Bag-Vavle-Mask problem?

[VentMedic]

Ok so now some questions? What is some of the terms that you have been using? But the one things that I can't figuer out is how bagging once every 5 seconds= 12 Resps per min, and if you bag once every 7-8 seconds it is faster but if I do the math and bag once every 7 seconds it is like 8 breaths a minute? That is where I am confused because the RT said that pt need 14 breaths a min so how many times is it?

1 : 5 seconds = 12 breaths

1 : 6 - 8 seconds = 8 - 10 breaths

The rates being quoted are for the initial phase as promoted by the AHA as quidelines. The new quidelines for slower rates with an ETT (Endotracheal Tube) are 1 in 6 - 8 seconds which is 8 - 10 breaths.

These quidelines are meant to get people to think about what they are doing and not just squeeze away at the bag. Or, in the case of the layperson, not to think, but rather just do something as in the Compressions Only CPR.

Once in the hospital, through lab values, a more appropriate rate is determined. THAT is what the RTs have as guides for establishing oxygenation and ventilation. The rules change with the known values, disease process, CXR and patient's own respiratory effort or how much that patient will be allowed to breathe over the ventilator through sedation or paralytics. The parameters may change several times while on the ventilator as the body adjusts, or not, to treatment. The RT may tell the ventilator to give bigger or smaller volumes and may need to adjust the breath rate accordingly if the same minute volume is to be kept. (Minute volume = number of breaths per minute X the volume of the breath)

The RT also knows how the BVM must work to compensate for the lack of the features that a ventilator can offer. It is very difficult to mimic a ventilator exactly just because a BVM is a $10 piece of plastic being controlled by a human verus a $50,000 ventilator that has a pretty sophisticated internal computer running it.

One of the lab tests that RTs do is an ABG or Arterial Blood Gas. This is blood drawn from the artery to determine oxygenation, ventilation and acid-base. It will give the amount of oxygen (PaO2) and carbon dioxide (PaCO2) in the blood which tells the RT what has to be done to get those values into a normal range. The pH of the blood is also affected by the carbon dioxide present as well as the buffering sytems of the body. The pH may need to be regulated by a change in the rate, either the Bag or vent, or through buffering medications and fluids.

You already said it in an earlier post: "every patient is different". Every disease process affects the body differently.

In the hospital, the RTs are working under the scope of their license and utilizing the protocols set by their Medical Director(s). They are responsible for that patient and ventilator when it comes to maintaining oxygenation and ventilation. They may also be trying to satisfy the orders or requests of several physicians for a variety of reasons. The guidelines of the AHA no longer apply once known values, protocols or orders are in motion.

Once you finish EMT class, continue your education with some college Anatomy and Physiology classes. EMT is barely an introduction into the world of medicine. It seems that you are one that will go further because you are asking questions. Many take the EMT or even the Paramedic class as being all there is to know about medicine.

[ccmedoc]

Many take the EMT or even the Paramedic class as being all there is to know about medicine.

:shock: :-s :pale:

Oh...that is a sad, sad statement. I got a chuckle at first, then reality hit...

I was having such a good day, too...

Enjoyed the post though, as always.. 8)

[firedoc5]

Hyperventilate - lower PaCO2

Hyperoxygenate - raise PaO2

EMS is Hyperventilating Resuscitation Patients

http://www.merginet.com/index.cfm?pg=cardi...yperventilating

The goal is to hyperoxygenate. If you hyperventilate, you raise intrathoracic pressure and drop the BP as well as the cardiac output defeating the hyperoxygenation goal. You also can vasoconstrict cerebral perfusion and shift the pH to extreme alkalosis which is just as bad if not worst than acidosis.

Again, this is the reason for the new rate for ETT ventilations as I mentioned earlier.

Sorry for the quote and quote.

That is one reason you watch the chest. Make sure it completely back to it's normal position as having expired. You don't keep pumping air in until the chest is relaxed. I guess it comes with experience and listening to any debriefing, or chewing out's after ward.

I'm by no means saying you are inexperienced and your reasoning is right on. Maybe my old school ways are catching up with me. Sometimes I feel like I need to audit some classes. In matter of fact I think I'm going to look into that.