With all the talk of turning ORs into ICU beds and utilizing the OR anesthesia machines....

[Iso4ane]

If this ever gets turned into a movie, I hope it goes something like this (revised transcript below):



(1242) It doesn't end like this.
(1243) What do you want us to do, Doctor?
(1244) We have no ventilators left.
(1245) We have a few more.
(1246) We have got some Narkomeds.
Pans towards pile of Narkomeds
(1247) Are you crazy? Those are museum pieces.
(1248) Not today.
(1249) This thing is 30-40 years old. It's totally outdated.
(1250) The dials and mechanical systems are all analog.
(1251) The bellows/vaporizers haven't been started in a decade.
(1252) Which would be fine, but they use Halothane,
(1253) Which I have no idea how to fire up.
(1254) And even if I had a user's manual
(1255) and six weeks to go through it all,
(1256) we still don't have enough anesthesiologist to fire it up.
(1257) I don't know what you're thinking, sir.
(1258) Is everyone all right?
....

---

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[Consigliere]

Dumb

 

[Status Sciaticus]

apparently you can jerry rig a ventilator to ventilate upto 3 patients at a time...

 

[deleted162650]

you can jerry rig

The term is “jury rig”. Common misconception.

 

[D P356]

The term is “jury rig”. Common misconception.

No, @SaltyDog
Jheri rig. Jury curl.

 

[nimbus]

The old Narkomeds were great reliable bulletproof machines.

 

[deleted162650]

The old Narkomeds were great reliable bulletproof machines.

We still have a couple at one of our sites complete with permanently mounted (albeit long empty) halothane vaporizers.

I love watching our new grad hires walking into those rooms for the first time. It’s like showing a rotary phone to an elementary school kid.

 

[nimbus]

We still have a couple at one of our sites complete with permanently mounted (albeit long empty) halothane vaporizers.

I love watching our new grad hires walking into those rooms for the first time. It’s like showing a rotary phone to an elementary school kid.

They must be 35 yrs old....bulletproof! I’m sure the vast majority that were taken out of service were still functioning perfectly.

 

[deleted126335]

The old Narkomeds were great reliable bulletproof machines.

True. But lacking many safety features that people take for granted on modern machines.

 

[deleted162650]

They must be 35 yrs old....bulletproof! I’m sure the vast majority that were taken out of service were still functioning perfectly.

Yup. Used ‘em right up until they got some hand me downs from the mothership.

When I find one in a storage closet I’m gonna grab a screw driver and snake one of the halothane vaporizers. I’m thinking it’d make a sweet French press.

 

[Status Sciaticus]

The term is “jury rig”. Common misconception.

'Jerry-built' vs. 'Jury-rigged' vs. 'Jerry-rigged'
either/or will work.

 

[cchoukal]

Interested in the topic. What do people think about the CO2 absorbent issue, and how to manage without heat/humidification? We’re talking about these machine as part of our surge plan and training the RTs how to use them. I’m imagining going thru a LOT of CO2 absorbent and have it cold patients with lots of mucus plugging.

 

[Crabbygas]

Interested in the topic. What do people think about the CO2 absorbent issue, and how to manage without heat/humidification? We’re talking about these machine as part of our surge plan and training the RTs how to use them. I’m imagining going thru a LOT of CO2 absorbent and have it cold patients with lots of mucus plugging.

Presumably you wouldn't be using any inhaled anesthetic so you can crank the fresh gas flows up and you shouldn't use much of the CO2 absorbent.

 

[cchoukal]

Yes, but the trade-off for that high fresh gas flow is cold, dry air, which causes tremendous evaporative heat loss and drying of the lung and bronchial mucosa, which leads to mucus plugs. Proper vents can be warmed and humidifier to offset this.

 

[deleted162650]

Yes, but the trade-off for that high fresh gas flow is cold, dry air, which causes tremendous evaporative heat loss and drying of the lung and bronchial mucosa, which leads to mucus plugs. Proper vents can be warmed and humidifier to offset this.

An HME would help no?

 

[Crabbygas]

Im sure if your RTs are creative they could come up with a solution. Though to be fair it probably won't be as good as a regular vent. What can I say? Maybe old people get triaged to old ventilators?

 

[cchoukal]

An HME would help no?

Probably help some. I know when I use low flow for anesthesia, I see a lot of moisture building up in the circuits. Doubt this is as good as active humidification, but would also only be useful probably at low flows, and then we would be burning through absorbent at a higher rate. Might just be the cost of doing business.

 

[Crabbygas]

Anybody remember the 60 minutes piece on Robert Bird? He made his first ventilator out of a tin can and similar bits and pieces. Seems if we really need thousands of ventilators made fast copying his design might be good enough.

 

[cchoukal]

Modern versions of these are still made and we’re buying some. You need a separate pressure monitoring and alarm plan, but in extremis...

 

[drmwvr]

Interested in the topic. What do people think about the CO2 absorbent issue, and how to manage without heat/humidification? We’re talking about these machine as part of our surge plan and training the RTs how to use them. I’m imagining going thru a LOT of CO2 absorbent and have it cold patients with lots of mucus plugging.

We just use the ICU respiratory circuit with the anesthesia machine. The warmer/humidifier goes with the circuit, not the machine, at least here.

 

[drmwvr]

Anybody remember the 60 minutes piece on Robert Bird? He made his first ventilator out of a tin can and similar bits and pieces. Seems if we really need thousands of ventilators made fast copying his design might be good enough.

If we need thousands of ventilators in one place, we won't be needing thousands of ventilators in one place....

 

[cchoukal]

We just use the ICU respiratory circuit with the anesthesia machine. The warmer/humidifier goes with the circuit, not the machine, at least here.

we just got some written guidance from GE which specifically states not humidifyjng the circuits on the machine. Of course, in these times of want and woe, anything goes

 

[drmwvr]

we just got some written guidance from GE which specifically states not humidifyjng the circuits on the machine. Of course, in these times of want and woe, anything goes

I suspect a lot of that would have to do with ET gas monitoring and equipment maintenance with the increased water load....might be emptying the trap more often and get inaccurate values...

 

[DocVapor]

I suspect a lot of that would have to do with ET gas monitoring and equipment maintenance with the increased water load....might be emptying the trap more often and get inaccurate values...

This is a great link:

FAQ on Anesthesia Machine Use, Protection, and Decontamination During the COVID-19 Pandemic

Last updated: July 27, 2023 Translations Now Available: 日本語 (Japanese), Español (Spanish), 简体中文 (Chinese (Simplified)), Français (French), Português

www.apsf.org

 

[deleted697535]

If we get this far, where are we going to find docs/nurses/IVs/blood/Abx etc to actually look after these patients?

The vents are basically useless without intensivists and icu nurses.

OR ventilators are not great in comparison to ICU vents.

1 OR vent rigged to vent 3 ARDSy patients is basically putting a bandaid on an rAAA

 

[DocVapor]

If we get this far, where are we going to find docs/nurses/IVs/blood/Abx etc to actually look after these patients?

The vents are basically useless without intensivists and icu nurses.

OR ventilators are not great in comparison to ICU vents.

1 OR vent rigged to vent 3 ARDSy patients is basically putting a bandaid on an rAAA

My guess would be that the usual circulating RN's would get a crash re-education in what it means to be a Nurse, and not just a foley-placing gopher.

I think using anesthesia machines for one patient at a time is probably the limit we should really consider. No data or anything in that assumption, just my feeling.

 

[kmurp]

Any thoughts on how to protect the anesthesia machine gas sampling when monitoring co2 during a MAC case?

 

[deleted697535]

My guess would be that the usual circulating RN's would get a crash re-education in what it means to be a Nurse, and not just a foley-placing gopher.

Just not possible. It may happen but poor outcomes will inevitably follow.

Theatre RNs are very good at what they do but just not ICU nurses. They tend to be older and most have checked out. It would be akin to promoting the new R1s to attending.

My ICU RNs are my eyes and ears. I trust the senior RNs to almost make better decisions than me. The junior ones I just don't trust.

Theatre RNs in an ICU would be super junior

 

[DocVapor]

Just not possible. It may happen but poor outcomes will inevitably follow.

Theatre RNs are very good at what they do but just not ICU nurses. They tend to be older and most have checked out. It would be akin to promoting the new R1s to attending.

My ICU RNs are my eyes and ears. I trust the senior RNs to almost make better decisions than me. The junior ones I just don't trust.

Theatre RNs in an ICU would be super junior

I mean, if you expect to get through this with all of your ICU RN's healthy and able to work through all of this, then I've got a bridge to sell you. Maybe instead of the OR RN's working as ICU nurses they go up to the floors and step down nurses get the promotion. We're likely going to be in uncharted territory. Noone is going to like it, and none of it is going to be close to ideal, but we're already talking about using ORs as ICU's. We likely won't even have enough of the literal beds.

 

[kmurp]

Everyone is talking about using their ORs as ICU rooms. Why not use the PACU instead?

 

[anbuitachi]

Everyone is talking about using their ORs as ICU rooms. Why not use the PACU instead?

pacu may be better if you do the 1 vent to 4 patient ventilation since its usually open room with more space

 

[vector2]

My guess is hospital employed CRNAs will absolutely have to function as ICU RNs if we hit a scenario where anesthesia vents are being used for covid pts. That, or face termination

 

[Status Sciaticus]

Everyone is talking about using their ORs as ICU rooms. Why not use the PACU instead?

It may make sense to move all non-COVID patients to PACU, but running an open unit with COVID patients will be hard to contain the spread, no?

 

[kmurp]

It may make sense to move all non-COVID patients to PACU, but running an open unit with COVID patients will be hard to contain the spread, no?

I don't really know. If all patients in the PACU are cover positive, you only have to worry about the staff. Perhaps staff in a setting like this is at higher risk being exposed if there are multiple cover patients in a big open room. I don't know. Our PACU can be closed off from the rest of the OR.

 

[jwk]

I don't really know. If all patients in the PACU are cover positive, you only have to worry about the staff. Perhaps staff in a setting like this is at higher risk being exposed if there are multiple cover patients in a big open room. I don't know. Our PACU can be closed off from the rest of the OR.

Or could move the non-Covid patients to the PACU, leaving the ICU for the Covid patients.

 

[Status Sciaticus]

Or could move the non-Covid patients to the PACU, leaving the ICU for the Covid patients.

This is a better idea.
However, that would mean you would have to test every patient going to the OR to rule out COVID before they can be brought to the PACU, in a time of test shortages. Pros and cons to both ideas, I'm afraid.

 

[kmurp]

COVID-19
This may be of some interest to some of you. I’d be interested in any comments. If I read this right, the machines need some modification if used without scavenging.

 

[vector2]

COVID-19
This may be of some interest to some of you. I’d be interested in any comments. If I read this right, the machines need some modification if used without scavenging.

Why wouldn't we just connect the scavenge to the main hospital vacuum system no matter where the machine moved?

 

[coffeebythelake]

New York City converting Javits Center into emergency field hospital




If **** hits the fan, we do have large convention centers in the major cities that could be used..





Alternatively, the Trump administration might have this option in their minds?