EMS World

JAN 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | JANUARY 2018 41 plete continuing education and train in the operating room with anesthesiologists for neonatal and pediatric intubations. They attend high-risk deliveries and assist with intubations of neonatal patients being cared for in the Level IV NICU at St. Joseph's Women's Hospital. Respiratory therapists must complete additional training and meet requirements in all aspects of airway management, including proficiency in the placement of laryngeal mask airways, surfactant admin- istration, and operation of endotracheal tube induction devices (e.g., bougies). Respirator y therapists are specially trained on each ventilator. Neonatal and pediatric patients require close monitor- ing of ventilator settings and monitored values such as peak inspiratory pressures and exhaled tidal volumes. Due to their smaller size and anatomy, children's lung compliance and require- ments for ventilation can often change during transport. The respiratory thera- pist can assess, implement, and evaluate these changes in status, allowing for bet - ter patient outcomes and fewer adverse effects such as volutrauma, barotrauma, pulmonary interstitial emphysema, and pneumothorax. Advanced Equipment The St. Joseph's Children's Hospital's neo- natal pediatric transport team employs highly specialized ventilators capable of caring for the entire range of pediatric patients. The RRT provides mechanical ventilation using the Crossvent 2i+ and MVP-10 (from Bio-Med Devices) for the neonatal population and the ReVel (Vyaire Medical) for pediatric patients. The Crossvent 2i+ provides a wide variety of modes, such as continuous mandatory ventilation (CMV), utilizing constant flow, assist control, synchronized intermittent mechanical ventilation, continuous posi- tive airway pressure (CPAP), and pressure support. This ventilator can deliver tidal volumes ranging from 5–750 mL per breath and respiratory rates of 5–150 breaths per minute. The MVP-10 is a pneumatically pow- ered ventilator that provides CMV and CPAP driven by flow. This allows the RRT to match the patient's current ventilator settings and facilitate a smooth transition from the hospital ventilator to the transport team's ventilator. The ReVel is a compact, lightweight transport ventilator ideal for the pediatric population. The RRTs are also trained in its secondary settings, allowing them to run nebulized breathing treatments in line with the ventilator, which increases patient comfort. A heated high-flow nasal cannula (HHFNC) is another advance that aids in the care of the smallest patients. As a specialty care team, we have implemented heated high-flow oxygen therapy on trans- ports to bridge the gap between traditional nasal cannula therapy and more complex treatments such as CPAP, bilevel positive airway pressure (BiPAP), and mechanical ventilation. The ability to deliver the heated and humidified higher flows from 10–60 lpm and variable oxygen titrations allows for noninvasive treatment of a wide variety of diseases that manifest as respiratory distress. HHFNC delivery to the pediatric population decreases anxiety and stress from the more invasive modalities, which increases comfort and satisfaction. St. Joseph's neonatal pediatric transport team also carries specialized breathing gases used to treat varying disease pro- cesses. Inhaled nitric oxide (iNO) is used in the treatment of hypoxic respiratory failure for neonates at a gestation of 35 weeks or greater. In November 2017 St. Joseph's Children's Hospital added a new ambulance equipped with modern electronic systems for regulating air and oxygen, a dual stretcher system, and capability to deliver inhaled heliox and ECMO. (Photos: Baby Face Portraits)

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