First, do no harm: With the vent

5 ways to protect the patient during mechanical ventilation

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

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