Re: Hyperventilation of the intubated patient

[Guest guest]

I am guessing that they are hyperventalating they are increasing the patient on

board oxygen for the patient to use kinda like a reserve while they are doing

the procedure.

Subject: Hyperventilation of the intubated patient

To: texasems-l

Date: Sunday, November 27, 2011, 12:57 PM

 

A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

[Guest guest]

Nitrogen washing. High-flow Oxygen for 4-5 minutes with passive normal

breathing or accomplished through deep breathing and/or hyperventilation.

Tony , EMT-P

Connected by DROID on Verizon Wireless

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is

good or bad once the patient is intubated(no trauma involved)in the hospital

setting. I am a paramedic moonlighting as an ER tech I see time and time

again the respiratory techs will hyperventile the patient before the patient

is placed on a vent with a rate of no more than 20. They do not use

capnography only a pulse ox to monitor the sats. What are your thoughts?

[Guest guest]

Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

Tell us more and maybe we can give a better answer.

Gene Gandy, JD, LP, NREMT-P

EMS Educator

PERCOMONLINE, Inc.

Tucson, AZ

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

[Guest guest]

Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

Tell us more and maybe we can give a better answer.

Gene Gandy, JD, LP, NREMT-P

EMS Educator

PERCOMONLINE, Inc.

Tucson, AZ

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

[Guest guest]

Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

Tell us more and maybe we can give a better answer.

Gene Gandy, JD, LP, NREMT-P

EMS Educator

PERCOMONLINE, Inc.

Tucson, AZ

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

[Guest guest]

But according to Bushdog's post the guy is already intubated. So why the

nitrogen washing?

GG

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is

good or bad once the patient is intubated(no trauma involved)in the hospital

setting. I am a paramedic moonlighting as an ER tech I see time and time

again the respiratory techs will hyperventile the patient before the patient

is placed on a vent with a rate of no more than 20. They do not use

capnography only a pulse ox to monitor the sats. What are your thoughts?

[Guest guest]

But according to Bushdog's post the guy is already intubated. So why the

nitrogen washing?

GG

Hyperventilation of the intubated patient

A simple question: is there any research showing that hyperventilation is

good or bad once the patient is intubated(no trauma involved)in the hospital

setting. I am a paramedic moonlighting as an ER tech I see time and time

again the respiratory techs will hyperventile the patient before the patient

is placed on a vent with a rate of no more than 20. They do not use

capnography only a pulse ox to monitor the sats. What are your thoughts?

[Guest guest]

I would guess that the simple answer for why it happens is that is how they were

trained by folks that did not have ETCO2. Even after a new technology is

introduced, it takes a long time and a group that dogmatically preaches the

science and EBM for why a change should occur. Many times the old technique

remains because of the " we've always done it that way " (WADITW) syndrome. If

you want to get passing grades from the old guard, you do it the way they want

it. It becomes habit for you, and you pass it on too.

Gene has laid out the new gospel. It is researched and proven. I try to train

students I come in contact with (and we are all, or should be, students)to ask,

" why do you do it that way? " and " what evidence is there that it works " . An

anatomy professor said it best, " If you can't explain why you are doing

something, you are probably doing the wrong thing the wrong way. "

The EMS director for Montgomery County Hospital District did a great

presentation on capnography in cardiac arrests. I loved seeing their waveforms

and the great numbers they maintained and then how it changed once RT got

involved. It is not an indictment of them, they just need to be shown the

evidence and reminded constantly to change their habits.

>

> Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

>

>

> We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

>

>

>

> Tell us more and maybe we can give a better answer.

>

>

> Gene Gandy, JD, LP, NREMT-P

> EMS Educator

> PERCOMONLINE, Inc.

> Tucson, AZ

>

>

>

> Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I would guess that the simple answer for why it happens is that is how they were

trained by folks that did not have ETCO2. Even after a new technology is

introduced, it takes a long time and a group that dogmatically preaches the

science and EBM for why a change should occur. Many times the old technique

remains because of the " we've always done it that way " (WADITW) syndrome. If

you want to get passing grades from the old guard, you do it the way they want

it. It becomes habit for you, and you pass it on too.

Gene has laid out the new gospel. It is researched and proven. I try to train

students I come in contact with (and we are all, or should be, students)to ask,

" why do you do it that way? " and " what evidence is there that it works " . An

anatomy professor said it best, " If you can't explain why you are doing

something, you are probably doing the wrong thing the wrong way. "

The EMS director for Montgomery County Hospital District did a great

presentation on capnography in cardiac arrests. I loved seeing their waveforms

and the great numbers they maintained and then how it changed once RT got

involved. It is not an indictment of them, they just need to be shown the

evidence and reminded constantly to change their habits.

>

> Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

>

>

> We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

>

>

>

> Tell us more and maybe we can give a better answer.

>

>

> Gene Gandy, JD, LP, NREMT-P

> EMS Educator

> PERCOMONLINE, Inc.

> Tucson, AZ

>

>

>

> Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I would guess that the simple answer for why it happens is that is how they were

trained by folks that did not have ETCO2. Even after a new technology is

introduced, it takes a long time and a group that dogmatically preaches the

science and EBM for why a change should occur. Many times the old technique

remains because of the " we've always done it that way " (WADITW) syndrome. If

you want to get passing grades from the old guard, you do it the way they want

it. It becomes habit for you, and you pass it on too.

Gene has laid out the new gospel. It is researched and proven. I try to train

students I come in contact with (and we are all, or should be, students)to ask,

" why do you do it that way? " and " what evidence is there that it works " . An

anatomy professor said it best, " If you can't explain why you are doing

something, you are probably doing the wrong thing the wrong way. "

The EMS director for Montgomery County Hospital District did a great

presentation on capnography in cardiac arrests. I loved seeing their waveforms

and the great numbers they maintained and then how it changed once RT got

involved. It is not an indictment of them, they just need to be shown the

evidence and reminded constantly to change their habits.

>

> Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

>

>

> We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

>

>

>

> Tell us more and maybe we can give a better answer.

>

>

> Gene Gandy, JD, LP, NREMT-P

> EMS Educator

> PERCOMONLINE, Inc.

> Tucson, AZ

>

>

>

> Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

To answer why the intubation: the patient was unresponsive and had possible

overdosed on something. This is even done on cardiac arrests patients. I know we

are to do no harm but is this a harmful practice to the patient?

>

> Bushdog, your question is NOT SIMPLE! It depends on what's going on with your

patient. You say no trauma involved, but why is the patient intubated? Not to

use capnography is mindlessly stupid and below standard of care. I can

understand it in ERs because lots of them don't yet have capnography routinely

available, and they probably won't until the lawyers force them through damage

awards. Sad, but true. This is one place where EMS is far ahead of the

hospitals. Pulse ox takes minutes to respond to a drop in saturation, while

capnography will reflect a misplaced tube instantly, but that's not what you're

asking about. Why are they hyperventilating the patient? For what reason? To

hyperventilate without capnography is not only stupid but asking for disaster.

There is lots of research on the subject but the reasons for hyperventilation

must be known. If it's for a patient that has just been resuscitated from a

cardiac arrest, BIG PROBLEMS are likely, as in survival to ROSC but death later,

or worse, survival without a functioning brain.

>

>

> We used to think that if some oxygen is good, more must be better, but not

always. We ventilate to maintain expired CO2 at certain levels. Without

capnography you have no clue what you're doing to the patient's CO2 level.

>

>

>

> Tell us more and maybe we can give a better answer.

>

>

> Gene Gandy, JD, LP, NREMT-P

> EMS Educator

> PERCOMONLINE, Inc.

> Tucson, AZ

>

>

>

> Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

It's important not to over-ventilate a post cardiac arrest patient.

GG

Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

It's important not to over-ventilate a post cardiac arrest patient.

GG

Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

It's important not to over-ventilate a post cardiac arrest patient.

GG

Hyperventilation of the intubated patient

>

>

>

>

>

> A simple question: is there any research showing that hyperventilation is good

or bad once the patient is intubated(no trauma involved)in the hospital setting.

I am a paramedic moonlighting as an ER tech I see time and time again the

respiratory techs will hyperventile the patient before the patient is placed on

a vent with a rate of no more than 20. They do not use capnography only a pulse

ox to monitor the sats. What are your thoughts?

>

>

>

>

>

>

>

>

>

>

>