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

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

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

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

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

5 Oxylator EMX Flow rate < 30 LPM Pressure cm H % oxygen to patient Delivers 500 cc/second Inspiratory goal Adult: 1 1 ½ second cc Child (must be >10 kg): 1 second 500 cc

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

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

8 Pilot Implementation Patient limitations > 8 years old > 55 lbs Won t cycle with uncuffed ETT 16 + age 4

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

10 Oxylator EMX Parts

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

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

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

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

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

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

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

18 Oxygen connection Does not require wrenches! Oxylator EMX Parts

19 You got all that?

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

21 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

22 BLS Automatic Use Use cuffed mask Position patient s head Use oral or nasal airway Good mask seal

23 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

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

25 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

26 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

27 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

28 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

29 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

30 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

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

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

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

34 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

35 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

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

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

38 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

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

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

41 Documentation Document use by adding the Oxylator procedure Not positive pressure ventilation

42 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

AUTOVENT 4000 VENTILATOR

OVERVIEW AUTOVENT 4000 Only properly trained and approved Escambia County Bureau of Public Safety Paramedics are to use the AutoVent 4000 ventilator manufactured by LSP to transport patients already on