in the right place I will bag to get better sats then suction, or suction first if I can see/hear something obvious. If the pt is not on the vent and decompensates it's going to take longer to get the vent back on/hooked up than to quickly bag him. Sometimes pts just need that extra support, babies especially will go down hill very fast if their respiratory issues are not taken care of immediately.

Also, ambubag is used quite frequently in pts who are breathing, if their breathing is not effective and does not improve with supplemental oxygen then bagging is an appropriate intervention, even on pts who are not intubated/trached.

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Specializes in LTC.

My gut reaction would have been to bag him. Much faster to start up and if he needed the vent again I would have gotten someone else to set it up while I bagged.

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I have seen patients bagged with sats falling just into the lower 80's when on a ventilator. Even when the pt was ventilated with the BVM, the sats did not seem to improve in this particular case.

Although I agree with the others - I would have suctioned and used the ambu, then more than likely had RT come have a gander.

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Specializes in NICU, ER.

First of all pts with trach's. who are being weaned from a vent are challenging pt's. Second of all you were able to improve the pt's resp. status by putting him back on the ventilator. So good job you accomplished what you needed. Ideally an ambu-bag is your friend. The vent. may not be able to accomplish the initial tidal volume the pt need's in order to oxygenate, and if they need to be suctioned it is the best way to prepare the items you need in order to suction the patient. Good Luck to you!!!

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Specializes in NICU, Post-partum.

I would have suctioned and bagged as well.

If you let the sats drop too low, the HR will go with it and before you know it, you are coding the patient.

Sometimes, the patient needs the pressure from the ambu bag to recover and go back on the vent settings. But grab the bag as soon as you realize they are going downhill.

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Think

emergency = basics

Don't rely on a machine. Simple is best and it's more reliable in more situations.

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Specializes in ER, ARNP, MSN, FNP-BC.

and, always listen to moms of sick kids.............(they learn FAST) LOL. It's amazing how much a mother can teach you about a disease process in their child or what works best for them. Not by any means saying BLINDLY listen, but they are right more often then not. And never be ashamed to ask a question. I've been a nurse 18 years, and you BET I ask questions that new grads would laugh at me for :coollook: . You know, like when you forget to how to spell THE lol

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Yep, smartnurse! We all learn when we come here for feedback, and taking care of patients like this in the home with no RT to call or rapid response team can be . . um fun! It seems like the same things never happen twice in a row, either!

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Specializes in ER/ICU/Flight.

Good job and quick thinking. You said that his sats immediately returned to the 90s after placing him on the vent...so what would have been different if you used the ambubag? probably nothing. mom's of sick kids learn fast, but they're not always right.

Do you know what caused the child to desat? a plug somewhere? Suctioning is good, when there's something to suction out. I'd say go with whatever can be useful within a few seconds: either bag or vent, as long as gas can be exchanged in the lungs they're both good choices. If the vent was on standby and only needed to be attached then I probably would've done the same thing you did.

usually we don't use a ventilator to hyperventilate a patient in an emergent setting. Also I never put an emergent patient with a ptx on a vent! gotta be able to detect subtle changes in bag compliance.

The big thing was your checking on the trach! Whenever there's a change in respiratory status, I always start with the patient's airway and troubleshoot back to the oxygen delivery device...the problem will be found somewhere in between.

and like other's have said....nothing wrong with asking questions. I ask anytime I'm not sure and can't easily find an answer.

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Specializes in ER, ICU.

Depends on what you think the problem is. A mucus plug sometimes needs some high pressures to clear. If it is simple ventilation, the vent will do. Ambu could be a first choice because you have complete control over your technique. You will feel if there is an obstruction.

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Wouldn't the vent alarm if air was not getting into the patient due to a mucus plug? Just wondering...I would have suctioned, then bagged, then put the patient back on the ventilator when the SATs came back up . Just my 2 cents.

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