CPR protocol - please can I have your amazing help again

RE: CPR protocol - please can I have your amazing help again

Selena Carnell — Sun, 07 Apr 2024 09:07:35 GMT

i would usually disconnect a smaller patient, but have left a larger one attached to the circuit. We now have O2 generators and the flush on them is pretty poor to be fair.

I've seen damage done from IPPV but not from using the flush valve. i think also experience comes in to it too.

RE: CPR protocol - please can I have your amazing help again

Nick Shackleton — Thu, 04 Apr 2024 03:35:49 GMT

This is an extract from the BSAVA Manual of Anaesthesia & Analgesia. Personally I would still disconnect pierogi to using the oxygen flush valve. Due the high flow rate and pressure created in the circuit.

RE: CPR protocol - please can I have your amazing help again

apache — Wed, 03 Apr 2024 22:47:06 GMT

The oxygen flush fear seems to be a new thing that has come out of nowhere in the last 20 years. When I was a student everyone in every practice used the flush valve to fill the bag when the patient was connected, and often to flush out the Halothane and nitrous at the end of the procedure. All with valves open and all with the patient connected. I never saw any harm, and I can't find any evidence of harm in the literature from its use.

Also consider where the O2 is coming from. We now use concentrators so the oxygen flow is much less than from a cylinder. Realistically, in an emergency I think you have bigger things to worry about and if you need to use the flush - do so. Even with the patient connected. I can agree that best practice may not be to use it this way routinely, but in an era of EBVM, we should really have evidence before making these changes. I suspect it's another dogma dreamt up and passed down in vet folk law (Legs under not over being another)!

RE: CPR protocol - please can I have your amazing help again

Laura Parker — Sun, 31 Mar 2024 23:08:33 GMT

Hi Karen,

I would say that it's potentially dangerous to advise anyone to press the oxygen flush button with a patient attached. In some circumstances this could be safe, as you say with the APL valve open. However, this depends on the type of system you are using and there is still risk of barotrauma. When the flush button is pressed it delivers O2 at ~70-100L/min at the pipeline pressure ~3.7bar. So I would stick with your initial option of flushing the system after disconnecting from the patient or switching your system.

The safest thing to do for CPR and the thing I like to do, is use an Ambu bag connected to the oxygen outlet. I really like this method as you don't need to be concerned about over pressuring whilst delivering IPPV, there is no need to think about opening and closing a valve between breaths either. I keep 2 sizes of Ambu bag on oxygen tubing with a 22mm connector attached and ready with very crash box in the hospital.

Also I think it's great to have a good and effective CPR protocol in place and it's great that you're championing it. If you haven't already I suggest you check out the RECOVER protocol. It's updated regularly using evidence based medicine and you can even get RECOVER certified. I advise very practice to have a RECOVER certified member of the team.

RE: CPR protocol - please can I have your amazing help again

Katherine Spear — Sun, 31 Mar 2024 21:54:04 GMT

This is interesting, I think id be scared to use a flush on an attached patient? Interested to see others thoughts. Also thinking why would a t piece not be available? Maybe worth keeping one only for crash cart/box if this is a concern? Interested to see others thoughts though? I guess for protocol its also going to depend on size/weight of patient?