APPENDIX D: IMPACT 754

The source document is at https://archive.org/details/manual_Impact_Uni-Vent_754_Operation_and_Service_Manual

RULE OF 5S (KEEP IT SIMPLE VENT SETTINGS FOR ADULTS)

There are five numbered dials on the front of the Eagle/Impact Vent. Most settings can be set by remembering multiples of five. Do not hook up casualty to the breathing circuit until after the PEEP is set.

1. Dial 1 — Turn on to calibrate. You must calibrate the vent every time you turn it on. Turn the knob to the right. The LED display will show "Cal-Mode" and then "Cal-OK;" turn the knob to the left past Continuous Positive Airway Pressure (CPAP) and to Synchronized Intermittent Mandatory Ventilation (SIMV) or Assist Control.
2. Dial 2 — Ventilatory Rate — set at 10.
3. Dial 3 — I:E ratio of 1:2. Turn the knob all of the way to the left. This setting is generally satisfactory for all adults and pediatrics with trauma related requirements for mechanical ventilation. Medical problems like chronic obstructive pulmonary disease and asthma may require longer ratios, and this should be assessed after the initial settings have been set.
4. Dial 4 — Tidal Volume of 500 ml and adjust as needed. Tidal volume calculation is 4-8 ml/kg, therefore 6 ml/kg is recommended after the initial setting of 500.
5. Dial 5 — Air/oxygen mixer. For room air the knob will be all of the way to the left and for 100% 02 will be all of the way to the right.

IMPACT 754 VENTILATOR PRE-MISSION CHECKS AND TROUBLESHOOTING

Routine Care

- Clean the unit and hose attachments with damp soapy cloth and wipe dry.
- Remove the inlet filter to check for dirt or debris.
- Check metal hose couplings for thread wear and debris.

Duty Inspection

1. Power Off Checks:

a. Verify inspection is within the calibration date (6-month maintenance cycle).

b. Check the air inlet is clear of obstructions and the filter is in place (Right side of vent).

c. Verify the Gas (“OXYGEN IN” and “AIR IN”) and Patient (“EXHALATION VALVE” and “TRANSDUCER”) connections are clear and tight (Top of ventilator).

d. Verify the “GAS OUT” clear leaf valve is installed and seated (reseat if loose, replace if missing).

e. Inspect green high pressure oxygen hose for cracks, dry rot, threads, black O-ring (replace if damaged).

f. Connect the ventilator to a high pressure oxygen source, turn on the oxygen tank and ensure no leaks are present.

g. Turn off O2 when complete (conduct in environment conducive to hearing leaks).

2. Power On Checks

a. Turn “MODE” (knob 1) to desired setting (AC, SIMV, CPAP). The ventilator will run a SELF-TEST upon set up (ventilator circuit should be disconnected). At this point, (CAL) is not required. If SELF-TEST results in a Calibration Failure, place (1) to CAL until CAL OK is displayed. If the calibration fails, the ventilator must be taken out of service.

b. Check BATT OK

c. Preset ventilator knobs to:

- Rate (knob 2) 14
- Inspiration Time (knob 3) 1:2
- TIDAL VOLUME: 6ml/kg IBW (4-8ml/kg IBW range)
- *QUICK REFERENCE (Male): (Detailed quick reference in Appendix A)
  - 66” = ~380cc [min: 255 / max: 510]
  - 69” = ~420cc [min: 283 / max: 566]
  - 72” = ~465cc [min: 310 / max: 621]
  - 75” = ~505cc [min: 338 / max: 676]
- FiO2 (knob 5) 100%
- Set HIGH pressure alarm to 35 cmH2O
- Set LOW pressure to 15 cmH2O

3. Turn OFF.

4.. Make sure the air inlet and gas out ports of the ventilator are protected and covered.

EMERGENCY PROCEDURES

These procedures should be practiced before being performed on live patients.

NOTE: Any known malfunction of the ventilator should be addressed prior to utilization. The following are not for routine use, but for emergencies when alternate ventilatory measures are not available and long term BVM is not practical.

*ALL CAUTIONS, WARNINGS, AND NOTIFICATIONS THAT CORRESPOND WITH THE 754 SCREEN WILL BE IN ALL CAPS*

- Inability to deliver high pressure O2 when needs exceed 21% FiO2 (i.e. missing/unserviceable green high pressure hose).
- Vent will alarm and show O2 Low/Fail-Check Oxygen Source/Connections on screen.

NOTE: First place the patient on BVM with supplemental oxygen. Second, check oxygen tank volume. Third, check the oxygen lines and connections.

Alternative Methods to Increase Delivered Oxygen Content

1. Oxygen reservoir kit for low pressure supply (Part # 820-0097-15).

2. Oxygen reservoir fashioned from primary circuit and BVM.

a. Connect short portion of main circuit tube to the BVM and to the air-inlet port.

b. Connect BVM oxygen hose to the BVM and regulator.

c. Set regulator to desired setting (~10LPM, but no lower than total minute volume).

3. Oxygen reservoir fashioned from second ventilator patient circuit.

a. Cut/disconnect exhalation valve off of second ventilator circuit.

b. Feed green transducer hose at least ¾ of the way down vent tubing (the goal is to get as close as possible to the air inlet port) and secure in place with tape (do not cover the end of the circuit).

c. Connect the 90 degree/”L” shape fitting of the green transducer line to the oxygen regulator.

d. Connect the opposite end of the vent tubing to the air inlet port.

e. Set regulator on oxygen source to 10 LPM to deliver up to 99% FIO2.

Missing or Damaged “Gas Out” Leaf Valve

Missing Gas Out leaf valve will trigger an alarm, give a DISCONNECT-CHECK CIRCUIT CONNECTIONS, no PEAK value will display, and little to no volume will be delivered to the patient.

1. Place the patient on BVM with supplemental oxygen.
2. Perform DOPE (Dislodgment, Obstruction, Pneumothorax, and Equipment) assessment.
3. Check Gas Out clear plastic leaf valve for installation and proper seating.

- If the valve is folded, use a small object to gently unfold or push the valve back into place.
- If missing, cover exterior Gas Out side ports with occlusive dressing (replacing Gas Out leaf valve is optimal, but is time consuming.)

WARNING: Occluding “Gas Out” side ports will enable the ventilator to provide full respirations, however, this will eliminate the anti-asphyxia function these ports provide. (Ventilator failure will result in increased resistance in spontaneous respiration) and strict surveillance must be kept on ventilator to ensure any further failure is caught immediately. Patients must immediately be transitioned to BVM in the event of any failure.

Compressor Failure/Alarms (may show CODE 2).

1. Place patient on BVM with supplemental O2.
2. Cycle ventilator to OFF.
3. Turn FiO2 (knob 5) to 100%.
4. Cycle back on and to desired settings. MUST leave FiO2 at 100%. PEEP will have to be reset when the vent is cycled on.

NOTE: This technique will transition the ventilator to using oxygen pressure instead of the compressor to gather drive ventilation and may hasten oxygen usage.

Battery Failure

1. Place patient on BVM with supplemental O2.
2. Turn ventilator OFF.
3. Replace ventilator battery with battery from 326M suction apparatus (per the manufacturer, they are the exact same). The 326M battery is in the same location as the 754.
4. Resume normal operations. PEEP will have to be reset.