MONITORS/MACHINE

Monitor

• Minimum: Pulse oximeter (SpO2), portable Capnometry (ETCO₂)/capnography assistant to monitor respirations and record manual vital signs. Trending vital signs using a flow sheet is recommended. Refer to the JTS Documentation in Prolonged Field Care CPG.⁹  Voice or data connections to perform telemedicine communication
• Better: Transmit photographs from smartphones or personal devices to augment telemedicine communications.
• Best: Automatic vital signs monitor with SpO2, ETCO₂/waveform capnography, +/- electrocardiogram (EKG); Synchronous (real-time continuous) telemedicine using video or remote patient monitoring systems

Monitoring is the active process of assessing the patient throughout a procedure.  It involves the gathering, documenting and interpretation of vital signs and other data, and the continuous assessment of their clinical status.  Telemedicine can be an important adjunct and critical capability to employ when monitoring a patient undergoing complex procedures.

Machine

• Minimum: Bag-Valve-Mask (BVM) with positive end-expiratory pressure (PEEP) valve
• Better: Automated portable ventilator (preferably with PEEP); oxygen concentrator
• Best: Full-feature portable ventilator (e.g., several ventilatory modes, PEEP); supplemental oxygen if available

Managing ventilators or advanced equipment unfamiliar to a provider presents challenges.  Initiate telemedicine consultation for best guidance at 833-ADVSRLN (833-238-7756)/DSN: 312-429-9089..

PEEP is important for prolonged ventilation. PEEP is the pressure in the airway at the end of the expiration which prevents the alveoli of the lung from completely collapsing.  In a spontaneously breathing person, this pressure is maintained by closing the glottis, clearing the throat, coughing, sighing, etc. With an invasive airway, the glottis is bypassed with the tube and “natural” PEEP is lost. PEEP should therefore be introduced into the ventilated patient using a PEEP valve on the BVM or using the PEEP setting on a ventilator. When using BVM or ventilator, provide PEEP. (Recommended initial setting is 5cm H2O.)¹⁰