Category: Video Library

What Does NICE Say About Epilepsy? The Video

The guidelines, summarised, and made relevant for Paramedics (anything irrelevant is not included):

The full guidelines:

https://www.nice.org.uk/guidance/cg137/resources/epilepsies-diagnosis-and-management-pdf-35109515407813

(full reference in video)

*update 28/02/22 – music volume reduced to ensure voiceover is clearer

July 5, 2021
Video – Burns: The Practical Stuff
Uploaded to YouTube in April 2019; Filmed 2018

Content warning: This video may contain sensitive content.

This video demonstrates the assessment and management of burns, using equipment that is recommended within the locality at the time of production. Remember to check your local, current guidelines before putting anything into practice. Produced by HCPs and students.

This video demonstrates use of burn gel wraps, which may no longer be used in your ambulance Trust. Please check your local guidelines regarding this. According to the British Burn Association:

Burn gel wraps may be used to provide analgesia, but only after adequate cooling has
occurred as they do not actively remove heat from the wound
Varley et al (2014)

Remember to follow good IPC in real life.

The transcript below has been slightly edited, with titles added, to make it easier to read.

Further recommended reading: The British Burn Association First Aid Clinical Practice Guidelines

Transcript

You must read the full disclaimer at www.article999.co.uk/disclaimer and check your local guidelines before putting into practice any of our content.

BURNS: The practical stuff

This video contains content some might find sensitive.

Treatment

With all assessments and interventions, use an aseptic technique, especially because ‘burns are prone to infection’
Purcell, 2003: 217

Airway

The patient’s airway might worsen. Here’s why:

‘A burned patient may have a patent airway on the initial evaluation. […] In the time that follows, the face, as well as the airway, will likely swell.’
NAEMT, 2016: 411

… So, consider HEMS for RSI.

Breathing

The patient’s breathing might worsen. Here’s why:

Is there a chest wall burn?

‘Burns constrict the chest wall similarly to having several leather belts progressively tightening around the patient’s chest. As time progresses, the patient cannot move the chest wall to breathe.’
NAEMT, 2016: 412

So, consider HEMS and ventilatory support where needed.

Other considerations:

Inhaled toxins ‘can produce asphyxiation’
NAEMT, 2016: 412

If:
– LOC in a fire with ‘heavy smoke’
– trapped patient in a fire
consider O2
El-Helbawy & Ghareeb, 2011

Circulation

Swelling might get worse. Here’s what to do about it:

‘Distal limb perfusion may be critically reduced’; ‘Burned extremities should be elevated during transport to reduce the degree of swelling in the affected limb’
NAEMT, 2016: 412

A complication of swelling:

Fluid loss occurs from swelling and evaporation
NAEMT, 2016: 416

Giving Fluids – Pros and Cons

Consider IV fluids, especially if the burn is >10% of the body (AACE, 2016: 265-266). Keep watching for info on how to determine this.

Give fluids with caution. Too much -> ‘cardiac failure, […] infectious complications, acute respiratory distress syndrome, and even death’.

Too little -> ‘hypovolemic shock, organ failure’

(NICE, 2016)

Judicious fluid management of children with severe burn injury can improve the respiratory outcome measures of these children
Duran and Sheridan, 2016

Cannulating – Essentials

When cannulating, ‘placement through the burn is appropriate [only] if no alternative sites are available’
NAEMT, 2016: 412

What about heat?

Patients with burns are not able to maintain their own body heat
NAEMT, 2016: 413

…So, give blankets

ECGs

ECGs are required for electrical burns (AACE, 2016: 265) but consider them for all burns as ‘cardiac dysrhythmias’ result from the release of ‘muscle potassium’ (NAEMT, 2016: 418) and studies have shown disturbances in the cardiac functions of in-hospital burn patients (Jeschke et al, 2008).

Disability

Do your BMs

Hyperglycemia may occur in burns patients and has a higher risk of ‘morbidity and mortality in critically ill patients’ (Wolfe et al, 1979; Mecott et al, 2010).

Pain management in children

In children, ‘a multi-modal approach to pain and sedation can improve the neurological status of severely burned children’
Duran and Sheridan, 2016

Expose/Examine

Cooling the burn:

Cool with a wet compress
Purcell, 2003: 217

‘Cooling gels such as Burnshield are often used by paramedics. These are useful in cooling the burn and relieving pain in the initial stages.’ *
Be aware of the risk of ‘heat loss’
Hudspith and Rayatt, 2004

*This guidance is changing. Check your local guidance first, and consider the use of cling-film after running water.

Documentation during examination:

Assess and document:

‘Burn depth & features’ (Purcell, 2003: 217)

Other considerations:

Anticipate Swelling. Take off jewelry. Be aware that these and clothing ‘retain residual heat’ (NAEMT, 2016: 413).

Cooling – more details

Irrigate early to cool and prevent further burning.

Chemical burns: 15 mins min (AACE, 2016: 265)

All burns: Max 20 mins (AACE, 2016: 266)

This is most effective ‘within 20 minutes of the injury’ (Hudspith and Rayatt, 2004).

Don’t use ice cold water as ‘intense vasoconstriction can cause burn progression’ (Hudspith and Rayatt, 2004).

When using cling film

Discard ‘the first few centimetres’ to be aseptic

‘lay this on the wound rather than wrapping the burn’ to anticipate swelling

(Hudspith and Rayatt, 2004)

Consider using wet dressings instead in chemical burns (Allison and Porter, 2004)

Estimating total burns

Consider the use of tools to estimate the total body percentage of the burns (NICE, 2016; Mersey Burns, 2013).

Transport

Using those tools [such as Mersey Burns] will help determine the right treatment centre for the patient and the treatment priority.

Time critical features:
- major abcd problems
- airway burns
- history of hot air or gas inhalation
- respiratory distress
- burns that completely encircle the chest, neck, or limb
- significant facial burns
- burns >10% total body area
- ‘presence of other major injuries’
(AACE, 2016: 266)

References

Association of Chief Ambulance Executives (AACE), 2016. UK Ambulance Services Clinical Practice Guidelines. Bridgwater: Class Professional Publishing

Allison, K. and Porter, K. 2004. Consensus on the prehospital approach to pain management. Emergency Medicine Journal. 21 (1), pp. 112-114

Duran, C. and Sheridan, R.L. 2016. Current Concepts in the Medical Management of the Pediatric Burn Patient. Current Trauma Reports. 2 (4), pp. 202-209

El-Helbawy, R.H. and Ghareeb, F.M. 2011. Inhalation injury as a prognostic factor for mortality in burns patients. Annals of Burns and Fire Disasters. 24 (2), pp.82-88

Hudspith, J. and Rayatt, S. 2004. First aid and treatment of minor burns. BMJ. 328 (7454), pp. 1487-1489

Jeschke, M.G. et al. 2008. Pathophysiologic response to severe burn injury. Anals of surgery. 126, pp. 37-51

National Association of Emergency Medical Technicians (NAEMT). 2016. PHTLS. Prehospital Trauma Life Support, 8th Edition. Burlington: Jones and Bartlett Learning.

NICE, 2016. Mersey Burns for calculating fluid resuscitation volume when managing burns. Available at: https://www.nice.org.uk/advice/mib58/chapter/summary (Accessed 06/04/19)

Purcell, D. 2003. Minor Injuries. A Clinical Guide. Edinburgh. Elsevier.

St Helens and Knowsley Teaching Hospitals NHS Trust, 2013. Mersey Burns. Available at: https://merseyburns.com (Accessed 06/04/19)

*Stiles, K. and Goodwin, N. 2018. British Burn Association: First Aid Clinical Practice Guidelines. Available Online: https://www.britishburnassociation.org/wp-content/uploads/2017/06/BBA-First-Aid-Guideline-24.9.18.pdf (Accessed 29/03/21)

*Varley, A. et al. 2014. British Burn Association: First Aid Position Statement. Available Online: https://www.nbt.nhs.uk/sites/default/files/attachments/British%20Burn%20Association%20First%20Aid%20Position%20Statement.pdf (Accessed 29/03/21)

Wolfe, R.R. et al. 1979. Glucose metabolism in severely burned patients. Metabolism. 28 (10), pp. 1031-1039

*Added to post 29/03/21
March 28, 2021
For Adult Patients: What to do when you have a high temperature or feel unusually cold (video)
What to do when you have a high temperature or feel unusually cold – for adults.

Introduction
Questions
Additional Information
References

This video has been created by Paramedics in response to the number of patients we are coming across who are unsure what to do when they have a high temperature or don’t know that the signs and symptoms they are experiencing may mean that they have a high temperature.

If this sounds like you, don’t worry, you’re not alone:

42% of working-age adults are unable to understand and make use of everyday health information, rising to 61% when numeracy skills are also required for comprehension
Public Health England (2015)

As Paramedics, we are frequently advising patients to take paracetamol if they are in pain – unless they have been specifically told not to. We are also advising patients to take off excess layers when they have high temperatures, even if they feel cold. I hope the video is helpful and informative. If there are any concerns, please let me know in the comment box below.

Questions

How do I know I can trust this information?
- Made by an HCPC Registered (and practicing) Paramedic
- Peer reviewed by other HCPC Registered Paramedics
- Informed by research & real-life experience
- Referenced
Are you a company? Who funds you?

Nope, just a website run by a Paramedic, without funding or sponsorship. If this changes, I’ll update this answer.

Can I share the video?

Yes, please do – but any shares must be accompanied by this link:

What to do when you have a high temperature or feel unusually cold – for adults. by Louise Sopher is licensed under Attribution-NoDerivatives 4.0 International

This license requires that reusers give credit to the creator. It allows reusers to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes.

I am a patient/member of the public. Can I contact you for medical advice?

Sadly, due to a whole combination of grey area legalities, I’m unable to offer direct medical advice, and these requests will not be responded to.

I am an HCP and I have a question or suggestion.

No worries, go ahead and contact me.

Is there anything else I should be aware of?

Yes. Please read our disclaimer and the accompanying information below.

Additional Information

When do I need to call 999 or attend A&E for a high temperature alone?
- If you have signs of SEPSIS.
- If you have signs of MENINGITIS.
- If you are a chemotherapy patient and you have had recent chemotherapy.
- If you have new signs of other conditions, such as difficulty breathing, chest pain, or sudden weaknesses (signs of strokes).
- If you do not have any of the above but you think you need to seek help. Your options are: 111, 999, self-transport to A&E, GPs, or urgent care centres.
How do I take my temperature?

The NHS has some useful information about this here.

Do I need to have an ear thermometer?

This is a question of much debate. In the link above, the NHS advises not using forehead strip thermometers due to lack of accuracy. Patient.info advises a blanket avoidance of forehead thermometers. Elsewhere on NHS sites, you’re advised that you don’t need a thermometer to work out if you have a temperature – you’ll likely feel hot to touch.

Is a temperature 37.8 or 38?

This is also a subject of much debate. In the NHS, here says 38C. As does here – in adults. NHS Scotland says 37.8. I have chosen the lower threshold.

References

Derry, C.J. et al, 2014. Caffeine as an analgesic adjuvant for acute pain in adults. [online] Available at: https://www.cochrane.org/CD009281/SYMPT_caffeine-analgesic-adjuvant-acute-pain-adults (Accessed 21/01/21)

EMC, 2017. Paracetamol & Caffeine 500/65 mg Effervescent Tablets. [online] Available at: https://www.medicines.org.uk/emc/product/7416/smpc#gref (Accessed 21/01/21)

Jensen, M.M. & Brabrand, M. 2015. ‘The relationship between body temperature, heart rate and respiratory rate in acute patients at admission to a medical care unit’ in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23: A12.

Knott, L. 2018. Fever. [online] Available at: https://patient.info/signs-symptoms/fever (Accessed 25/01/21)

NHS, 2021. When to self-isolate and what to do. [online] Available at: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-and-treatment/when-to-self-isolate-and-what-to-do/ (Accessed 25/01/21)

NHSb, 2020. High temperature (fever) in adults. [online] Available at: https://www.nhs.uk/conditions/fever-in-adults/#:~:text=A%20high%20temperature%20is%20usually,your%20body%20fighting%20an%20infection.

NHS Inform, 2020. Fever in adults. [online] Available at: https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/fever-in-adults (Accessed 25/01/21)

NPS MedicineWise, 2010. Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies. [online] Available at: https://www.nps.org.au/radar/articles/paracetamol-with-caffeine-panadol-extra-available-over-the-counter-from-pharmacies (Accessed 21/01/21)

Public Health England, 2015. Local action on health inequalities: Improving health literacy to reduce health inequalities [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/460710/4b_Health_Literacy-Briefing.pdf (Accessed 25/01/21).

Sorensen, K. et al, 2015. Health Literacy in Europe: Comparative results of the European Health Literacy Survey (HLS-EU), The European Journal of Public Health, 25: 6.

By Louise Sopher, HCPC registered Paramedic.
February 10, 2021
Revise the NICE Head Injury Guidance in Under 5 Minutes

Check out the video summary below.

For more information, have a look at the related Article 999 post here.

Other posts that may interest you:

Fast Fact: Head Injury is the commonest cause of death

Reference: National Institute for Health and Care Excellence. (2014). Head injury: assessment and early management (NICE Clinical Guideline 176). Retrieved from https://www.nice.org.uk/guidance/cg176

This has not yet been peer reviewed. Comment and review below 🙂

September 13, 2020
ROLE

August 25, 2018

Ventilators: How?

A shorter version of Ventilators: Why, What, How, When? featuring how-to use the ventilator demonstrations only. Made by UK Paramedics, this demonstrates how to use the PneuPac ParaPac ventilator.

Read more:

Ventilators: Why, What, How, When?

How do I get the ventilator off the racks?

What is the relief pressure dial on the ventilator?

The Discovery of Negative and Positive Pressure Ventilation – Fast Fact

What is positive pressure breathing?

What is Negative Pressure Breathing?

Disclaimer

You must read the full disclaimer at www.article999.co.uk/about/ (disclaimer tab) before putting into place anything you see here. Useful information is available in the text on this video, so if you only listen to the narration you will miss important facts. The ventilation settings mentioned in this video are what is recommended by Smiths Medical, current guidelines and some articles – however, as with all topics, there is always varying information available online & alternative expert advice, and no video can cater for all of that. Similarly, this video is intended to demonstrate how to use equipment & to introduce or remind you to the Why, What and When of ventilators – not to tell you that you should or shouldn’t be using it. That is dependent on local guidelines, your research & your choice as a clinician. This video merely highlights the varying advice regarding tidal volume settings, and in the text points out the potential problems with some of the figures. No specific volume is recommended.

Transcript

Article 999. Ventilators: Why, What, How, When?

This video has been made by UK Paramedics following guidelines. It is not endorsed by any author, organisation or Ambulance Trust. You must read the full disclaimer at www.article999.co.uk/about/ and refer to your local guidelines before putting into place anything you see here. This video is intended to demonstrate how to use the ventilator according to use guides and guidelines – not to tell you that you should or shouldn’t use it. That decision is up to you and should be dependent on local guidelines and your own research. This is what the textbooks, the manufacturer and a few articles say & is not intended to represent the expert opinions or experience of others within healthcare.

Remember hand hygiene, bare below the elbows and gloves in real life.

How?

To remove the ventilator from the racks, pull the flap to the side and push the ventilator up. To put it back in, simply push it down and pull the flap to the side again.
To connect to the gas supply, push the hose into the socket and twist. It’s the same when connecting to a portable oxygen cylinder.
When you turn it on, the ventilator should complete a self check. The alarm lights should flash in sequence, there should be one burst of the high pressure audible alarm, and the orange indicator should flash for 60 seconds.
Next, check the indicator shows white for O2.
Connect the patient circuit [shown in video].
Next on the list, adjust the ventilation parameters. Set the air mix control to no air mix for respiratory arrest or CPR. Set the relief pressure control to 40. Set the respiratory rate to 12. As for the tidal volume, it varies massively as you can see on the screen. It depends on whether you opt for an average value or base it on the patient’s weight. Smiths Medical (2017) advise 800-900ml on their training video, [but this may not be advisable] but don’t worry too much about the slight differences in tidal volume because the PneuPac features a high pressure alarm that we’ll discuss shortly. The alarm will help you identify if the tidal volume is too high for your patient.

(Gregory & Mursell, 2010: 44; Pilbery & Lethbridge, 2016: 189; Baker, 2012; Smiths Medical, 2017)

The following demonstrate the variance in researched texts and guidelines – not necessarily the advised settings:

400-600ml	Baskett, 1996
500-600ml	Perkins et al, 2015
600ml	Baker, 2016
800-900ml	Smiths Medical, 2017 – may not be advisable due to risks of barotrauma. See below
6-8ml/kg	Bocklage & Balk, 2017; Frakes, 2007
10ml/kg or 5-8ml/kg	Baker, 2012 – depending on the extent of the risk of barotrauma

7. Next, temporarily occlude the patient connection. The relief pressure monitor should go to the maximum setting – i.e. 40cmh20.

(Gregory & Mursell, 2010: 44; Pilbery & Lethbridge, 2016: 189; Baker, 2012; Smiths Medical, 2017)

What do the audible warnings mean?

Top left is the high pressure alarm
Top right is low pressure
Bottom left is the battery indicator
The middle one tells you when breathing is detected by the ventilator

(Smiths Medical, 2017)

High pressure = excessive tidal volume, incorrect airway position, kinked ET tube, or incorrect ventilation settings.
If the pressure is reaching it’s max, there may be something wrong with the circuit.

If you’ve checked the above and the alarm is still sounding, Smiths Medical (2017) advise that your tidal volume setting might simply be too high.

Low pressure = leakage or insufficient tidal volume/settings, faulty valve in the patient’s circuit
This alarm tends to occur when pressure drops below 10cmh20

Earlier, I pointed out the alarm in the middle, at the bottom. This is SMMV. It’s an indicator that will flash green if the patient is breathing for themselves. The ventilator will assist if the patient breathes with less than 150ml of tidal volume. Between 150-400ml the ventilator will extent the exhalation time to allow the patient to complete their own breath, and above 400ml the ventilator will allow the patient to breathe and will not assist, but may still assist on the next breath if required (Smiths Medical, 2017; Baker, 2012).

Extra facts:

McCarty et al (2012) found that ‘ventilation rates and tidal volumes commonly exceeded Guideline recommendations. This resulted in […] excessive mean airway pressure’

Smiths Medical (2017) advise that peak inflation pressure should be below 20cmh20 when using a mask to ventilate due to the issues of too high pressure

Inspiration to Expiration should be 1:2 (Smiths Medical, 2017; Baker, 2012)

References

Baker, D. 2012. Emergency and Transport Ventilation, an introductory guide, Smiths Medical International Limited: Luton

Baker, D.J. 2016. Artificial Ventilation: A Basic Clinical Guide. Springer International: Switzerland

Baskett, P. et al. 1996. ‘Tidal volumes which are perceived to be adequate for resuscitation’, Resuscitation, 31 (3), pp. 231-4

Bocklage, T. & Balk, R.A. 2017. Setting the Tidal Volume In Adults Receiving Mechanical Ventilation: Lessons

Learned From Recent Investigations, Available Online: https://www.nbrc.org/wp-content/uploads/2017/07/Setting-the-Tidal-Volume.pdf (Accessed 17/12/17)

Frakes, M. 2007. Ventilation Modes and Monitoring, Available Online: http://www.rtmagazine.com/2007/02/ventilation-modes-and-monitoring/ (Accessed 17/12/17)

Gregory, P. and Mursell, I. 2010. Manual of Clinical Paramedic Procedures, West Sussex: John Wiley & Sons

McCarty, K. et al, 2012. Ventilation rates and tidal volume during emergency department cardiac resuscitation, Resuscitation, 83: 4, p45

Owen, R. and Castle, M. 2006. ‘EtCO2: the key to effective prehospital ventilation’, Emergency Medical Journal, 23 (7), pp. 578-579

Perkins, G.D. 2015. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation, Available Online: https://ercguidelines.elsevierresource.com/european-resuscitation-council-guidelines-resuscitation-2015-section-2-adult-basic-life-support-and/fulltext#back-bib0760 (Accessed 17/12/17)

Pilbery, R. & Lethbridge, K. 2016. Ambulance Care Practice, Bridgwater: Class Professional Publishing

Smiths Medical, 2017. ‘Pneupac – ParaPAC’, Pneupac Transport Ventilators – Breathe Easy, Available Online: https://www.smiths-medical.com/resources/pneupac-transport–ventilators—breathe-easy (Accessed 27/10/17)

With thanks to Smiths Medical for their correspondence and information

Music:
Dobroide, 2010. 20091229.ambulance.siren.wav. Available Online: https://freesound.org/people/dobroide/sounds/8713/ (Accessed 21/08/17)

Productiontrax.com

Images:

Article 999’s own or licenses purchased via Adobe Stock & Dreamstime

Feedback is welcome & responded to. Stay tuned for more content!

Displayed on one of our ‘Fast Facts’ pages. Click on the image for the link & reference!

December 29, 2017

Ventilators: Why, What, How, When?

Made by UK Paramedics, this video demonstrates how to use the PneuPac ParaPac ventilator.

What is the relief pressure dial on the ventilator?

What is positive pressure breathing?

What is Negative Pressure Breathing?

The Discovery of Negative and Positive Pressure Ventilation – Fast Fact

Disclaimer

Transcript

Article 999. Ventilators: Why, What, How, When?

Remember hand hygiene, bare below the elbows and gloves in real life.

Why use the ventilator?

Research suggests that mechanical ventilators can reduce the variability of breath timings & as a result, capnography readings. They can also increase the likelihood of ‘effective ventilation’ (Owen and Castle, 2006)

To quote from Gregory & Mursell (2010: 47) ‘A high flow rate over a short inflation time inevitably produces a high peak airway pressure in an unprotected airway [as with BVM technique]. High peak airway pressure overcomes the pressure of the lower oesophageal sphincter and causes gastric inflation. […] Use of […] mechanical ventilation may help to overcome the high pressures involved. […] In an intubated patient or a patient with an LMA in situ, use of a mechanical ventilator has been shown to allow paramedics to accomplish extra tasks, document better, and provide better patient care’ (Gregory & Mursell, 2010: 47)

What?

This is a time-cycled, volume preset flow generator (Baker, 2012). In other words, the pressure can vary, volume is always the same, and the air must be delivered within a preset time, which helps to control the tidal volume.

There are many different types. One of the most common ones in UK ambulances at this time (Gregory & Mursell, 2010: 44) is the Pneupac paraPAC (Smiths Medical, 2017) but the ParaPac Plus may soon replace it.

Here are the useful parts:

The supply gas failure alarm
The inlet connection
The relief pressure control
The ‘main pneumatic switch’
Air mix control
Inflation pressure monitor
Frequency control
Tidal volume control
(Pilbery and Lethbridge, 2016: 189)

How?

To remove the ventilator from the racks, pull the flap to the side and push the ventilator up. To put it back in, simply push it down and pull the flap to the side again.
To connect to the gas supply, push the hose into the socket and twist. It’s the same when connecting to a portable oxygen cylinder.
When you turn it on, the ventilator should complete a self check. The alarm lights should flash in sequence, there should be one burst of the high pressure audible alarm, and the orange indicator should flash for 60 seconds.
Next, check the indicator shows white for O2.
Connect the patient circuit [shown in video].
Next on the list, adjust the ventilation parameters. Set the air mix control to no air mix for respiratory arrest or CPR. Set the relief pressure control to 40. Set the respiratory rate to 12. As for the tidal volume, it varies massively as you can see on the screen. It depends on whether you opt for an average value or base it on the patient’s weight. Smiths Medical (2017) advise 800-900ml on their training video, [but this may not be advisable] but don’t worry too much about the slight differences in tidal volume because the PneuPac features a high pressure alarm that we’ll discuss shortly. The alarm will help you identify if the tidal volume is too high for your patient.

(Gregory & Mursell, 2010: 44; Pilbery & Lethbridge, 2016: 189; Baker, 2012; Smiths Medical, 2017)

The following demonstrate the variance in researched texts and guidelines – not necessarily the advised settings:

400-600ml	Baskett, 1996
500-600ml	Perkins et al, 2015
600ml	Baker, 2016
800-900ml	Smiths Medical, 2017 – may not be advisable due to risks of barotrauma. See below
6-8ml/kg	Bocklage & Balk, 2017; Frakes, 2007
10ml/kg or 5-8ml/kg	Baker, 2012 – depending on the extent of the risk of barotrauma

7. Next, temporarily occlude the patient connection. The relief pressure monitor should go to the maximum setting – i.e. 40cmh20.

(Gregory & Mursell, 2010: 44; Pilbery & Lethbridge, 2016: 189; Baker, 2012; Smiths Medical, 2017)

What do the audible warnings mean?

Top left is the high pressure alarm
Top right is low pressure
Bottom left is the battery indicator
The middle one tells you when breathing is detected by the ventilator

(Smiths Medical, 2017)

If you’ve checked the above and the alarm is still sounding, Smiths Medical (2017) advise that your tidal volume setting might simply be too high.

Low pressure = leakage or insufficient tidal volume/settings, faulty valve in the patient’s circuit
This alarm tends to occur when pressure drops below 10cmh20

When?

– AACE (2016) recommend considering ventilation if a ptn’s o2 sats <90 on high con o2,
if the RR is <10 or >30 bpm or if there is ‘inadequate chest expansion’ (p42) but the mechanical ventilator is to be used …
– for ’emergency and transport ventilation’ in 5kg + patients (Smiths Medical, 2017)

Extra facts:

McCarty et al (2012) found that ‘ventilation rates and tidal volumes commonly exceeded Guideline recommendations. This resulted in […] excessive mean airway pressure’

Smiths Medical (2017) advise that peak inflation pressure should be below 20cmh20 when using a mask to ventilate due to the issues of too high pressure

Inspiration to Expiration should be 1:2 (Smiths Medical, 2017; Baker, 2012)

References

Baker, D. 2012. Emergency and Transport Ventilation, an introductory guide, Smiths Medical International Limited: Luton

Baker, D.J. 2016. Artificial Ventilation: A Basic Clinical Guide. Springer International: Switzerland

Baskett, P. et al. 1996. ‘Tidal volumes which are perceived to be adequate for resuscitation’, Resuscitation, 31 (3), pp. 231-4

Bocklage, T. & Balk, R.A. 2017. Setting the Tidal Volume In Adults Receiving Mechanical Ventilation: Lessons

Learned From Recent Investigations, Available Online: https://www.nbrc.org/wp-content/uploads/2017/07/Setting-the-Tidal-Volume.pdf (Accessed 17/12/17)

Frakes, M. 2007. Ventilation Modes and Monitoring, Available Online: http://www.rtmagazine.com/2007/02/ventilation-modes-and-monitoring/ (Accessed 17/12/17)

Gregory, P. and Mursell, I. 2010. Manual of Clinical Paramedic Procedures, West Sussex: John Wiley & Sons

McCarty, K. et al, 2012. Ventilation rates and tidal volume during emergency department cardiac resuscitation, Resuscitation, 83: 4, p45

Owen, R. and Castle, M. 2006. ‘EtCO2: the key to effective prehospital ventilation’, Emergency Medical Journal, 23 (7), pp. 578-579

Pilbery, R. & Lethbridge, K. 2016. Ambulance Care Practice, Bridgwater: Class Professional Publishing

With thanks to Smiths Medical for their correspondence and information

Music:
Dobroide, 2010. 20091229.ambulance.siren.wav. Available Online: https://freesound.org/people/dobroide/sounds/8713/ (Accessed 21/08/17)

Productiontrax.com

Images:

Article 999’s own or licenses purchased via Adobe Stock & Dreamstime

Feedback is welcome & responded to. Stay tuned for more content!

December 29, 2017

How to size and insert an OP airway adjunct (insertion only)

This video demonstrates how to insert an OP airway adjunct to an adult patient. A full video, showing how to size & insert the adjunct, along with information about relevant anatomy, is available on our YouTube channel. For more videos like this, stay tuned to www.article999.co.uk as well as the YouTube, Facebook and Twitter pages.

This is the shorter version of the OPA video. For the long version, featuring the when, where and how of OP airway adjuncts, please click here.

Menu

0:08 disclaimer

0:25 Seen this video before? Skip to the main content

0:33 Sizing the OPA

0:38 Inserting the OPA

1:01 References

Disclaimer

All of the content published by Article 999 follows reputable guidelines and are referenced. This video has not been endorsed by any organisation, author or ambulance trust. You must read the full disclaimer available at www.article999.co.uk/about/ (disclaimer tab) before putting into place anything you read or watch here. Please also remember to check your local guidelines before practicing any of these skills.

Transcript

Remember hand hygiene, bare below the elbows, and gloves in real life! (AACE, 2016)

Having opened the airway using manual airway manouvres and checking it is clear of obstruction, and having already selected the appropriate airway adjunct and size, now insert the adjunct back to front (Pilbery & Lethbridge, 2016) with the bendy part, named ‘the body’ (Beattie, 2005), curved towards the patient’s upper lip and nose. Once the adjunct has reached the soft palate, rotate it 180 degrees and advance it (Pilbery & Lethbridge, 2016). It should now rest in the pharynx (Pilbery & Lethbridge, 2016).

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Full disclaimer available at website.

References

Beattie, S. 2005. Placing an oropharnygeal airway, Available Online: http://www.modernmedicine.com/modern-… (Accessed 18/05/17)

Pilbery, R. and Lethbridge, K. 2016. Ambulance Care Practice, Bridgwater: Class Professional Publishing

Music:

Dobroide, 2010. 20091229.ambulance.siren.wav. Available Online: https://freesound.org/people/dobroide… (Accessed 21/08/17)

Productiontrax.com

Images:

Article 999’s own or licenses purchased via Adobe Stock & Dreamstime

Final note.

Why is it so important to size the adjunct? Because ‘If the airway [device] is too long it may occlude the airway by […] displacing the epiglottis; if too short it will not separate the soft palate or tongue from the posterior wall of the pharnyx’

Gregory, P. & Mursell, I. 2010. ‘Airway management’ in Manual of Clinical Paramedic Procedures, Sussex: Blackwell Publishing, pp. 2-34

This post has been peer reviewed by at least one other individual. Let us know what you think in the comments below.

October 12, 2017
How to size and insert and OP airway adjunct: Where, When and How?

This video demonstrates how to size and insert an OP airway adjunct and points out relevant airway anatomy. A summary, showing OP airway insertion only, is available on our YouTube channel. For more videos like this, stay tuned to www.article999.co.uk as well as the YouTube, Facebook and Twitter pages.

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0:07 disclaimer

0:24 anatomy

1:04 When?

1:14 How? Sizing

1:54 Insertion

2:26 References

Disclaimer

All of the content published by Article 999 follows reputable guidelines and are referenced. This video has not been endorsed by any organisation, author or ambulance trust. You must read the full disclaimer available at www.article999.co.uk/about/ (disclaimer tab) before putting into place anything you read or watch here. Please also remember to check your local guidelines before practicing any of these skills.

Transcript

Remember hand hygiene, bare below the elbows, and gloves in real life! (AACE, 2016)

Airway adjuncts ‘prevent the tongue from partially or completely obstructing the airway’ (Anaesthesia UK, 2010).

The key parts of the upper airway for this video concern the nasal cavity, the oral cavity, the hard palate, the soft palate (at the back of the mouth), the oropharnyx and the pharynx, which is a ‘muscular membranous channel’ (QA International, 2017) that ‘begins at the base of the skull’ and ‘connects the nasal cavities to the […] oesophagus’ (Pazhaniappan, 2017). It is made up of the nasopharynx, oropharynx, and laryngopharynx (Pazhaniappan, 2017). It is also the location a correctly sized OP airway should sit in.

Use an OP airway on ‘an unresponsive patient’ who does not have a gag reflex (Pilbery & Lethbridge, 2016).

Having opened the airway using manual airway manouvres and checking it is clear of obstruction, now size the adjunct (Pilbery & Lethbridge, 2016). OP airways range from size 000 to 5 (AACE, 2016). To find the right size, measure ‘the vertical distance between the patient’s incisors and the angle of the jaw’ (Pilbery & Lethbridge, 2016), as shown. The flange (Beattie, 2005) should align with the lips and ‘the tip to the angle of the jaw’ (Anaesthesia UK, 2017). When correctly fitted, the OP airway should be just big enough to have the flange (Beattie, 2005) resting over the patient’s lips. Now insert the adjunct back to front (Pilbery & Lethbridge, 2016) with the bendy part, named ‘the body’ (Beattie, 2005), curved towards the patient’s upper lip and nose. Once the adjunct has reached the soft palate, rotate it 180 degrees and advance it (Pilbery & Lethbridge, 2016). It should now rest in the pharynx (Pilbery & Lethbridge, 2016).

Made by www.article999.co.uk

Full disclaimer available at website.

References

Anaesthesia UK, 2010. Guedal Airway, Available Online: http://www.frca.co.uk/article.aspx?ar… (Accessed 22/08/2017)

Association of Ambulance Chief Executives (AACE). 2016. UK Ambulance Services Clinical Practice Guidelines 2016, Bridgwater: Class Professional Publishing

Beattie, S. 2005. Placing an oropharnygeal airway, Available Online: http://www.modernmedicine.com/modern-… (Accessed 18/05/17)

Pazhaniappan, N. 2017. The Pharynx, Available Online: http://teachmeanatomy.info/neck/visce… (Accessed 22/08/17)

Pilbery, R. and Lethbridge, K. 2016. Ambulance Care Practice, Bridgwater: Class Professional Publishing QA International, 2017. Respiratory System, Available Online: http://visual.merriam-webster.com/hum… (Accessed 22/08/17)

Music:

Dobroide, 2010. 20091229.ambulance.siren.wav. Available Online: https://freesound.org/people/dobroide… (Accessed 21/08/17)

Productiontrax.com

Images:

Article 999’s own or licenses purchased via Adobe Stock & Dreamstime

Final note.

Why is it so important to size the adjunct? Because ‘If the airway [device] is too long it may occlude the airway by […] displacing the epiglottis; if too short it will not separate the soft palate or tongue from the posterior wall of the pharnyx’

Gregory, P. & Mursell, I. 2010. ‘Airway management’ in Manual of Clinical Paramedic Procedures, Sussex: Blackwell Publishing, pp. 2-34

This video has been peer reviewed by one or more people. Let us know what you think by commenting below.

October 12, 2017
I-Gel: When, How?

This video shows only the when and how of I-Gels. To view a longer video, which contains the why, what, when and how, click here.

This version has been created to enable those of you who want to refresh yourself on only the need to knows – the use of the i-gel – to do so quickly and easily.

This video has not been endorsed by any organisation, author or ambulance trust. You must refer to local guidelines and read Article 999’s full disclaimer, available at www.article999.co.uk/about/ (disclaimer tab), before putting into place anything you see or read here.

This video has been peer reviewed by 2 or more individuals. No drastic changes have been suggested, so improvements will be made to future posts.

October 12, 2017

Category: Video Library

Transcript

Treatment

Airway

Breathing

Circulation

Disability

Expose/Examine

Transport

References

References

Feedback is welcome & responded to. Stay tuned for more content!

Feedback is welcome & responded to. Stay tuned for more content!

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Transcript

References

Music:

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Final note.

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Transcript

References

Final note.