Resident dint know how to work with vents!?

[CopaceticOne]

And even for anesthesiologists who run ventilator in the OR daily, the ICU vents are not the same with also a different array of brands and setups.

I had to go in, in the middle of the night, and do an OOR EGD in the ED. Ended up being a 4 hour disaster disimpaction. Had some transport vent from the 80's there. I've never been trained on it. RT set it up then had to go away once patient connected. Took me 2 minutes to figure out how to change the settings.

My guess is that the issue wasn't the actual vent they were using - it was the choice in settings. (And understanding that sometimes you really need to ask for help.)

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[Mman]

Not joking even a little bit. I think it’s reasonable to expect anyone with “Dr” in front of their name to know what a reasonable PEEP value is, especially so close to graduation. If you’ve been out practicing FM in the community for thirty years, that’s a different story. And I’m not saying they should know how to titrate a vent or the differences between models, but to me this is the same as knowing CPR, how to place an IV/draw blood, read a CXR, interpret a CBC/chem panel/simple blood gas, take a history and perform a physical exam, and having a working knowledge of anatomy and physiology: basic doctor ****. One month in an ICU as a med student should be plenty for the level of knowledge I’m describing. I don’t need you to be able to explain to me the nuances of APRV, but you should know that a PEEP of 10 is reasonable and a PEEP of 80 is not. I’m not a surgeon but if someone handed me the EC and said “bovie to a million!” I’d know something wasn’t right.

My larger point is maybe we need to stop trying to turn every med student into a public health researcher/disparities expert/ethicist (there are plenty of grad degree programs for that important work) and make sure we’re getting the basics down.

there is a difference between understanding the textbook answer of what a normal PEEP setting might be and the technical act of setting it on a ventilator. We have multiple different types of vents in our ICUs and when I go preop somebody in them, it often takes me more than a glance to determine the settings and I am not sure of how to even adjust all of them if I wanted to. Some ventilators are more user friendly than others in terms of interface.

 

[chocomorsel]

I'm trying to figure out how this happened, as any competent RT would have caught obviously lethal settings and been like, no way I'm doing that. Either the resident did it alone or the RT was equally as clueless which seems doubtful

This was in a time when the system was OVERWHELMED. What the hell is there to figure out? All hands were on deck and there was likely not enough RTs or ICU docs and nurses around to help.

 

[deleted171991]

Once again, for those who missed this when I first posted it:

It's unclear who set the ventilator. The original article had been posted on Business Insider, and has been corrected since.

A NYC coronavirus patient died after her ventilator was set too high under the care of inexperienced medical residents

The incident happened at the Montefiore Medical Center in the Bronx in March, The Wall Street Journal reported on Wednesday.

www.businessinsider.com

Editor's note: A previous version of this article stated that the medical residents set the patient's ventilator too high. It's unclear who set the ventilator.

 

[Mad Jack]

This was in a time when the system was OVERWHELMED. What the hell is there to figure out? All hands were on deck and there was likely not enough RTs or ICU docs and nurses around to help.

Even in the case of an overwhelmed system, getting patients on fresh vents should be priority one. If staffing was an issue, the institution should be held to account, as there were likely pre-existing issues with staffing and PPE that led to such a desperate situation. Even if you are tuning 30 patients a day, in a department that is running 20 RTs daily they should have more than enough time to set aside for an intubation and initial vent setup at 30 minutes a pop. I've had to work in austere staffing situations during a disaster as an RT before in a very large system, you prioritize intubations first, period. It's irresponsible and potentially deadly to have a non-RT set up a vent for initial use, there's a lot that goes into pre-use checks and the like, as well as initial alarms and settings that literally no one outside the field aside from overseas nurses that have run ventilators might have any clue how to do. You leave your PIP alarm set too low for the patient and they'll literally die on some vents, as the alarm also sets the maximum deliverable pressure, for instance.

However it happened, it's most likely a major system failure more than it falls on this individual resident, unless they broke protocol.

 

[chocomorsel]

Even in the case of an overwhelmed system, getting patients on fresh vents should be priority one. If staffing was an issue, the institution should be held to account, as there were likely pre-existing issues with staffing and PPE that led to such a desperate situation. Even if you are tuning 30 patients a day, in a department that is running 20 RTs daily they should have more than enough time to set aside for an intubation and initial vent setup at 30 minutes a pop. I've had to work in austere staffing situations during a disaster as an RT before in a very large system, you prioritize intubations first, period. It's irresponsible and potentially deadly to have a non-RT set up a vent for initial use, there's a lot that goes into pre-use checks and the like, as well as initial alarms and settings that literally no one outside the field aside from overseas nurses that have run ventilators might have any clue how to do. You leave your PIP alarm set too low for the patient and they'll literally die on some vents, as the alarm also sets the maximum deliverable pressure, for instance.

However it happened, it's most likely a major system failure more than it falls on this individual resident, unless they broke protocol.

Ok. Monday Morning Quarterback. You weren’t there. None of us were.
Again, I am not going to place blame on an overwhelmed situation. And residents who were trying to help.

 

[IMGASMD]

there is a difference between understanding the textbook answer of what a normal PEEP setting might be and the technical act of setting it on a ventilator. We have multiple different types of vents in our ICUs and when I go preop somebody in them, it often takes me more than a glance to determine the settings and I am not sure of how to even adjust all of them if I wanted to. Some ventilators are more user friendly than others in terms of interface.

We only have two different types of vents here. I s**t you not, I couldn’t even just “start” the vent the other day. Just because the bottom is hiding somewhere in the back..... probably to prevent me, or someone like me, who aren’t familiar with it to fiddle with it.