RTs – Take Charge!

Interview with Amanda Dexter, module co-author (with Eric Kriner)

Q: IngMar Medical will be releasing its new Initiation of Mechanical Ventilation Modules for the RespiSim® System shortly. Why is this topic important?

IngMar Medical Clinical Educator Amanda Dexter, MS, RRT, CHSE
Amanda Dexter, MS, RRT, CHSE

A: This is a high-stakes emergency situation where the Respiratory Therapist (RT) plays a central role. Everyone is relying on the RT to be the expert and take charge. Unfortunately, there are no nationally accepted guidelines for initiating mechanical ventilation or for setting alarms. Guidelines vary from school to school and from hospital to hospital, therefore students need to have a deep understanding of lung mechanics.

Q: What are some common problems that occur when initiating mechanical ventilation?
A: People tend to use the modes they feel most comfortable with – this is understandable in a high-risk situation. However, sometimes the modes used are not appropriate for the particular patient.  RT’s can also be timid about using spontaneous modes at initiation. Setting the correct alarms can be a challenge. Students can forget that a patient may require mechanical ventilation for reasons other than a problem with the lungs. For example, patients with a drug overdose often cannot breathe on their own as a result of a neurological issue, not a lung issue.

Q: What can be the impact of those errors?
A: Using an inappropriate mode can result in a longer time on the ventilator. If alarms are not set correctly, alarm fatigue can occur. This is a serious patient safety concern.

Q: How can simulation training help?
A: Simulation training allows students and clinicians to become comfortable with a wide range of ventilator modes. Learners can experiment, take risks, and practice individual skills and teamwork without harming patients. You can also fast-forward to a point when the patient’s condition or their effort has changed.

Q: Can you walk me though how the new “Initiation of Mechanical Ventilation” modules work?
A: Learners get to experience the whole process, starting with intubating the RespiPatient manikin. The learners then must set up the initial ventilation and alarms according to the flowchart. Then we fast-forward four hours and the ventilator is alarming because the patient’s condition has changed. The student must adjust the ventilator and alarm settings, making sure to record ventilator and alarm settings on their flow sheets. See example.

There are ten different modules so learners can become familiar with a wide range of cases.

Q: Will these modules help students pass the NBRC Simulation exam?
A: Initiating mechanical ventilation is big topic in the NBRC SIM exam. Practicing the analytic and hands-on skills should help to deepen and anchor knowledge. We are also working on a set of modules specifically designed to help prepare for the NBRC SIM exam.