ltv 1200 ems training 12-18-07
TRANSCRIPT
![Page 1: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/1.jpg)
Mechanical Mechanical VentilationVentilationWith the LTVWith the LTV® ®
12001200Ventilator:Ventilator:
Applications for Applications for EMSEMS
![Page 2: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/2.jpg)
LTVLTV ®®’s Versatile Applications’s Versatile Applications
• Adult & Pediatric (> 5kg)
• Invasive (ETT, King LT, or Combitube) or Non-Invasive (Mask) Ventilation
• Emergency and Non-emergency Transport
• Long-Term Care
• Rehab
• Homecare
![Page 3: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/3.jpg)
LTVLTV ®® 1200 Ventilators 1200 Ventilators
Small & Light Weight
• 3” x 10” x 12”
• Weighs less than 15 pounds
• Built-in turbine; no compressor or 50 psi air source needed
• Multiple power options
![Page 4: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/4.jpg)
Indications for UseIndications for Use
The majority of the time the LTV 1200 will be used during the transport of a patient already supported by a ventilator
Emergency patients for whom the ventilator may be used: – Cardiac and/or Respiratory Arrest (apnea)– Respiratory Failure (inadequate rate and/or volume)– Impending Respiratory Failure (multiple causes)– Patients already on a vent with unassociated problems
![Page 5: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/5.jpg)
Mechanical VentilationMechanical Ventilation
The BasicsThe Basics
![Page 6: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/6.jpg)
Ventilation vs. OxygenationVentilation vs. Oxygenation
Ventilation is the movement of gas into and out of the lungs and does not necessarily provide oxygenation. (e.g. a patient with no heart beat or circulatory support is not being oxygenated by simply blowing oxygen into their lungs.)
Oxygenation is the delivery of oxygen to the blood and tissue level of the patient and does not necessarily require ventilation. (e.g. a patient on heart-lung bypass is being oxygenated without any ventilation of the lungs)
![Page 7: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/7.jpg)
Of Course …Of Course …
Humans usually provide oxygen to their system by ventilating themselves (breathing) with air which includes approximately 21% oxygen.
A functioning circulatory system will send enough blood flow past the alveoli in the lungs to adequately absorb oxygen and excrete CO2.
![Page 8: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/8.jpg)
and . . .and . . .
A decrease in blood oxygenation (hypoxemia) or increase in blood carbon dioxide levels (hypercarbia) will increase the body’s need for ventilation.
CO2 and/or O2 Respiratory Drive
Need for More Ventilation
![Page 9: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/9.jpg)
Mechanical VentilationMechanical Ventilation
Definition Mechanical ventilation is the use of a
mechanical device to inflate and deflate the lungs.
Purpose Mechanical ventilation provides the force
needed to deliver air to the lungs in a patient whose own ventilatory abilities are diminished or lost.
![Page 10: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/10.jpg)
Mechanical VentilatorsMechanical Ventilators
Range of devices:
Bag-Valve-MaskEmergency Vents
Transport VentsHomecare Vents
Critical Care Vents
![Page 11: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/11.jpg)
Pressure vs. Volume VentilationPressure vs. Volume Ventilation
Ventilating Pressure is controlled and the resulting tidal volume is based on the physical size of airways and lungs and the patient’s lung compliance (stiffness).
or Tidal Volume is controlled and the
resulting pressure is based on the physical size of airways and lungs and the patient’s lung compliance (stiffness).
![Page 12: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/12.jpg)
“ “Modes” of Ventilation on the LTV 1200Modes” of Ventilation on the LTV 1200
AC – Assist/Control SIMV - Synchronized Intermittent Mandatory
Ventilation PSV - Pressure Support Ventilation (PSV) CPAP – Continuous Positive Airway Pressure NPPV – Non-Invasive Positive Pressure
Ventilation (a.k.a. Bi-Level)
![Page 13: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/13.jpg)
Assist / Control Ventilation Assist / Control Ventilation
A minimum number of mandatory breaths per minute is set, the breaths are given at either a set tidal volume or a set pressure. The patient may breath faster than the set rate, but the breaths will be measured and may be assisted in order to reach the set tidal volume or set pressure.
– Example: The ventilator is set to a rate of 8. The patient will get at least 8 “controlled” breaths per minute, but the ventilator can respond to patient effort and “assist” with additional breaths, all at the set tidal volume or pressure.
![Page 14: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/14.jpg)
Assist / Control VentilationAssist / Control Ventilation If patient DOES NOT have any spontaneous respiration's, then the patient will receive the set number of breaths at either the set
pressure or the set tidal volume each minute.
If the patient DOES try to initiate a spontaneous breath, the patient will receive the set tidal volume or pressure.
Time
Pressure
Machine-initiated and/or patient-initiated breaths are all delivered at the set parameters (volume or pressure)
Controlled breath Assisted breath
Patient effort
![Page 15: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/15.jpg)
Basic Assist / Control SettingsBasic Assist / Control Settings
Breath Rate Tidal Volume or Pressure Control level Inspiratory Time (or Peak Inspiratory Flow rate) Oxygen % PEEP Sensitivity
![Page 16: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/16.jpg)
PSV - Pressure Support Ventilation PSV - Pressure Support Ventilation
The patient’s spontaneous breathing effort is supported to a set positive pressure from the ventilator.
There are no mandatory breaths from the ventilator. Patient effort determines respiratory rate, inspiratory time, peak flow, and tidal volume
![Page 17: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/17.jpg)
PSV - Pressure Support VentilationPSV - Pressure Support Ventilation
Goals– Overcome the work associated with moving
gas through the artificial airway and circuit– Improve patient/ventilator synchrony– Augment spontaneous tidal volume
10cm
Time
Pressure
Patient effort
Pressure Support Setting
![Page 18: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/18.jpg)
Basic PSV SettingsBasic PSV Settings
****THE PATIENT MUST HAVE ADEQUATE SPONTANEOUS RESPIRATORY EFFORT
PSV - Range 5-25 cmH2O (typical)
PEEP FiO2
![Page 19: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/19.jpg)
Assist / Control vs. Pressure SupportAssist / Control vs. Pressure Support
Assist / Control
Set Tidal volume or set Pressure
Breaths may or may not be spontaneous
Tidal Volume, inspiratory time, flow rate, and minimal set breathing rate are determined by clinician
Pressure Support
Set Pressure assist level
All breaths are spontaneous
Patient determines respiratory rate, inspiratory time, peak flow, and tidal volume
![Page 20: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/20.jpg)
Spontaneous breath
SIMV – SIMV – Synchronized Intermittent Mandatory VentilationSynchronized Intermittent Mandatory Ventilation
• This ventilation mode provides a mixture of mandatory (controlled) and spontaneous breath types.
• The LTV will give and/or “sync” with enough breaths to achieve the set breathing rate; the patient may breath in between these mandatory breaths, but the “in between” breaths will not be assisted
Time
Pressure
Synchronized machine breath
Patient effort
Machine breath
![Page 21: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/21.jpg)
Basic SIMV SettingsBasic SIMV Settings
Breath Rate Tidal Volume or Pressure Control level Inspiratory Time Oxygen % PEEP Sensitivity
Time
Pressure
Synchronized machine breath
Patient effort
![Page 22: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/22.jpg)
PEEP and CPAPPEEP and CPAP
Definition:– PEEP = Positive End Expiratory Pressure– CPAP = Continuous Positive Airway Pressure
PEEP: a technique of assisting breathing by increasing the air pressure in the lungs and air passages near the end
of expiration so that an increased amount of air remains in the lungs following expiration
CPAP: a technique of assisting breathing by maintaining the air pressure in the lungs and air passages constant and above atmospheric pressure throughout the breathing cycle
![Page 23: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/23.jpg)
PEEP and CPAPPEEP and CPAP
Function:** Functionally, CPAP and PEEP do the same thing:
Splint open airways and alveoli - Increases functional residual capacity (FRC)
Improves oxygenation Redistributes lung water from alveoli to
perivascular space (very beneficial in CHF and Pulmonary Edema patients)
![Page 24: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/24.jpg)
CPAPCPAP
CPAP is actually not a mode of “ventilation” as CPAP does not move gas into and out of the patient. CPAP requires a spontaneous breathing patient.
Paw
SpontaneousSpontaneous Spontaneous Spontaneous
![Page 25: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/25.jpg)
CPAPCPAP
CPAP machines used for obstructive sleep apnea are typically used to “splint” upper airway structures open, but have the same effect as CPAP on the ventilator.
![Page 26: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/26.jpg)
Sensitivity:Sensitivity:Understanding how the vent cyclesUnderstanding how the vent cycles
Sensitivity determines when the ventilator will recognize a patient’s inspiratory effort.
The LTV 1200 offers flow sensitivity.
![Page 27: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/27.jpg)
Flow SensitivityFlow Sensitivity
Flow Sensors
![Page 28: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/28.jpg)
SensitivitySensitivity
Ventilator delivers a low level of constant flow (10 lpm) into the patient circuit. This is called the “bias” flow.
Delivered flowReturned flow
No patient effort
![Page 29: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/29.jpg)
Sensitivity Sensitivity
As the patient begins to inhale, some of this constant flow is diverted to the patient.
Change in flow in the vent circuit will cause the vent to “cycle” and deliver gas to patient.
Delivered flowLess flow returned
![Page 30: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/30.jpg)
SensitivitySensitivity
Sensitivity is usually set 2-3 liters per minute in the hospital.
May require slightly higher setting during transport in field to avoid “auto-cycling” of the ventilator.
Delivered flowLess flow returned
Setting too low can cause auto-cycling of the ventilator (usually due to leak in system)
Setting too high can “lock out” patient from being able to “trigger” any spontaneous breaths
![Page 31: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/31.jpg)
Ventilator AlarmsVentilator Alarms
High airway pressure Low airway pressure Low minute volume Apnea
![Page 32: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/32.jpg)
Ventilator Alarms- Ventilator Alarms- High pressure limitHigh pressure limit
– Setting High Pressure Limit Alarm:
• Usually set within 10 cmH2O above patient’s average Peak Pressure.
• *** When activated, ventilator will terminate breath and the patient does not receive full tidal volume
![Page 33: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/33.jpg)
Ventilator Alarms- Ventilator Alarms- High pressure limitHigh pressure limit
Causes of high pressure alarm violation:– Resistance to gas flow:
• kinks in tubing or monitoring lines• patient coughing• secretions• bronchospasm• gagging, “fighting the ventilator”
– Decrease in lung compliance:• atelectasis• pneumothorax• pulmonary edema
![Page 34: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/34.jpg)
Ventilator Alarms- Ventilator Alarms- Low Pressure AlarmLow Pressure Alarm
– Setting Low Pressure Alarm:• 5-8 cmh2o less than ventilating pressure
![Page 35: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/35.jpg)
Ventilator Alarms- Ventilator Alarms- Low Pressure AlarmLow Pressure Alarm
Causes of Low Pressure Alarms:– Cuff Leak– Vent Circuit
• Check tubing for holes or kinking• Check monitoring lines for tight fit or kinking (Leur
connections can become loose)
• Check connection at “Y” connector
– If using a Ballard suction device, check that all connections are secure (cap for saline port)
– Vent not meeting patient’s inspiratory need (A/C)
![Page 36: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/36.jpg)
Ventilator Alarms- Ventilator Alarms- Low minute volumeLow minute volume
Definition: Minute volume = total volume of breaths over 1 minute time
e.g. 10 breaths per minute x 600 ml per breath = minute volume of 6000 ml 6.0 L minute volume
– Setting Low Minute Volume:• Set 3 Liters under patient’s minute volume, with a
minimal setting of 5L/m.• Ensures adequate alveolar ventilation is maintained.
![Page 37: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/37.jpg)
Ventilator Alarms- Ventilator Alarms- Low minute volumeLow minute volume
– Causes of Low Minute Volume alarms:
• Neuro changes (A/C or PSV)
• Sedation issues (A/C or PSV)
• Patient fatigue (PSV)
• Decrease in compliance (PSV)
• High pressure alarm active and ventilator dumps delivered tidal volume (A/C or PSV)
![Page 38: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/38.jpg)
Ventilator AlarmsVentilator Alarms
Apnea Parameters
– Activated when no exhalation is detected for a selected time period (e.g. 20 seconds)
– Tidal volume and pressure control level should be set appropriately for patient, as these will be used for apnea ventilation.
![Page 39: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/39.jpg)
Key Points Key Points BEFOREBEFORE Transporting Transporting
– See how the patient is interacting with their current vent
• If in A/C– Breathing Rate– Minute Volume– Peak Pressures – Peak Flow on the hospital vent?– Sensitivity
![Page 40: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/40.jpg)
Key Points Key Points BEFOREBEFORE Transporting Transporting
– See how the patient is interacting with their current vent
• If in PSV– Breathing Rate– Spontaneous tidal volumes – Minute Volume– Sensitivity
![Page 41: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/41.jpg)
Key Points Key Points BEFOREBEFORE Transporting Transporting
– Talk to the patients therapist and nurse:• Secretions
– (If already in place, keep the in-line suction device attached to the patient when you go)
• Weaning schedule or ventilator goals for this patient• Any “Quirky” respiratory patterns
– example: pt will breath 50 times per minute when he/she gets anxious.
– See what relieves the “quirkiness” (changing modes, settings, favorite medication, reassurance, etc)
![Page 42: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/42.jpg)
Key Points Key Points While While TransportingTransporting
– Set alarms appropriately• if set appropriately, alarms can alert you to subtle
changes before they become large problems.
– Monitor patients vent parameters• Minute Volume (A/C or PSV)• Peak Pressure (A/C)• Tidal Volumes (PSV)
– Anticipate what changes you would make if patients vent needs change?
![Page 43: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/43.jpg)
LTV 1200 Ventilator SetupLTV 1200 Ventilator Setup
Overview
![Page 44: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/44.jpg)
LTV 1200 Ventilator Setup - OverviewLTV 1200 Ventilator Setup - Overview
Making the connections
Turning the unit ON
Adjusting the settings
Extended Menus
Monitoring the patient
Turning OFF and processing the unit
![Page 45: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/45.jpg)
THE LTV 1200 VENTILATORTHE LTV 1200 VENTILATOR
![Page 46: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/46.jpg)
Front Panel OverviewFront Panel Overview
![Page 47: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/47.jpg)
Left Side Panel OverviewLeft Side Panel Overview
Cooling Fan
Power and Communication
Connections
High/Low Pressure O2 connection
Turbine Intake Filter
![Page 48: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/48.jpg)
Power SourcesPower Sources
External AC Adapter 120VAC/12VDC External Lithium Ion Battery 12V (3 hours) Internal Battery (1 hour)
![Page 49: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/49.jpg)
Lithium Ion BatteryLithium Ion Battery
Lithium Ion Battery in pocket of Backpack carrying case
![Page 50: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/50.jpg)
Oxygen SourceOxygen Source
The LTV 1200 can be used with either a 50-PSI oxygen source or with Low Pressure oxygen.
![Page 51: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/51.jpg)
Oxygen Source Oxygen Source – 50 PSI– 50 PSI
A 50 PSI Oxygen source allows you to use the internal oxygen-air blender to set a specific O2% from 21-100%.
The 50 PSI source can be from a regulated oxygen cylinder or off the ambulance or hospital wall source.
An input O2 of less than 35 PSI will cause an alarm.
![Page 52: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/52.jpg)
Oxygen Source Oxygen Source – Low Pressure– Low Pressure
Home ventilator patients may utilize low pressure oxygen (from a flow meter or oxygen concentrator) bled into the unit using a nipple adapter on the oxygen fitting on the unit.
The “Low Pressure O2 Source” button must be activated and the blender will no longer active.
An O2 Input pressure of more than 35 PSI will cause an alarm.
![Page 53: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/53.jpg)
Right Side Panel OverviewRight Side Panel Overview
![Page 54: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/54.jpg)
![Page 55: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/55.jpg)
Front Panel OverviewFront Panel Overview Display of Monitored Data
Ventilation ControlsAlarm Settings Set Value Knob
LED Pressure Bar
Silence + Reset
Other indicators
![Page 56: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/56.jpg)
Key LTV Ventilator SettingsKey LTV Ventilator Settings
Rate: 0 to 80 bpm Tidal Volumes: 50 to 2000 ml Press. Control: 1 to 99 cmH2O I-time: 0.3 to 9.9 sec Press. Support: 0 to 60 cmH2O O2%: 21 to 100% PEEP: 0 to 20 cmH2O
![Page 57: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/57.jpg)
High Pressure
Low Pressure
Low Minute Volume
Apnea Low/High Oxygen
Pressure Disconnect/Sense Power Low, Power Lost Hardware Fault Battery Low, Battery
Empty Vent Inoperative
LTV® Alarms
Operator Set Preset - Automatic
![Page 58: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/58.jpg)
Monitored ParametersMonitored Parameters
Display Monitored Data Description
PIPPeak Inspiratory
Pressure
Greatest pressure measured during the inspiratory phase
Updated at end of inspiration
MAP Mean Airway Pressure The average airway pressure for the last
60 seconds. Updated every 10 seconds
PEEPPositive End Expiratory
Pressure
The pressure in the patient circuit at the end of exhalation.
Updated at the end of exhalation
f Total Breath Rate
Breaths / minute based on the last 8 breaths. Includes all breath types.
Recalculated and updated at the end of each exhalation or 20 seconds
![Page 59: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/59.jpg)
Monitored ParametersMonitored Parameters
Display Monitored Data Description
Vte Exhaled Tidal Volume
Displays the Exhaled Tidal Volume as measured at the patient wye
Updated at the end of exhalation
VE Exhaled Minute Volume
Displays the exhaled tidal volume for the last 60 seconds, calculated from the last 8 breaths.
Updated every 10 seconds
I:EInspiratory / Expiratory
Ratio
Displays the ratio between measured inspiratory and expiratory time
Also displays inverse I:E ratios
VcalcCalculated Peak Flow(Volume Breaths only)
The calculated peak flow based on tidal volume and inspiratory time settings
Displayed when selected or whenever these two controls are selected
![Page 60: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/60.jpg)
Front Panel – On/OffFront Panel – On/Off
Press to turn ONTo turn OFF, press On/Standby for 3 seconds, then press Silence/Reset
![Page 61: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/61.jpg)
LTV 1200 PresetsLTV 1200 Presets
Presets are loaded in the LTV to facilitate the quick initiation of mechanical ventilation when operators with limited knowledge of the equipment must apply it.
![Page 62: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/62.jpg)
LTV 1200 PresetsLTV 1200 Presets
SAME
NEW
![Page 63: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/63.jpg)
PresetsPresets
INFANT
PEDIATRIC
ADULT
![Page 64: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/64.jpg)
PresetsPresets
![Page 65: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/65.jpg)
PresetsPresets
The preset values are simply recommended starting points and should be safe levels for most patients. Once mechanical ventilation is initiated, adjustments and changes should be made to meet the needs of the patient.
The full range of ventilator settings is available to the operator, regardless of the preset used.
![Page 66: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/66.jpg)
Basic Operations – Vent SettingsBasic Operations – Vent Settings
When there are variable settings or options:– Press the button by the parameter or setting to
be changed– Turn the Set Value knob clockwise or
counterclockwise to the desired setting– Press the parameter button again to confirm
setting
![Page 67: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/67.jpg)
Rules to keeping it simpleRules to keeping it simple::
Rule # 1
You either set the ventilator to deliver a volume or you set the ventilator to deliver
a pressure.
• If you set volume, you monitor pressure closely.• If you set pressure, you monitor volume closely.
![Page 68: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/68.jpg)
Basic Operation - Mode SelectionBasic Operation - Mode Selection
Modes are selected on the bottom row of the green ventilator setting box.
Selections are made by pressing the Mode “Select” button. One push and the next mode selection flashes. A second push confirms the mode and makes the change.
The NPPV mode (Non-invasive Positive Pressure Ventilation) is the Bi-Level setting for the LTV. – A non-vented mask is necessary when applying NPPV with
the LTV.
![Page 69: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/69.jpg)
![Page 70: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/70.jpg)
Rules to keeping it simpleRules to keeping it simple::
Rule # 2
Monitor minute volume closely
If minute volume changes, understand what caused it to change.
Anticipate what adjustments you will make if patient’s minute volume changes. (dependant on what mode patient is in)
![Page 71: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/71.jpg)
Monitor Display (scrolling)Monitor Display (scrolling)
![Page 72: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/72.jpg)
Rules to keeping it simpleRules to keeping it simple::
Rule # 3
Alarms:if set and used appropriately, they will alert
you of changes in the patient’s ventilation before they become life threatening.
![Page 73: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/73.jpg)
Alarm SettingsAlarm Settings
![Page 74: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/74.jpg)
AlarmsAlarms
Audible and visual alarm when parameter is violated.
If situation is corrected, audible alarm will silence, but visual will stay lit until Silence/Reset button is hit.
The monitor display will show the active alarm violation until reset.
![Page 75: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/75.jpg)
Basic Ventilator SettingsBasic Ventilator Settings
Breath Rate, Tidal Volume, Pressure Control, Insp. Time, Pressure Support, O2 %, Sensitivity
Set by selecting the parameter button, rotating the set value knob, and pushing parameter button again or waiting 5 seconds
![Page 76: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/76.jpg)
Basic Ventilator SettingsBasic Ventilator Settings
![Page 77: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/77.jpg)
Monitoring the PatientMonitoring the Patient
Measured and calculated values scroll through the monitor display
Press the ‘Select’ button to find to a desired parameter
Double click the ‘Select’ button to resume the automatic scroll
Airway pressure is dynamically displayed on the light bar above monitoring display
![Page 78: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/78.jpg)
Monitor Display (scrolling)Monitor Display (scrolling)
![Page 79: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/79.jpg)
Other Settings on Front of LTVOther Settings on Front of LTV
Insp/Exp Hold– These are maneuvers that are used to assess
the lung compliance of the patient and determine if there is any air-trapping happening during ventilation.
– You will not be utilizing these maneuvers. Low O2 Source
– This button must be selected when a low pressure O2 source is used.
– You will be utilizing a high pressure source, so this option should not be On, or lit.
![Page 80: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/80.jpg)
Manual Breath– This can be used to temporarily increase
the ventilation for a patient – Sometimes used after a stressful situation
to help the patient “catch up” with their ventilation demands
– Manual breaths also send burst of air through sensing lines to clear them of fluid/secretions
Other Settings on Front of LTVOther Settings on Front of LTV
![Page 81: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/81.jpg)
Other Settings on Front of LTVOther Settings on Front of LTV
Control Lock– Pressing this button will lock the controls on
the unit, so they may not be accidentally (or intentionally) changed.
– The indicator is lit when the controls are locked out.
– Simply press the button again to turn off the lock, thus allowing changes.
![Page 82: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/82.jpg)
Extended MenusExtended Menus
Accessed by pressing and holding the ‘Select’ button
Access to extended Alarm and Ventilator setup and operations including:
![Page 83: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/83.jpg)
Extended MenusExtended MenusAlarm OpAlarm VolApnea IntHP Delay
LPP AlarmHigh Rate
High PEEPPt. Assist
Exit
Vent OpRise TimeFlow TermTime Term
PC Flow TermNPPV ModeLeak CompCtrl UnlockLanguageVer XXX
Usage XXXCom Setting
Set DateSet Time
Date FormatPIP LEDO2 Flush
O2 Cyl DurExit
XDCR ZeroAP XXP
FDw xxPFDn xxP
Event Trace256 Event Codes
455 Events
Set ValueKnob
RT XDCR DataLeak
![Page 84: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/84.jpg)
Extended MenusExtended Menus
The extended menu settings can be preset to standard and acceptable levels for most applications, then accessed only when necessary, by properly trained personnel.
![Page 85: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/85.jpg)
Extended Menus Extended Menus – O2 Cylinder Duration– O2 Cylinder Duration
Particularly useful for transport teamsAccessed in:
Extended Features Vent Op
O2 Cylinder Duration Cyclinder Type?Cylinder Pressure?Calculate >>>
![Page 86: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/86.jpg)
O2 Cylinder DurationO2 Cylinder Duration
O2 DUR 04:55
O2 CYL DUR 04:55
![Page 87: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/87.jpg)
IMPORTANT !!!IMPORTANT !!!
NEVER silence an alarm without knowing the cause of the alarm and attempting to correct.
ALWAYS reset the alarm after you’ve taken corrective measures or completed suctioning.
![Page 88: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/88.jpg)
IMPORTANT !!!IMPORTANT !!!
Treat the patient, not the machine
Troubleshoot, starting with the patient:– Look at your patient – distressed, moving,
coughing, seizing, disconnected from vent, ???– Look at the vent alarm – which one is activated?– Look at the physiologic monitor – how is patient
responding? If patient is not being ventilated effectively,
solve the problem quickly or ventilate manually (BVM)
![Page 89: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/89.jpg)
Suctioning / Clearing SecretionsSuctioning / Clearing Secretions
Utilize the suction catheter on the patient’s existing circuit, or have catheter available
May need to pre-oxygenate and/or post-oxygenate some patients using O2% button
Use of the ‘Manual Breath’ button will deliver a breath at set volume or pressure, and will also send burst of air through sensing lines to clear any fluid/secretions blocking ports
![Page 90: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/90.jpg)
Use of a “closed” suction systemUse of a “closed” suction system
ATTACH SALINE BULLET, THEN UNLOCK THUMB VALVE WHILE DEPRESSING THUMB VALVE, SET WALL SUCTION (120-140 mm Hg) HOLD CONNECTOR WITH ONE HAND AND INSERT TIP OF
CATHETER INTO THE ENDOTRACHEAL TUBE LAVAGE (DEPENDING ON PROTOCOL) PASS CATHETER DOWN THE ENDOTRACHEAL TUBE
(measured or until resistance)
![Page 91: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/91.jpg)
Use of a “closed” suction systemUse of a “closed” suction system
DEPRESS THUMB VALVE ,WAIT FOR 1-2 SECONDS BEFORE SLOWLY PULLING THE CATHETER BACK (CONTINUOUS SUCTION)
WITHDRAW CATHETER UNTIL BLACK STRIPE IS VISIBLE IN SHEATH (*see below)
WHILE CONTINUING TO DEPRESS THE THUMB VALVE, FLUSH THE INSIDE OF THE CATHETER WITH 15 ML OF SALINE ** then release thumb valve**
DISCONNECT SALINE, LOCK THUMB VALVE CHANGE CATHETER EVERY 24 HOURS.
![Page 92: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/92.jpg)
Providing Oxygen “Flush”Providing Oxygen “Flush”
Pressing and holding the O2% button for 3 seconds will set the vent to deliver 100% oxygen (oxygen flush) for 2 minutes
This can be used to pre-oxygenate or post-oxygenate the patient during suctioning or a stressful event
![Page 93: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/93.jpg)
Oxygen % (100% flush)Oxygen % (100% flush)
![Page 94: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/94.jpg)
Oxygen % (100% flush)Oxygen % (100% flush)
![Page 95: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/95.jpg)
Sequence of LTV SetupSequence of LTV Setup
1. Connect breathing circuit to the LTV ventilator.2. Make sure ventilator is connected to adequate
power source – battery, UPS, or AC-DC supply (internal battery should only be used for short transport or during switch to alternate power supply).
3. Connect oxygen source to ventilator (if ventilating at greater than 21% O2).
4. Turn unit ON – UNIT SHOULD NOT BE CONNECTED TO THE PATIENT AT THIS TIME.
5. Select the patient type (Adult, Pediatric, Infant) using the Presets in the LTV.
6. Make any necessary adjustments in the ventilator settings.
![Page 96: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/96.jpg)
Sequence of LTV SetupSequence of LTV Setup
7. Set proper alarm limits, as appropriate for patient.8. Check the low pressure, high pressure, and disconnect alarms before applying to the patient. 9. Connect LTV breathing circuit to the patient and closely monitor the patient.
*Utilize HME (heat and moisture exchanger) and closed suction catheter, if on patient circuit at facility.10. Keep flow sensing lines up to avoid water and
secretions in these lines.11. Monitor your patient. Make appropriate adjustments,
and CALL FOR HELP, if you’re uncomfortable with what you see. Use the BVM if necessary.
![Page 97: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/97.jpg)
Key Points Key Points BEFOREBEFORE Transporting Transporting
See how the patient is interacting with their current vent.• If in A/C
– Breath Rate– Minute Volume– Peak Pressures – Sensitivity
• If in PSV– Breath Rate– Spontaneous tidal volumes – Minute Volume– Sensitivity
![Page 98: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/98.jpg)
Key Points Key Points BEFOREBEFORE Transporting Transporting
Talk to the patients therapist and nurse:• Secretions
– (keep the in-line suction device attached to the patient when you go)
• Weaning or goals• Any “Quirky” respiratory patterns
– example: pt will breath 50 times per minute when he/she gets anxious.
– See what relieves the “quirkiness” (changing modes, settings, favorite medication, reassurance, etc)
![Page 99: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/99.jpg)
Key Points Key Points While While TransportingTransporting
Set alarms appropriately• if set appropriately, alarms can alert you to subtle
changes before they become large problems. Monitor patient’s monitored vent parameters
• Breath Rate• Minute Volume (A/C or PSV)• Peak Pressure (A/C)• Tidal Volumes (PSV)
Anticipate what changes you would make if patient’s vent needs change?
If you need help, ask for it.
![Page 100: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/100.jpg)
TroubleshootingTroubleshooting
![Page 101: Ltv 1200 ems training 12-18-07](https://reader033.vdocument.in/reader033/viewer/2022061416/554b1eb4b4c90569098b52cd/html5/thumbnails/101.jpg)
Scenarios – Practical Training Scenarios – Practical Training