Some Scary Vent $%!#

[pixmedic]

so...there I was.
basic pediatric vent transport. (< 1 year old)
Pt on ventilator via trach (3.5 Shiley)
SIMV/PC
pressure control 20
pressure support 15
rate of 25
inspiration time 0.4
PEEP 5
O2 delivered at 28% (non blended)

Pt's SpO2 at time of transport - 100% with EtCO2 at 50.
HR 126, RR 46

everything looked good for the first half of the ride.
then I got this alarm on the vent. It means the PT is not getting the amount of air volume to their lungs that the vent is set to deliver. Can be bad. the bars you see on the left is the volume that was delivered to the PT. the single bar on the right is how much volume the PT was supposed to get. Big differences between those two numbers usually mean trouble.

This alarm can be caused by any number of things, from poor lung compliance to kinked or unplugged tubing.... and a whole lot in between.
with an adult, you usually have at least several minutes of adequate compensation before desaturation starts, which is hopefully enough time to figure out the problem and fix it.
A baby however....not so much. They crash hard and fast into respiratory arrest. This is the point where a good medic realizes this and doesn't just hit the silence/reset button and go back to writing the report, So I start looking fast.

In less than a minute, I had checked the O2 intake, pressure, tubing connections to the vent, full length of vent circuit for kinks or breaks, and the vent settings, finding no issues with anything.
In that "less than a minute", baby's O2 saturation dropped to 78, heartrate jumped to the 180's, and respiratory rate jumped to 60 BPM.
made me nervous as hell.

next step is to deep suction babys airway with the ballard. no change.
I upped the O2% to try and help compensate a bit. no change,
at that age, a babies lungs are so so fragile,(and this kid had a bunch of medical issues) so i don't want to try making too many adjustments to the vent settings until its an absolute last resort, but almost 2 minutes of baby being at 78% O2 saturation is quickly pushing me to desperate measures.

so...I did what were really not supposed to do.
I took my gloves off.
and felt around the trach.
I felt an air leak that I had not noticed with my gloves on. A leak between the trach tube and the vent circuit. on closer inspection, it looked like the vent circuit connector was slightly warped and if it moved juuuuust right, caused a pretty significant leak.
one small piece of stretchy trauma tape later and the leak was sealed, giving me time to get another vent circuit ready.
Kind of a quick and dirty solution, but within 30 seconds or so babys O2 saturation came back up into the mid 90's and the HR and RR dropped back to normal levels. There were no further drops with the circuit change or for the duration of the transport.

pediatric transports are the hardest.
they are often times the sickest, going the farthest distance for treatment, and almost never a DNR.
the expectations are higher because they are so young...the doctors are willing to try anything and everything to treat them no matter how far we have to go to get them there, or how risky it might be, in order to give these kids a chance at a life.
I transport a lot of PT's to Shands in Gainesville for organ transplants, or PT's that have already had a transplant but are having problems with organ rejection. Even worse are the 4 hour rides to Miami General. It is some scary transports, but they are the reason I did the critical care program.
It does put a lot of pressure on us to get these people to that higher level facility in at least somewhat stable condition. especially the kids.

At least I only have to get them there....I can only imagine the pressure on the doctors that have to do the actual fixing.


oh, before someone mentions it....*ahem*
this picture was taken when we reached the destination. long after any issues were happening. the LTV 1200 vent retains the alarm message until I clear it from the que.

 

[BrickHouse]

Nice work with the pedivent. I am consistently impressed with the quality of prehospital care that is delivered by the paramedic teams. You guys train harder than any group of professionals I know and it pays off in saved lives.

 

[pixmedic]

Nice work with the pedivent. I am consistently impressed with the quality of prehospital care that is delivered by the paramedic teams. You guys train harder than any group of professionals I know and it pays off in saved lives.

Thanks.
I figured most people probably wouldn't understand or care about the vitals and vent settings i listed, but I knew we had a few medical professionals around that might be interested in the details, and for them, those details paint a clearer picture.

 

[bribrius]

nice work! Impressive lucky kid! i have a question i never really knew the answer too, maybe you can answer it. When one of my kids was less than one they transported him from one hospital to another icu. But they put him in this glass bubble thing. so he was in like a glass casket of sort with lots of wires. What was the glass for?

 

[astroNikon]

Great work.
a scary profession surely that many don't understand (me included).

 

[pixmedic]

nice work! Impressive lucky kid! i have a question i never really knew the answer too, maybe you can answer it. When one of my kids was less than one they transported him from one hospital to another icu. But they put him in this glass bubble thing. so he was in like a glass casket of sort with lots of wires. What was the glass for?

The neonatal incubator does a few things.
It's often used with an O2 blender so a very precise oxygen concentration can be majntained. It also keeps outside germs to a minimum since preterm babies will have an underdeveloped immune system. It also has a warmer attached so you can regulate temperature, since newborns (especially preterm) are very sensitive to temperature changes.

 

[vintagesnaps]

Wow. Jason it sounds like you saved a life that day.

Usually in EI we started seeing babies after they may have been in the hospital, although I have been to a NICU and seen babies in the isolettes etc.

I've been involved in the education and development part of things, I couldn't do this medical part. But it's interesting to get a glimpse at what you do.

 

[DarkShadow]

 

[FFphoto]

Nice work!! Sometimes you just need to do what is needed for the PT. I hate pediatric calls. I have had some tough ones. Good job staying focused and figuring out the issue.

 

[pixmedic]

Nice work!! Sometimes you just need to do what is needed for the PT. I hate pediatric calls. I have had some tough ones. Good job staying focused and figuring out the issue.

Equally pucker inducing are the premature labor calls we get our of our areas hospital going to the women's hospital in town. Took a woman a few months ago that was scary.
26 years old.
G4P5
4cm dilated.
Preterm labour @ 28 weeks.
Chronic drug user, last shot heroine 2 hours ago.

By the time we made the 25 minute code 3 transport, the baby was crowning as we ran into the ER.

And that was with mag sulfate running.

Scary ****

 

[FFphoto]

Nice work!! Sometimes you just need to do what is needed for the PT. I hate pediatric calls. I have had some tough ones. Good job staying focused and figuring out the issue.

Equally pucker inducing are the premature labor calls we get our of our areas hospital going to the women's hospital in town. Took a woman a few months ago that was scary.
26 years old.
G4P5
4cm dilated.
Preterm labour @ 28 weeks.
Chronic drug user, last shot heroine 2 hours ago.

By the time we made the 25 minute code 3 transport, the baby was crowning as we ran into the ER.

And that was with mag sulfate running.

Scary ****

Yea I have had only one not make it to the hospital and after that I have a rule of no babies delivered in my ambulance! To messy Lol

 

[manny212]

 

[pixmedic]

Nice work!! Sometimes you just need to do what is needed for the PT. I hate pediatric calls. I have had some tough ones. Good job staying focused and figuring out the issue.

Equally pucker inducing are the premature labor calls we get our of our areas hospital going to the women's hospital in town. Took a woman a few months ago that was scary.
26 years old.
G4P5
4cm dilated.
Preterm labour @ 28 weeks.
Chronic drug user, last shot heroine 2 hours ago.

By the time we made the 25 minute code 3 transport, the baby was crowning as we ran into the ER.

And that was with mag sulfate running.

Scary ****

Yea I have had only one not make it to the hospital and after that I have a rule of no babies delivered in my ambulance! To messy Lol

I tape the women's knees together

 

[FITBMX]

I know this is late, but great work!!!