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

• xygen 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 H20  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 O2 button -

• xygen 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 H20  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 cmH20

 As patient exhales, when

pressure in airway falls below 5 cmH20, it triggers inspiratory cycle

 Avoids “stacking breaths”

because will not start inspiration until exhalation complete

 Delivers 2-4 cmH20 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 cmH20  Turn gold O2 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 cmH20 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 cmH20

– Higher maximum airway resistance required since ETT narrows airway

 Turn gold O2 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 CO2 – Chest rise and fall – Color improvement

 Always reset to 20

cmH20 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 O2 oxygen release

button

1 – 1 ½ seconds for adults 1 second for child

 INH knob open

Baseline PEEP 2-4 cmH20

 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 cmH20 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

• xygen 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

5cmH20 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

• ther 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