Virginia Beach EMS Oxylator EMX Debra H. Brennaman, RN, MPA, - PowerPoint PPT Presentation

Virginia Beach EMS Oxylator EMX Debra H. Brennaman, RN, MPA, NREMT-P

Oxylator EMX Overview Patient responsive oxygen powered resuscitation / ventilation device intended to provide emergency ventilatory support for apneic patients.

Oxylator EMX  Oxygen-powered – No batteries – Uses compressed oxygen – Can use compressed air (SCBA adapter)

Oxylator EMX  Not a demand valve or vent  Patient responsive  Adapts to patient’s inspiratory:expiratory ratio to deliver “normal” breaths

Oxylator EMX  Flow rate < 30 LPM  Pressure 20-45 cm H 2 0  100% oxygen to patient  Delivers 500 cc/second  Inspiratory goal – Adult: 1 – 1 ½ second • 500-750 cc – Child (must be >10 kg): 1 second • 500 cc

Oxylator EMX Uses  Anytime BVM used – BLS with Cuffed Mask – Cuffed ETT – Combitube – Cricothyrotomy (Melkor)

Pilot Implementation  Approved for use by Paramedics and Intermediates who have completed the required training  Initial deployment – Zone cars – MCI truck

Pilot Implementation  Patient limitations > 8 years old > 55 lbs  Won’t “cycle” with uncuffed ETT  16 + age 4

Oxylator EMX Operation  Automatic  Manual without PEEP  Manual with PEEP  Spontaneous respirations

Oxylator EMX Parts

Oxylator EMX Parts  Gold O 2 button - oxygen release button  Press for manual  Turn ¼ turn clockwise to lock for automatic

Oxylator EMX Parts  Maximum airway pressure setting  Indicator eye  20-45 cm H 2 0  Acts as “pop - off” setting  When airway pressure reaches set level, inspiration stops

Oxylator EMX Parts  INH inhalator knob  Open to allow free-flow oxygen  When open in manual mode creates PEEP

Oxylator EMX Parts  Top Cap  Black piston moves as Oxylator “cycles”  Piston in = inspiratory phase  Piston out = expiratory phase

Oxylator EMX Parts  Filter – internal  Single patient use  Prevents contaminants from entering Oxylator EMX

Oxylator EMX Parts  Filter - external – 1644 Clear Guard Midi 99.9% Efficient – HME Humidifying  Single patient use  Prevents contaminants from entering Oxylator EMX

Oxylator EMX Parts  Extension Tubing  Prevents weight of Oxylator from dislodging ETT

Oxylator EMX Parts  Oxygen connection  Does not require wrenches!

You got all that?

Oxylator EMX Operation  Automatic  Manual without PEEP  Manual with PEEP  Spontaneous respirations

Automatic Use  Inspiratory “trigger pressure” 5 cmH 2 0  As patient exhales, when pressure in airway falls below 5 cmH 2 0, it triggers inspiratory cycle  Avoids “stacking breaths” because will not start inspiration until exhalation complete  Delivers 2-4 cmH 2 0 PEEP

BLS Automatic Use  Use cuffed mask  Position patient’s head – Use oral or nasal airway  Good mask seal

BLS Automatic Use  Start at 20 cmH 2 0  Turn gold O 2 knob ¼ turn clockwise to lock  Once Oxylator EMX “cycles” adjust pressure setting upward until correct inspiration time achieved 1 to 1 ½ seconds for adult 1 second for child

BLS Automatic Use  Confirm ventilation – Chest rise and fall – Color improvement – Breath sounds  Always reset to 20 cmH 2 0 after use

ALS Automatic Use  Intubate patient with cuffed ETT  Verify placement – Visualize cords – Breath sounds – End-tidal CO2  Use extension tubing to prevent dislodged ETT  If extension tubing is unavailable, ensure ETT well secured

ALS Automatic Use  Set pressure to 35 cmH 2 0 – Higher maximum airway resistance required since ETT narrows airway  Turn gold O 2 knob ¼ turn clockwise to lock  Once Oxylator EMX “cycles” adjust pressure setting upward until correct inspiration time achieved 1 to 1 ½ seconds for adult 1 second for child

ALS Automatic Use  Confirm ventilation – Breath Sounds – End tidal CO 2 – Chest rise and fall – Color improvement  Always reset to 20 cmH 2 0 after use

What about AHA Guidelines 2005 concerning hyperventilation??  AHA Guidelines for BVM  BVM dependent on number of breaths per minute administered by provider  Increase ventilation rate does not allow for complete expiration  Results in stacking of breaths = increased intrathoracic pressure

Manual Use  If inspiratory time is too long in automatic mode: > 2 second for adults > 1 second for child must switch to manual mode  To assist ventilations – Irregular airway patterns – CHF with inadequate ventilations • CPAP contraindicated with inadequate ventilations

Manual Use  Press gold O 2 oxygen release button 1 – 1 ½ seconds for adults 1 second for child  INH knob open Baseline PEEP 2-4 cmH 2 0  INH knob closed Baseline PEEP 0

Oxylator EMX with CPR  Unprotected airway Use manual mode 30 compressions: 2 breaths  Intubated patient Continuous compressions Automatic mode Start pressure at 20-25 cmH 2 0 Increase pressure if needed to avoid device stuttering

Patient with Spontaneous Ventilations  Open INH knob  Allows free flow of oxygen at approximately 15 LPM

Trouble shooting Fails to cycle  ETT cuff leak?  ETT too small?  Not enough oxygen in tank?  Esophageal intubation???

Oxygen Duration Cylinder Capacity Oxygen duration D portable 420 liters 28 minutes Super D portable 650 liters 43 minutes M main 4,950 liters 5.5 hours

Troubleshooting “Stuttering” sound  Turn oxygen release button off  Check for airway obstruction or kinked tube  If no obstruction, increase pressure by 5cmH 2 0 and reapply in automatic mode. Repeat until stuttering ceases.  Use manual mode if necessary

Troubleshooting When lung volume decreases, cycles speed up Cycles speed up suddenly  Tension pneumo?  Right mainstem intubation?

Troubleshooting Cycles speed up slowly  Lung compliance falling?  Pulmonary edema worsening?

Asthma  As bronchoconstriction worsens, pressure in airways increases  Oxylator will cycle faster  Results in hyperventilation rate  Increased airway pressure results in hypoventilation by volume  BVM use preferred  Consider slowing ventilations

Troubleshooting Gastric distension  Check tube placement  If using Combitube, consider using other lumen

Cleaning  Separates into 4 parts  Throw away filter  Soak all parts in disinfectant  Rinse with water  Dry and reassemble with new filter

Documentation  Document use by adding the “ Oxylator ” procedure – Not “positive pressure ventilation”

Documentation - Narrative  Mode used – Automatic – Manual – Oxygen for spontaneous respirations  Pressure setting  Inspiratory time  Did it cycle?  Did you have to trouble shoot?  Patient response