New trends in prehospital emergency medicine. ALS algo nex step, TCA targeted algo, new devices and lot of more

1. XII Congresso Nazionale SIS 118
Mario Rugna 118 Firenze Soccorso

2. XII Congresso Nazionale SIS 118
• 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.

3. XII Congresso Nazionale SIS 118
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’.

4. XII Congresso Nazionale SIS 118
The point

5. XII Congresso Nazionale SIS 118
What we need

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Medical cardiac arrest

7. XII Congresso Nazionale SIS 118
Medical cardiac arrest

8. XII Congresso Nazionale SIS 118
Medical cardiac arrest

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Traumatic cardiac arrest

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Evidences
Traumatic cardiac arrest

11. XII Congresso Nazionale SIS 118
Traumatic cardiac arrest

12. XII Congresso Nazionale SIS 118
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

16. XII Congresso Nazionale SIS 118
What we need

17. XII Congresso Nazionale SIS 118
Better Training

18. XII Congresso Nazionale SIS 118
What we need

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Better devices

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Ventilation

21. XII Congresso Nazionale SIS 118
M
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Mapelson Circuits
MAPLESON B & C SYSTEMS
Inefficient. 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 FGF
exceeds peak inspiratory flow rates (3xMV).
The C circuit is compact and was used for short transports before
self-inflating bags became available. Acceptable CO2 levels could be
achieved with a FGF of 2 x MV and mild hyperventilation. If the cylinder
became empty ventilation was impossible.
virtual-anaesthesia-textbook.com
Ventilation

22. XII Congresso Nazionale SIS 118
M
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Mapelson Circuits
MAPLESON B AND C
They 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.
Tej K Kaul and Geeta MittalMapleson's Breathing Systems
Indian J Anaesth. 2013 Sep-Oct; 57(5): 507–515.
Ventilation

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V.A.R. Vortran
Automatic Resuscitator
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• 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 C
Storage environmental limits...... -40 to 60o C
Ventilation

24. XII Congresso Nazionale SIS 118
M
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V.A.R. Vortran
Automatic Resuscitator
Ventilation

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L
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N
V.A.R. Vortran
Automatic Resuscitator
Ventilation

26. XII Congresso Nazionale SIS 118
Mario Rugna 118 Firenze Soccorso
www.medest118.com
medest118@gmail.com