more chest trauma petals from Doc Dubose
Doc Dubose is an experienced AF Trauma Surgeon with decades of GWOT experience.
Col D discusses the trauma surgeon's perspective on incoming chest trauma, and things for PJs and Medics to think about.
THAT OTHERS MAY LIVE
Easily one of our best vent podcasts. Good sound! We are in the process of fixing the sound (of course by a NY PJ- not me).
This talk covers the basics but also blast lung, TBI and trouble shooting from an experienced respiratory tech with deployments under his belt. He is currently at Baltimore Shock Trauma where we have a great rotation going. Your Flight Doc knows how to get you set up.
Notes from Sgt Noll-
Vent Bullet Points
Initial calculation for TV is 6ml/kg
increasing RR or TV lowers C02
decreasing RR or TV increases C02
increasing fio2 increases pao2 and sat
increasing peep will increase pa02 sat o2 sat
initial peep setting on vent is usually 5, can increase 1-2 at a time to 12 maximum
Primary indications for resedation of intubated Pt:
Increased HR, Increased BP,
Is Pt diaphoretic? Bucking?
Consider using “Boom stick” Take a 10cc syringe if Flight Doc approved:
Draw up 3cc Ketamine (150 mg) Draw up 5cc Fentanyl (250 mcg) Draw up 2cc Midazolam (10 mg)
Recommend a 1cc push PRN every 10-15 mns
Re-paralyzing the intubated patient:
sTBI Patient – consider re-paralyzing w 100mg ROC if:
continuous bucking and not responding to sedation and is hypertensive.
Management of intubated patients (pulmonary contusion, blast lung, sTBI,)
S/S: hypoxia, build up of fluid (blood) in lungs, high PIP ie: above 30 or 35 (if no DOPE issues) -Can be bi-lateral but more often unilateral from blunt force trauma
-If contusion is unilateral (only one side is affected) consider placing in recovery position with the “good” lung down (more blood will go to the lung)
-consider lowering TV and increasing RR in order to maintain proper minute ventilation Blast Lung
-hypoxia, dyspnea, cyanosis, increased Etco2
-high PIP over time as lung compliance decreases
-reverberations for the blast can damage AC (alveolar capillary) membrane
-damaged alveoli become damaged and cannot get rid of C02 properly
- increase fio2
-consider lowering TV and increasing RR (note: this is only temporary as Pt will clinically deteriorate as compliance will be poor)
S/S per PJmed handbook
Tx: per PJmed handbook
Vent: maintain target 35-40 etco2
COMPARING THE IMPACT 731 AND SAVe II
Pros: manipulation of I:E times, advanced synchronization settings, can detect patient effort and be triggered by Pt, can maintain 100% fio2 w supplemental O2, can be used down to a 5 kg Pt
Cons: weight and cube size, complicated to use if not current, must manually calculated weight/size of patient
Pros: Small, light, automatically populates initial settings after pushing Pt height, simple to use Cons: Does not detect patient effort resulting in patient-ventilator “desynchrony”
THAT OTHERS MAY LIVE!
an SF Doc and Duke neurointensivist talks more about sTBI
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"The Last Full Measure" to help the box office opening.
Evolving info on sTBI.
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