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First, do no harm: With the vent

5 ways to protect the patient during mechanical ventilation


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We get many of our ideas for podcast topics directly from our MCHD field medics. Recently, a discussion came up around best sources for a vent basics lecture and, of course, one answer was to check out the podcast. Surprisingly, this topic has not been tackled until today. In this episode of the MCHD Paramedic Podcast, join MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick as they walk through some ventilator basics and simple tips to “First, do no harm” when managing and troubleshooting an EMS patient placed on the ventilator. Remember, we are a ground-based 911 service and that’s the foundation of this talk.

Our cohosts discuss why mechanical ventilation is risky, and the things we can control, including:

  • Modes
  • Volume
  • Respiratory rate
  • PEEP
  • Oxygenation
  • Sedation
  • Position

We also discuss can’t miss ventilator problems:

  • Awake patient
  • Dislodgement
  • Obstruction
  • PTX
  • Equipment disconnection
  • Alarms (high and low pressure)

Listen below for 5 ways to protect the patient from harm during mechanical ventilation:

  1. Adequate sedation (second dose is required)
  2. Proper tidal volume is lung protective
  3. Don’t torpedo compensatory respiratory alkalosis (Rate = 30)
  4. Wean the oxygen (except CO)
  5. Know your dopes

MCHD Ventilator Roundup


  1. Fuller BM, Ferguson IT, Mohr NM, Drewry AM, et. al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med, 2017.
  2. Marbel D. Demonstration of peep on lungs.
  3. Pappal RD, et al. ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.

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