Links To And Excerpts From EMCrit 239 – Vent Alarms = Code Blue From Dr Weingart

Links to and excerpts from EMCrit 239 – Vent Alarms = Code Bluet [Link is to the podcast and show notes] January 26, 2019 by Dr Scott Weingart.

This EMCrit 239 is part of Dr Weingart’s minicourse [my term] EMCrit – Critical Care for Non-Intensivists during COVID19 Pandemic [Link is to his excellent post-I’m working my way through all of his resources on the post].
March 25, 2020 by Dr Scott Weingart

Here is the podcast of EMCrit 239:

And here are excerpts from the show notes:

Vent Alarms should be Regarded as Code Blue

If you cannot instill the above into your culture, patients will die

If they are crashing, do DOPES [Link is to EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy
December 23, 2009 by Dr Scott Weingart]

Or if you have The Resuscitation Manual, go to Chapter 11, Crashing On the Ventilator [When you purchase the manual you will recieve a PDF copy which  you can put on your smart phone, or tablet.}

So in the show notes, Dr. Weingart goes through how we approach the alarms if the patient is not crashing meaning that:

• the oxygen saturation is not low or falling.
• the patient is not hypotensive
• the patient does not have a zero end-tidal CO2
• the patient does not look like he or she is in extremis

Note to myself: Dr Weingart’s show notes are a perfect checklist.

Resuming the excerpts:

This chart is from The Resuscitation Crisis Manual [Not an affiliate link]

Dyssynchrony

• Patient-Ventilator Dyssynchrony
  by Dr Chris Nickson, last update March 29, 2019 from Life in the Fast Lane
• Patient-Ventilator Dyssynchrony [PubMed Abstract] [Full Text HTML] [Full Text PDF] Korean J Crit Care Med. 2017 Nov; 32(4): 307–322.

Peak Only

• Check the circuit
  • fluid pooling in circuit
  • fluid pooling in filter
  • kinking of circuit
• Tube too small or biofilmed
• Bronchospasm
• Biting on ETT

Low Peak Pressure

• Disconnected
• ETT Cuff Deflated
• Pt effort

Low Ve/Vt

• Cuff Issues (See EMCrit Wee )*                                     *Wee – Avoiding Disaster – Endotracheal Tube Cuff Leaks and Tube Exchanges
  August 28, 2015 by Scott Weingart</li>            [I wasn’t able to follow this Wee. But then I watched the YouTube video that Dr. Weingart included and it was clearer to me.]
• Bronchopleural Fistula

Low O2 Alarm

• Not hooked Up
• Gases Messed Up
• Sensor Messed up

What to Do with Continued Alarms Despite Sedation, Equipment Check, Suctioning

• Consider Bronchoscopic Assessment
• If Patient begins to crash, consider tube exchange if bronch not available

Article On Vent Alarm Stats

Ventilator Alarms in Intensive Care Units: Frequency,
Duration, Priority, and Relationship to Ventilator
Parameters [PubMed Abstract] [Full Text PDF]                            Anesth Analg. 2018 Sep 18.

Assessing High Peak Pressures

Alarms from the ventilator: Troubleshooting high peak pressures from ALiEM Jul 30, 2013
By: Todd A. Seigel, MD