Impact Ventilator

This procedural slide set will introduce you to the basic set up of the IMPACT ventilator used on Air Care & Mobile Care
This video shows Dr. Hinckley going through the basic settings on the IMPACT vent with a focus on how to change common settings and how to set up a patient on NIPPV.

Circuits:

  • >25kg = Adult

  • 5-25kg = Pediatric

  • <5kg = bag patient

 Set-up:

  • Green to green (pressure transducer)

  • Clear to silver (exhalation valve)

  • Patient circuit to gas outlet

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  • In-line EtCO2 to patient circuit hook-up

  • HME (green filter) to EtCO2

  • Viral/Bacterial filter (white filter) to exhalation port

Ventilator Setting Locations:

FiO2

PIP:

  • PEEP

  • Pressure Support (PS): press and hold button for 2-3 sec and PS menu will pop up

Vt

BPM (RR):

  • I:E ratio

  • Press and hold for:

    • Rise Time (1= fast, 10 = slow)

    • Cycle off %

Mode:

  • AC (P), AC (V), SIMV, CPAP

  • PPV (positive pressure ventilation), NPPV (noninvasive PPV)

  • Apnea back up in NPPV: press and hold button to pop up menu with BPM, PIP target, I:E

Menu Button:

  • Alarm Config- turn off/cancel alarms (automatically turn back on next time vent turned on)

  • Powerup Settings- DO NOT TOUCH THIS (changes initial vent settings on start up)

  • Pulse Oximeter- allows you to connect pulse ox to the vent, we don’t do this

  • Trigger level- adjust assisted breath trigger

  • O2 Reservoir- we don’t use this (tell ventilator how much O2 you have)

  • Unit Info

  • Contrast- adjusts display contrast

Alarm Info

  • Automatically appears in upper left when alarm active

  • Recommends corrective actions

  • To switch between multiple alarms, scroll over clear bell and select (current alarm will be a solid bell)

Alarm Priority Indicator: Triangle to left of BPM

  • No ! = low priority

  • ! = medium priority

  • !! = high priority (you cannot mute these)

Vent Waveform (pressure/time or volume/time)

  • Automatically appears on upper left

  • If alarm text blocking waveform, scroll over bells to wave-box then select

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Ventilator Alarms:

PEEP Leak

  • What: Measured PEEP drops by ≥ 2

  • Common Cause: Leak in circuit, exhalation valve, patient airway

  • Fix: ensure all connections are tight

Incomplete Exhalation

  • What: continued expiratory flow during initiation of next breath

  • Common Cause:

    • Patient: bronchoconstriction, ARDS (look at your patient then vent scalar)

    • System: inline Nebs, HME, suction catheters (increase expiratory resistance)

  • Fix:

    • If air trapping, increase I:E ratio to allow full exhalation

    • If system, can ignore/turn alarm off (caution if patient has any risk factors for true incomplete exhalation)

Gas Intake Fault

  • What: fresh gas/emergency air inlet (upper right side) blocked

  • Common Cause: external blockage

  • Fix: remove blockage

Inspiratory Demand Not Met

  • What: end inspiratory pressure < -1.0 (more negative)

  • Common Cause: deep inspiration by patient (air hunger, neuro breathing pattern, compensating for metabolic acidosis, etc.)

  • Fix:

    • If fighting vent/neuro breathing, consider sedation

    • If air hunger, increase flow rate via decreased I time or rise time

  Setting up bi-level ventilation

Ventilator Settings:

  • Set Mode to CPAP

  • Change PPV to NPPV in Mode box (press Mode button twice to highlight PPV)

  • Set PEEP

  • Press and hold PIP button for 2-3 sec to open Pressure Support Menu

  • Set Pressure Support

    • This is your delta pressure!!

    • If PEEP increases PIP automatically increases to keep constant delta pressure/ventilatory support

 Troubleshooting

  • Patient cannot breath in for as long as they want to —> Increase cycle off %

    • Due to air leak, vent switches to exhalation too early

Zoll Monitor 

This video shows how to use the many features of the the Zoll monitor on Air Care & Mobile Care.

Radio Operations

This video shows how to operate your handheld radio, helmet radio, as well as the radio equipment in the back of the helicopter.

Handheld Radio

Aircraft Radio

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Buddy Lite

General Info:

  • Infuses by gravity (does NOT control flow rate)

  • Heats blood and/or fluids to 38 degrees Celsius (100.4 degrees F)

    • Heats crystalloids at 20 degrees Celsius up to 80ml/min

    • Heats PRBCs at 10 degrees Celsius up to 50ml/min

    • You can infuse faster than these rates, but fluid may not be fully warmed

  • Rechargeable battery; docking station in the nursing office to charge

Instructions for use:

  1. Open heater unit door




2. Line up orientation hub on the disposable set with the notch in the heater unit (red to red)

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3. Close door and secure the latch







4. Attach the disposable set to the IV administration set (red capped end, red to blood) and prime as you normally would, then hook up to patient (blue capped end, blue to you)

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5. Press the “ON” button and begin infusing

6. Don’t forget to watch the battery life…and remove and dock on charger if needed

Blood temperature INdicator

Inactive: before it is applied to blood product bag, indicator should never be yellow

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Active: actively monitoring temperature, indicator should always be green

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Triggered: blood has gone over acceptable temperature and should NOT be administered

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sapphire pump

Set-up and Use:

  1. Obtain Supplies: Sapphire tubing, 60cc luer-lock syringe, 10cc flush, Sapphire pump

2. Flush side port of Sapphire tubing with NS flush then replace sterile cap

3. Draw up medication to infuse in 60cc syringe (draw up entire 60cc or as much of the medication as is available)

4. Ensure there is no air in syringe

5. Remove sterile cap from end of tubing, attach 60cc syringe, and flush entire line

NOTE: must ensure no air in tubing (otherwise pump will alarm and stop infusing)

6. Leave 60cc syringe attached to Sapphire tubing (this is your medication reservoir)

7. Insert tubing into pump:

  • Open clear plastic cover on Sapphire pump

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  • Arrow on plastic connector points down

  • Hook plastic ‘feet’ into metal rod

  • Press plastic firmly to click on place

  • Close Sapphire pump cover

8. Turn on pump and program your drip (example below for esmolol drip)

  • Select ‘New Infusion’ then ‘Dose Calculation’

NOTE: for any titratable drip ALWAYS select dose calculation, for non-titratable drip (heparin/tPA) you can select ‘mL’ and simply program in the rate (mL/time)

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  • Select medication concentration units then type in concentration

  • Select ‘Weight-based Infusion’ if applicable then enter patient’s weight

  • Select units for infusion dose rate, then select ‘Dose Rate’ and enter rate

  • Select ‘VTBI’ (Volume To Be Infused) and enter total volume of medication drawn up (60mL if syringe was full prior to priming tubing)

  • Pump then automatically calculates how long you can infuse medication before running out, ‘Time’

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  • Click ‘OK’ and screen will appear with all the settings you have programed in. Show this screen to your partner to confirm that all information entered is correct.

  • Select ‘OK’ then ‘Start’ and infusion will begin

  • Select ‘Lock’ to lock the screen (this prevents accidental setting changes from bumping screen during transport)

  • To unlock screen and change dose in flight, press and hold ‘Press to unlock screen’ then select ‘OK’

9. To remove tubing after use:

  • Lift up upper metal clip holding plastic tubing connector in place

  • Plastic connector will pop out and can then be removed

epoc

Labs Provided:

Measured:

  • Blood Gas: pH, pO2, pCO2, Lactate

  • Renal: Na, K, Cl, Ca, Cr, Gluc

  • CBC: Hct

Calculated:

  • Blood Gas: HCO3, BE

  • Renal: AG, GFR

  • CBC: Hb

Storage and Use:

  • Keep in padded carrying case unless in use

  • Take out of aircraft between flights to avoid damage from high/low temperatures

  • Quality control performed every 2 weeks by flight nurse

  • Charged weekly/as needed

Quick Start:

  • Power on both screen and base unit

  • For user, enter 0000 + Employee ID

  • For password, leave blank

  • For patient ID, enter aircraft (e.g., AC1)

  • Allow to calibrate (takes ~ 3 minutes) & draw patient’s blood sample

  • Insert sample cartridge with blue triangle facing in

  • Using syringe drop a fraction of a ml (> 0.92) of blood onto sample entry port (sufficient sample when machine beeps + “analyzing sample”)

nebulizer

Aerogen Nebulizer Set-up 

Procedure:

  • Cut inspiratory limb of circuit 6in from ETT

  • Attach T-Piece/Aerogen adaptor to circuit

  • Plug in Aerogen controller à USB / AC/DC Adapter

  • Add neb solution to medication port

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Use with Aerosol facemask:

  • Minimum O2 flow 1L (range: 1-6L adult, 1-2L peds)

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Continuous Nebulization:                                              

  • Draw up medication in Aerogen syringe and prime tubing

  • Attach tubing to nebulizer (see below)

  • Run neb per above

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This video will introduce you to the operation of the ultrasound on Air Care & Mobile Care

dual patient set-up on the ec-145

Blog post

This video shows how to set up the EC-145 helicopter so that it can carry 2 patients simultaneously.