vents and cpr

[smartnurse1982]

quick question: client is on a vent ltv 950 and i take her to school. her setting are breath rate of 6, pc 18 ps 18 sensitivity 4 ins time limit 1.4. if her heart rate stopped would i just disconnect the vent and start cpr or would i leave the vent on and just do chest commpressions. a co worker told me to turn the vent up to 20 if i see and feel her apical hr dipping below 40 and that should speed up her hr but that does not sound right any info appreciated

[PICURN74, ASN, RN]

as a general rule follow the abcs, not know anything about your patient i don't want to give you specific advice but personally i would check airway (assume trach) is patent (a), then breathing (b) personally in code/cpr situations bmv is my first choice and then © compressions. depending on who you are certified in cpr through there may be variation. aha's new recomendations just changed for cpr for single rescuers to be compressions only as people were taking too long to give breathes but with more than one professional rescuer breathing is still in the protocol.

[EricJRN, MSN, RN]

aha's new recomendations just changed for cpr for single rescuers to be compressions only as people were taking too long to give breathes but with more than one professional rescuer breathing is still in the protocol.

the changes were certainly interesting, but i don't believe they apply to this situation. the new "hands-only cpr" was intended to apply only to the layperson responding to an adult sudden cardiac death situation. we know that cardiac arrest in kids is most commonly respiratory in origin.

if you needed to do cpr on a ventilated patient by yourself, that would certainly be a tough situation. in pals, we talk about the dope mnemonic for mechanically ventilated patients who deteriorate. there are four big etiologies that you want to rule out:

d: displacement of the tube (accidental extubation/migration)

o: obstruction of the tube (kink/plug in the tubing)

p: pneumothorax

e: equipment failure

usually the easiest way to rule out "e" is to disconnect the vent and bag by hand. it can also help you judge lung compliance, which can speak to the other etiologies.

tough call. when in doubt, i'd focus on ventilation, however.

[love-d-OR]

You want to limit interruptions to your compressions. After you have gone through the ABC's of course and you determine you have to do chest copmressions, leave the vent on and usually 12-15 breaths/min should do it. As hyperventilation is associated with high mortality. You will not disconnect the vent and start bagging unless you were certain there was a problem with the vent. I don't know if this answers your question.

My answer is based on what you would do in ACLS, I am not sure how that differs from PALS.