Pocket Reference Guide to Mechanical Ventilation......What would you like in one?

[DropkickMurphy]

---

Members don't see this ad.

OK.....the talk of Quinn's new book ( 👍 ) and ICU months has made me decide to point out that I'm part of the way through writing a quick reference handbook on mechanical ventilation. The idea behind this came from the fact that I've had several PM's from residents and med students asking questions on this topic and that there seems to be little in the way of user friendly pocket guides on this topic available out there.

What would you like to see covered? Anything in particular that has always confounded you? Something you use just once in a blue moon and would like to have a quick reference to refer to? Any input would be appreciated.....

So far the topics that are being covered are these:
"The Resident’s Pocket Guide to Mechanical Ventilation"
-Airway management algorithm
-Assessing the chest x-ray of the intubated patient
-Airway adjunct size guide
-Oxygen therapy
-Basics of volume ventilation
-Assist/Control ventilation (AC)/Continuous mandatory ventilation (CMV)
-Synchronized intermittent mandatory ventilation (SIMV)
-Continuous positive airway pressure (CPAP)
-Bi-level positive airway pressure (BiPAP)
-Basics of pressure ventilation
-Pressure regulated volume control (PRVC)
-Pressure controlled SIMV (PC-SIMV)
-High frequency jet ventilation (HFJV)
-High frequency oscillation ventilation (HFOV)
-Airway pressure release ventilation (APRV)
-Pressure support ventilation (PSV)
-Pressure control ventilation (PCV)
-Setting the minute ventilation
-Setting the tidal volume
-Setting the PEEP
-Setting the trigger or sensitivity
-Setting the oxygen concentration (FiO2)
-Setting inspiratory flow and inspiratory time
-Setting the alarms
-Monitoring and assessing the ventilator patient
-Blood gas assessment
-Bedside spirometry
-Central venous pressure monitoring
-Pulmonary artery (Swan-Ganz) catheter
-Arterial lines
-Pulse oximetry
-The ventilator check
-Permissive hypercapnia
-Nitric oxide
-Heliox
-Surfactant therapy
-Suctioning and other airway clearance techniques
-Weaning protocol
-Troubleshooting the high pressure alarm
-Troubleshooting the low pressure alarm
-Troubleshooting airway adjuncts
-Troubleshooting the desaturating patient
-Troubleshooting the patient “bucking the vent”
-Alternative means of support
-ECMO
-Liquid ventilation
-NPPV in the management of sleep disorders
-Respiratory pharmacology
-Bronchoscopy
-Normal values

Eventually I'd like to do a second version covering pediatric and neonatal ventilation, but I figure I should get this done and available to anyone who might want a copy. It will probably simply be available as a free PDF that you can download and print out. As I said....any advice or topics you would like to see covered, please let me know. 👍 😀

 

[Hard24Get]

As a med student that has personally cornered RTs on the floors, I say way to go! 👍

I assume that each category will cover what it is, why you might choose it, and what an "average" or range of settings would be? I'd like to be able to hear a pt's settings and know how much support they need.


Oh, and can you finish it by x-mas? I start SICU next month 😳

Thanks!

OK.....the talk of Quinn's new book ( 👍 ) and ICU months has made me decide to point out that I'm part of the way through writing a quick reference handbook on mechanical ventilation. The idea behind this came from the fact that I've had several PM's from residents and med students asking questions on this topic and that there seems to be little in the way of user friendly pocket guides on this topic available out there.

What would you like to see covered? Anything in particular that has always confounded you? Something you use just once in a blue moon and would like to have a quick reference to refer to? Any input would be appreciated.....

So far the topics that are being covered are these:
"The Resident’s Pocket Guide to Mechanical Ventilation"
-Airway management algorithm
-Assessing the chest x-ray of the intubated patient
-Airway adjunct size guide
-Oxygen therapy
-Basics of volume ventilation
-Assist/Control ventilation (AC)/Continuous mandatory ventilation (CMV)
-Synchronized intermittent mandatory ventilation (SIMV)
-Continuous positive airway pressure (CPAP)
-Bi-level positive airway pressure (BiPAP)
-Basics of pressure ventilation
-Pressure regulated volume control (PRVC)
-Pressure controlled SIMV (PC-SIMV)
-High frequency jet ventilation (HFJV)
-High frequency oscillation ventilation (HFOV)
-Airway pressure release ventilation (APRV)
-Pressure support ventilation (PSV)
-Pressure control ventilation (PCV)
-Setting the minute ventilation
-Setting the tidal volume
-Setting the PEEP
-Setting the trigger or sensitivity
-Setting the oxygen concentration (FiO2)
-Setting inspiratory flow and inspiratory time
-Setting the alarms
-Monitoring and assessing the ventilator patient
-Blood gas assessment
-Bedside spirometry
-Central venous pressure monitoring
-Pulmonary artery (Swan-Ganz) catheter
-Arterial lines
-Pulse oximetry
-The ventilator check
-Permissive hypercapnia
-Nitric oxide
-Heliox
-Surfactant therapy
-Suctioning and other airway clearance techniques
-Weaning protocol
-Troubleshooting the high pressure alarm
-Troubleshooting the low pressure alarm
-Troubleshooting airway adjuncts
-Troubleshooting the desaturating patient
-Troubleshooting the patient “bucking the vent”
-Alternative means of support
-ECMO
-Liquid ventilation
-NPPV in the management of sleep disorders
-Respiratory pharmacology
-Bronchoscopy
-Normal values

Eventually I'd like to do a second version covering pediatric and neonatal ventilation, but I figure I should get this done and available to anyone who might want a copy. It will probably simply be available as a free PDF that you can download and print out. As I said....any advice or topics you would like to see covered, please let me know. 👍 😀

 

[a_ditchdoc]

It would be nice if you could throw an index in the rear of the book covering the basics of paralytics, seditives, and meds associated with ventilator patients. More specifically: doses, indications, contraindications, and special characteristics (preferred use in asthma. pulm htn, etc...).

Hurry up...I will hopefully start residency in July. Make sure my copy is signed...

ditch

 

[DropkickMurphy]

July would be plausible...having this done before Christmas isn't going to happen....sorry, but I have a couple of other projects that are also taking up my time.

 

[Dr.Evil1]

DKM this sounds awesome but hardly a pocket guide. As mentioned earlier a section on inhaled drugs, sedatives, and paralytics would be great to include.

 

[DropkickMurphy]

Trust me....I can condense a lot of information into something about the size of the pocket guides I've seen for EMT's and what not. The rough plan for it is about 65 pages front and back, and roughly 4"x6" or so....I'll incorporate the other information that you all suggested. 🙂

 

[kbrown]

July would be plausible...having this done before Christmas isn't going to happen....sorry, but I have a couple of other projects that are also taking up my time.

dude, where were you this month? i just posted this exact same question in in ccm forum, before i started sicu. this sounds like a bad ass project. i know that you are an rt, i don't remember if you were planning to go to med school or what the hell the deal is. but this project is worthy of 'scholarly project' title that would count in residency as research. obviously this is likely not an option since you are likely not in medical school, and thus 4 years away from needing a scholarly project. but damn, what a great idea. i wish i knew enough about anything to put together something that would be helpful to everyone in the hospital. good job, you kick arse

 

[DropkickMurphy]

Yeah, I'm probably 2-3 years out from medical school because I can only do undergrad part time because of work. But thanks for the positive comments.....

 

[a_ditchdoc]

Oh yeah, if you could put a few words about positioning (ie supine vs prone). I had a lecture from a pulmonologist one in which he saidthat this can be very beneficial in ARDS patients in whom ventilation is difficult to achieve. Of course, it was a long time ago...

ditch

 

[vtucci]

That sounds fantastic. I look forward to seeing it published!!

 

[Chronic Student]

Dude, how did I miss this post. I would love to have a copy of it.

Could you include some pearls and/or protocols on the management of the head injured patient.

I would be eternally grateful.

-Mike

 

[DropkickMurphy]

Actually, I'll make sure all of the EM regulars on here get free copies of it. All I ask is that you provide suggestions for improvement once you have them. One of my friends is going to convert it to a format suitable for use in PDAs. Hopefully, that will make things easier for everyone. I'll keep you updated as things move along with the project.

 

[membsr-8890]

Everything, ventilators are confusing.

 

[vtucci]

PDA Format would be perfect. I have just started to learn that there are great resources but not all are on PDA and to lug them all around would give us a major backache. LOL!

 

[substanceP]

Everything, ventilators are confusing.

Yeah! What he said! This is an excellent idea! 👍

 

[DropkickMurphy]

Everything, ventilators are confusing.

Trust me, I know.....I've been doing RT for five years and there are still a couple of things that confuse me at times. Hopefully this project will make it easier on everyone.... 👍

 

[USCDiver]

Honestly, strictly from an EM perspective I don't care that much about ventilators and their intricasies

If you really want input on this project, ask the IM and Surg residents who are rotating through the MICU/SICU more than 1-2 months and could potentially be doing critical care.

I can intubate and make initial settings on a vent no problem. Long term changes etc don't matter to me because hopefully that patient will be long gone by that time.

 

[hyperbaric]

Yeah, I'm probably 2-3 years out from medical school because I can only do undergrad part time because of work. But thanks for the positive comments.....

Spoken like a true medic (in addition to all your other titles).

Sounds like this will be a really useful guide. I start rotations in July. Keep me in mind. 🙂

 

[DropkickMurphy]

Spoken like a true medic

Yeah, my girlfriend jokes she expects when I drive up to see her that she'll receive a call that starts with "We are presently en route to your facility with....."

I start rotations in July. Keep me in mind.

I'll do my best to get you a copy, even if it's just the working copy.

 

[basementbeastie]

Honestly, strictly from an EM perspective I don't care that much about ventilators and their intricasies

If you really want input on this project, ask the IM and Surg residents who are rotating through the MICU/SICU more than 1-2 months and could potentially be doing critical care.

I can intubate and make initial settings on a vent no problem. Long term changes etc don't matter to me because hopefully that patient will be long gone by that time.

mostly agree except occasionally ya get acute post tube vent management problems....high pressures, desating, hypotension, etc....

 

[DropkickMurphy]

mostly agree except occasionally ya get acute post tube vent management problems....high pressures, desating, hypotension, etc....

That and there is increasing evidence for using alternate modes of ventilations and lung protective strategies from the word go rather than waiting for ALI or ARDS to arise, and sadly most docs are not that up to speed on it.

 

[basementbeastie]

That and there is increasing evidence for using alternate modes of ventilations and lung protective strategies from the word go rather than waiting for ALI or ARDS to arise, and sadly most docs are not that up to speed on it.

lung protective low volumes yes....definitely up to speed.....other alternative modes -> not up to speed.

 

[vtucci]

I start rotations in May- I would love to have a copy too if you could also keep me in mind. 🙂

 

[leviathan]

Don't forget a few pages on iron lungs.

 

[DropkickMurphy]

Don't forget a few pages on iron lungs.

Yes, for all the Canadians out there. 😉

 

[DropkickMurphy]

I know this is dredging up an old thread, but I've made some progress on the project, so I'm getting close to releasing the field guide....it should be done within the next month or so. Chances are it will be around 120 pages (3"x4"), and I will offer a laminated and spiral bound version for $12, including shipping (within the US).

 

[psychbender]

Awesome. Thanks, DKM!

 

[sphincter tone]

Sweet

Our clinical department just dragged us in for a 4 hour CE on "customer satisfaction" but no one seems concerned that most of us don't have a clue how to use our vents... 🙄

 

[DropkickMurphy]

Sweet

Our clinical department just dragged us in for a 4 hour CE on "customer satisfaction" but no one seems concerned that most of us don't have a clue how to use our vents... 🙄

My advice on how to get up to speed on your particular vents is to go find one of your RTs and pick their brain. Most are happy to teach. If you have any general questions, feel free to PM me.

 

[Chronic Student]

I'm ready to put my order in!

-Mike

 

[met19]

trying to wait patiently for dkm's book

 

[phamthanhluy]

thankssssssss

 

[highlyfavoured]

where can i get this book?