How to use Ventilation, BiPAP and Bag Valve Mask in the Emergency Department

This document by Dr James French is part of a learning package to help doctors and nurses understand how to:

1. Maximise success using a BVM

2. Use CPAP and BiPAP

3. Use a ventilator.

4. Prevent desaturation during RSI.

5. Reoxygenate someone during RSI.

Read this document first and then listen to the following podcasts and videos:

1. http://emcrit.org/podcasts/niv/

2. http://emcrit.org/lectures/vent-part-1/

3. http://emcrit.org/podcasts/vent-part-2/

4. http://emcrit.org/podcasts/bvm-ventilation/

Download (PDF, 633KB)

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In Situ Simulation Season 2013-14

Dear Colleagues,

Last week’s in situ sim, concluded the simulation sessions for the season. It has certainly been a busy season for all those involved, delivering simulation sessions to our department and beyond. I would personally like to thank all the debriefers and facilitators for all the hard efforts and continued support in making this program work. Without them the educational value would be lost and the Sim program would die.

I would also like to make special thanks to all the participants (Physicians, Nurses, LPNs, RTs, PSWs and Pharmacists). The “buy-in” that you display really helps us get the most out of each session.
There have been difficult times where by the ED has been especially busy, however the sessions have continued. This may initially seem a little odd in that if the department is busy, should we not pool resources to help?….However this is the ideal time to test our resource planning and crisis resource management. We don’t want to find out about resource problems when there are real patients that we can’t handle. We are better off learning that from a simulation. This has been displayed on several occasions and well done to those who have continued to participate.

The focus of in situ simulation is not only clinical, but also resource structure and teamwork.

We will pick up the new season in September 2014. We will be hoping to get more participation from the whole team so that everyone has the chance to participate and benefit. It is important to emphasise that the aim of these Simulations is not the individual, but the team, so don’t be afraid about stepping up.

The Simulation program continues to grow and we as a department will find that we are more and more in demand from other departments to deliver Sims to them.
With that said, we are always looking for more people to help us and participate. So if you are interested please let me know.

Once again my sincerest thanks to all of you. Have a great Summer,

Jay Mekwan

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Debriefing Workshop

Having just benefited from a fantastic and thoroughly enjoyable debriefing workshop delivered by Dr Jay Meckwan, I thought I would share a few take home points.

1. Simulation is here to stay. It is a proven method of delivering training and improving team performance.

2. Both taking part in and facilitating in-situ simulation is a fun way to practice rare event case management and I would highly recommend getting involved.

3. Debriefing well is key to the success of in-situ simulation. It’s not as easy as Dr Mekwan makes it look. As he says “if you think its easy to debrief, then your not doing it right!”

4. Debriefing is not about being ‘non-judgemental’ its about using ‘good judgement’.

5. Observations made during the debrief should be dealt with as soon as they are raised.

6. Use the ‘advocacy/inquiry’ method to bring your observations to the group

ADVOCACY / INQUIRY

  • Advocacy: “I noticed _______”…
  • Inquiry: “I was wondering what you thought about that?”
  • Example:  “I noticed _____, I’m concerned that _____, and am wondering _____.  It seems that it may be helpful to talk about this in more detail.”
  • Increases participation – people are more willing to share their thoughts if you share yours first

7. Use ‘normalisation’ or ‘generalisation’ to avoid personal criticism. e.g “closed loop communication can really help improve team performance and harmony but it’s not always easy for experienced teams to implement”  would be better than “you didn’t communicate very well with the rest of the team”

8. See the Quick Ref. Guide for Debriefing on the Simulation Page  for more pointers…

9. Attend one of Dr Mekwan’s workshops on debriefing – They are extremely informative and great fun!

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