Weinmann ‘Medumat Transport’ Ventilator

These slide sets were provided by Weinmann for training purposes.

The following 3 slide sets cover use of the ventilator, ventilator modes, and how to interpret the monitors on the display

1) Medumat Transport Product Training – Essential viewing – overview of switching on, function test, and placing patient on ’emergency’ ventilation (preset IPPV parameters for adult/child/baby) and more advanced ventilation modes, including NIPPV

2) Ventilation – Review of different ventilation modes

3) Monitoring – Review of monitoring available on ventilator display and how to assess quality of ventilation


The following 3 slide sets review respiratory anatomy and physiology

1) Anatomy – Review of anatomy relevant to ventilation

2) Physiology & Pathophysiology – Review of respiratory physiology relating to ventilation

3) Physiologic basics of respiration

Podcasts – needle versus knife

Still listening to the Backstreet Boys on the way to work? Clearly urgent intervention is required.

Here are some excellent podcasts, with blog pages including discussion, videos, and references:

Needle versus knife I – discussion between Minh Le Cong (prehospitalmed.com) and Scott Weingart (emcrit.org) about interventions for can’t intubate/can’t ventilate

“One of the best things Minh expressed is the need to say OUT LOUD: “This is a can’t intubate/can’t oxygenate situation.” Saying it out loud lets everyone in the room know, there will be no more screwing around with attempts at direct laryngoscopy.”

Podcast is here

Needle versus knife II – chest decompression – from Scott Weingart

“Anterior approach is not where you think it is”

“ED Docs got it wrong a lot!”

Podcast is here

Is there more to meets the eye to pre-hospital intubation than just a tube?

In a recent review of the literature about pre-hospital intubation in traumatic brain injury (TBI) and the potential impact of hyperventilation, Gaither et al. explore the potential confounders for outcomes in previous studies. 

The authors provide a nice overview about the “old school” rationale for hyperventilation in TBI and why it is unlikely a good idea!

Why hyperventilation thought to be beneficial in TBI: 1) decreases arterial PaCO2 with CNS vasoconstriction 2) decreased cerebral blood flow. Net result is improved cerebral perfusion pressure (CPP). However, hyperventilation after intubation may increase intrathoracic pressure, increase JVP and subsequently decrease CPP. Hypocarbia may also lead to free radical formation and cellular damage. So net result is PaCO2 of 25 isn’t a good idea! Probably best to target into something like 35.

The authors then outline the historical concerns about pre-hospital intubation (low success rates, long scene times and complications like hypoxia). However, they argue that perhaps its not the intubation itself that may confound these “worse” outcomes, but perhaps the greater potential for hyperventilation! And the detrimental effects may in fact occur post-intubation.

There’s some evidence that in pre-hospital settings where end-tidal CO2 is closely regulated (assuming high intubation success…which probably requires well-trained personnel) that patients do better if they’re intubated…just so long as we keep their ETCO2 under control! The following is a direct quote from the article:

There is a strong possibility that the negative effects of intubation that have been identified in several clinical trials may be due to a paradox: intubation may protect the airway and prevent hypoxia, but it also makes it easier to inadvertently hyperventilate. Consequently, although intubation is intended to reduce secondary brain injury, it may enhance it if specific, intentional measures are not taken to ensure proper post intubation ventilation

A nice conclusion is provide (which I fits well within the general tone of the article).

When properly performed, intubation is effective for airway protection and ensures adequate oxygenation; it also makes hyperventilation (and associated negative outcomes) easier and more likely. Optimal outcomes require choosing the right patients, achieving the highest success rates through training, and avoiding hyperventilation after intubation in patients with traumatic brain injury

This article makes a great case for well trained medical personnel who perform pre-hospital intubations and then provide the best post-intubation care possible.

Full text pdf is available here (secure area limited to ADHB staff only – ADHB has subscription access for staff to these journals through the Philson Library at the University of Auckland School Of Medicine)