Progressi nel soccorso extraospedaliero: utilizzo del VAR in emergenza urgenza extraospedaliera
26
XII Congresso Nazionale SIS 118 Mario Rugna 118 Firenze Soccorso
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New trends in prehospital emergency medicine. ALS algo nex step, TCA targeted algo, new devices and lot of more
Transcript of Progressi nel soccorso extraospedaliero: utilizzo del VAR in emergenza urgenza extraospedaliera
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Mario Rugna 118 Firenze Soccorso
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• Non ho conflitti d’interesse• Non percepisco compensi dalle ditte produttrici dei
device e dei farmaci menzionati nella presentazione
• Le idee e le opinioni espresse non riflettono in nessun modo le posizioni dell’Azienda per cui lavoro.
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Sappiate comunque che quello di buono (e di meno buono) che vedrete ed ascolterete è
basato su evidenze scientifiche ed esperienze cliniche di ottima qualita’.
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The point
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What we need
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118 Medical cardiac arrest
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Medical cardiac arrest
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Medical cardiac arrest
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118 Traumatic cardiac arrest
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Evidences
Traumatic cardiac arrest
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Traumatic cardiac arrest
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Traumatic cardiac arrest
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Traumatic cardiac arrest
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What we need
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Better drugs
Gestione delle vie aeree
Controllo dell’emorragia
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What we need
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Better Training
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What we need
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Better devices
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ANIKIN SIMULATION
Ventilation
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ANIKIN SIMULATION
MAPLESON B & C SYSTEMSInefficient. Once the bag is full during expiration,fresh gas is vented.Not suited for spontaneous breathing -rebreathing is inevitable (with CO2 entering the tubing or bag) unless FGFexceeds peak inspiratory flow rates (3xMV).The C circuit is compact and was used for short transports beforeself-inflating bags became available. Acceptable CO2 levels could beachieved with a FGF of 2 x MV and mild hyperventilation. If the cylinderbecame empty ventilation was impossible.
Mapelson Circuits
virtual-anaesthesia-textbook.com
Ventilation
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ANIKIN SIMULATION
MAPLESON B AND CThey are similar in construction, with the fresh gas flow entry and the expiratory valves located at the patient end of the circuit and reservoir bag is at the machine end of the circuit, except that corrugated tubing is omitted in Mapleson C. They are not commonly used in anaesthetic practice although C system may be used for emergency resuscitation. High flow of gases is needed to prevent rebreathing of CO2 and theatre pollution is maximum. Fresh gas flow required is equal to peak inspiratory flow rate (20-25 lit/min) to prevent rebreathing. So there is lot of wastage of fresh gases.
Mapelson Circuits
Tej K Kaul and Geeta Mittal Mapleson's Breathing SystemsIndian J Anaesth. 2013 Sep-Oct; 57(5): 507–515.
Ventilation
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V.A.R. Vortran Automatic Resuscitator
MANIKIN SIMULATION
• For patients 10 kg and above• Automatic pressure cycled ventilation• For breathing or non-breathing patients• Delivers FiO2 at 50% or 100%• Safe for MRI and CT scan• No batteries no electricity needed• Hands free emergencyventilation• Single patient
Ventilatory frequency.................. Auto-adjusting to lung capacity Adjustable peak pressure range... 10 to 45 cm-H2O PEEP.......................................... 1/5th of PIP (2 to 9 cm-H2O)Operating environmental limits... -18 to 50o CStorage environmental limits...... -40 to 60o C
Ventilation
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ANIKIN SIMULATION
Ventilation
V.A.R. Vortran Automatic Resuscitator
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VE EXPERIENCES
V.A.R. Vortran Automatic Resuscitator
Ventilation
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Mario Rugna 118 Firenze Soccorsowww.medest118.com
