The clinical focus of Module 2 is centred on the diagnosis and pre-hospital management of respiratory failure. The non-technical/CRM topic for this module is leadership. Chapter one of this module reviews the management of paediatric asthma. Chapter two focuses on the differential diagnosis and management of respiratory failure – it is divided into two separate lecture focusing specifically on both adult and paediatric medicine. Chapter two also explores the pros and cons of different leadership styles and team dynamics.

The simulations to be completed in this module are closely related to the content contained in these lectures.

Module #2 – Objectives

Module #2 – Chapter 1 – Pediatric Asthma Management

Module #2 – Chapter 2a- Respiratory failure-Leadership – Adult

Module #2 – Chapter 2b – Respiratory failure-Leadership – Pediatrics

Below you will find reference material to supplement the above lectures:

Childhood asthma: a guide for pediatric emergency medicine providers.
Kline-Krammes S1, Patel NH, Robinson S.
Emerg Med Clin North Am. 2013 Aug;31(3):705-32.

Starship Clinical Guidelines – Asthma: Acute Management

More coming soon!!!!

Module #2 – Ventilation Strategies and the Management of Respiratory Emergencies.

Clinical and Technical Skills

Upon completion of module two, course participants should be able to complete the following:

1.1Respiritory Physiology
1.1.2 Define the following terms:
i. Total Lung Capacity
ii. Tidal Volume
iii. Vital Capacity
iv. Functional Residual Capacity
v. Expiratory Reserve Volume
vi. Residual Volume
vii. Inspiratory Reserve Volume
1.1.3 Define compliance
1.1.4 List 5 common causes for decreased compliance
1.1.5 List the difference between adult and pediatric respiratory physiology

1.2 Non-invasive Positive Pressure Ventilation Support
1.2.1 Describe the effects of PEEP on respiratory and hemodynamic physiology
1.2.1 Describe the use of NIPPV in pre-oxygenation
1.2.2 Demonstrate effective 1-person and 2-person BVM technique
1.2.3 List pulmonary conditions in which the use of NIPPV should be considered
1.2.4 Understand the use of CPAP/BiPAP.
1.2.5 List absolute contraindication to the use of NIPPV

1.3 Invasive Positive Pressure Ventilation
1.3.1 Describe the basic types ventilation control
1.3.2 Describe the basic modes of ventilation
1.3.3 Describe the following terms:
i.FiO2
ii. PEEP
iii. Peak inspiratory pressure
iv. Plateau pressure
v. Peak expiratory pressure
vi. I/E ratio
vii. Pressure support
viii. Frequency
ix. Basic understanding of flow-volume curves on ventilator
1.3.4 Demonstrate the initial ventilator setup for an intubated patient and explain your rational for doing so.
1.3.5 Describe the use of waveform capnography and outline variances with pathology

Common Presentations

1.4 Asthma
1.4.1 Describe the classic presentation of asthma.
1.4.2 Describe the pre-hospital management of severe asthma including (discuss pharmacokinetics, dosages and relative risks):
i. Nebulized salbutamol
ii. Nebulized Ipratroprium
iii. Hydrocortisone
iv. IV fluid
v. IV Magnessium
vi. IV Salbutamol
vii. IM/IV Adrenaline
1.4.3 Describe an approach to intubating a patient with status asthmaticus
1.4.4 Describe your initial approach to ventilating a patient with severe asthma

1.5 COPD
1.5.1 Describe the classic presentation of COPD.
1.5.2 Describe the pre-hospital management of severe asthma including (discuss pharmacokinetics, dosages and relative risks):
i. Nebulized salbutamol
ii. Nebulized Ipratroprium
iii. Hydrocortisone
iv. IV fluid

1.6 CHF
1.6.1 Describe the classic presentation of CHF.
1.6.2 Describe the pre-hospital management of severe asthma including (discuss pharmacokinetics, dosages and relative risks):
i. Position patient in an upright position
ii. NIPPV w/ BVM
iii. GTN
1.6.3 Describe your approach to intubating the patient with CHF
1.6.4 Describe your initial approach to ventilating a patient with CHF

1.7 Pneumonia
1.7.1 Describe the classic presentation of pneumonia.
1.7.2 Describe the pre-hospital management of severe pneumonia/sepsis including (discuss pharmacokinetics, dosages and relative risks):
i. Position patient in an upright position; provide O2 as necessary
ii. Fluid resuscitation
iii. Antibiotics
1.7.3 Describe your approach to intubating the patient with pneumosepsis.
1.7.4 Describe your initial approach to ventilating a patient with pneumosepsis.

1.8 Pneumonthorax
1.8.1 Describe the classic presentation of pneumothorax/ tension pneumothorax.
1.8.2 Describe the pre-hospital management of pneumothorax including (discuss pharmacokinetics, dosages and relative risks):
i. Diagnosis
ii. Oxygenation
iii. Decision to transport by helicopter
iv. Decompression: Finger vs. Needle Thoracostomy
v. Risks of positive pressure ventilation in pneumothorax.