Make It Stop!!- Vent Alarms and What To Do with Dr. Andrew Phillips
May 18, 2023
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In this engaging discussion, Dr. Andrew Phillips, an EM and Critical Care trained physician and founder of EMCoach, shares his insights on managing ventilator alarms. He delves into the complexities of ventilator support in emergencies, particularly during respiratory failure and asthma attacks. Dr. Phillips emphasizes the crucial teamwork between physicians and respiratory therapists, and offers strategies for interpreting alarm signals. With a focus on patient safety, he also discusses the physiological implications of alarms and the technicalities behind effective ventilator management.
Effective management of ventilator alarms is essential for emergency physicians, as it directly impacts patient care and outcomes.
Differentiating between high peak pressure and plateau pressure alarms is crucial for determining the appropriate clinical response to ventilation issues.
Deep dives
Understanding Ventilator Alarms and Their Importance
Managing ventilator alarms is a crucial skill for emergency department physicians, impacting patient care outcomes significantly. It is essential to understand both why alarms trigger and the physiological implications for patients, rather than merely relying on respiratory therapists to handle these situations. Physicians must grasp the underlying causes of alarms, such as patient vent settings and physiological changes, to intervene effectively. Acknowledging that managing ventilation is a core responsibility reinforces the need for clinicians to remain actively engaged in addressing these alarms.
Common Ventilator Alarms and Their Causes
High respiratory rate alarms often indicate that patients are breathing more than the set minimum due to physiological factors, such as an acute propofol deficiency or metabolic issues. In cases like respiratory failure from conditions such as DKA, it's vital to adjust patient management strategies to accommodate their specific needs, ensuring a balance between respiratory drive and oxygenation. Air leak alarms reveal potential deficiencies in the endotracheal tube cuff, necessitating an immediate assessment of cuff function and possibly adjusting air volume to avoid loss of ventilation. High peak pressure alarms signal increased resistance within the ventilatory circuit, demanding a careful investigation of tubing, kinks, or bronchospasm to restore function.
Recognizing the difference between high peak pressure and plateau pressure is critical when assessing vent alarms, as it informs the appropriate clinical response. High peak pressures with normal plateau pressures typically reveal resistance-related issues, where interventions should include checking for obstructions or bronchospasm, which are prevalent in conditions such as asthma. Conversely, high peak pressures coinciding with high plateau pressures indicate severe pathophysiological problems, like tension pneumothorax or lung compliance failure, requiring immediate and aggressive treatment. Understanding these distinctions allows physicians to implement the correct management strategies effectively, thus avoiding detrimental oversights in patient care.
Vent management is a integral skill for the Emergency Medicine doctor, but it is a tricky art. We sat down with Dr. Andrew Phillips, EM and Critical Care trained physician and founder and Editor in Chief of EMCoach, an AI powered board review suite to talk about vent alarms, what they mean, and what to do about them.