PUSCII Medical Inc. (tm)

diy ventilators

advice written for doctors

https://pastebin.com/cyww1hVV italian advice (in dutch) https://nvic.nl/covid-19-bericht-van-de-voorzitter https://nvic.nl/sites/nvic.nl/files/Ad%20hoc%20protocol%20Beademen%20bij%20patienten%20met%20respiratoire%20insufficientie%20met%20COVID19%20luchtweginfectie.pdf

terms

anatomische phenotypes

  • diffuse
    • hoge PEEP tabel
    • buikbeademing
    • gemonitorde recruitment
  • focale
    • lage PEEP tabel
    • afwezige te verwachten respons op buikbeademing
    • geen of nadelig effect van recruitment
  • hyperinflammatore
    • long protectief beademd worden (driving pressure < 15 cm H2O, teugvolume 6 ml/kg ideaal lichaamsgewicht,
    • hoge PEEP
    • restrictief vochtbeleid
    • statines

saturatie

ARDS Acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs.[1] Symptoms include shortness of breath, rapid breathing, and bluish skin coloration.[1] Among those who survive, a decreased quality of life is relatively common.

Lung recruitment maneuver

Lung recruitment maneuver, are efforts to open collapsed areas of the lungs and keep them open

n donning and doffing procedures

properly putting on and of the protective gear https://preceptmed.com/wp-content/uploads/2018/01/Donning-Doffing-Full-Coverage-OTH-Gown-Inst-PA0105-Rev-2-1609-.pdf

P/F ratio

The P/F ratio equals the arterial pO2 divided by the FIO2 (the fraction of inspired oxygen expressed as a decimal) the patient is receiving. It is most familiar, and commonly used, in the context of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) where a P/F ratio <300 is diagnostic of acute lung injury or mild ARDS, <200 is consistent with moderate ARDS and <100 indicates severe ARDS.

long compliantie

passagère hypercapnie

EIT Electrical impedance tomography

Electrical impedance tomography (EIT) is a noninvasive type of medical imaging in which the electrical conductivity, permittivity, and impedance of a part of the body is inferred from surface electrode measurements and used to form a tomographic image of that part.

Fio2

https://www.ausmed.com/cpd/articles/oxygen-flow-rate-and-fio2 FiO2 is defined as the percentage or concentration of oxygen that a person inhales (the fraction of inspired oxygen)

PEEP

https://en.wikipedia.org/wiki/Positive_end-expiratory_pressure

Positive end-expiratory pressure (PEEP) is the pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration.[1] The two types of PEEP are extrinsic PEEP (PEEP applied by a ventilator) and intrinsic PEEP (PEEP caused by an incomplete exhalation). Pressure that is applied or increased during an inspiration is termed pressure support.

ECMO Extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life.

  • mechanische ventilatie
  • bilateraal interstitieel longvocht
  • CPAP
  • NIV niet invasieve beademing
  • teugvolume

statin

https://en.wikipedia.org/wiki/Statin

intubation (inserting a tube in the lungs)

rapid sequence intubation or (RSI) rapid sequence induction and intubation (RSII)

"Classic" RSI involves pre-filling the patient's lungs with a high concentration of oxygen gas, followed by applying cricoid pressure, administering rapid-onset sedative or hypnotic and neuromuscular-blocking drugs that induce prompt unconsciousness and paralysis, inserting an endotracheal tube with minimal delay, and then releasing the cricoid pressure. * fill the lungs with pure oxygen for a while * give the drugs (fentanyl, ketamine, and lidocane and some other ones) * look with a camera (or optical device) and insert a tube

commercial materials

  • https://www.verathon.com/glidescope-core/
  • NIV

    protective materials

  • schort
  • handschoenen
  • FFP2 masker
  • spatbril.

diy materials

  • oxygen in bottles
  • oxygen regulators
  • tubing
  • air compressors
  • vacuum pumps (fridges)
  • plastic sheets
  • heat sealing machine
  • car wiper motors
  • flow meters

medical ventilator designs

  • [modification_of_radcliffe_ventilator.pdf] modification of the radcliffe ventilator (based on car wiper motor)
  • https://www.sciencedirect.com/science/article/pii/S0007091217508922

high flow nasal canule (optiflow)

high flow nasal cannula. The air is warmed and humidified to not dry out mucus membranes. Frequently sold under the brand name Optiflow and should be easy to construct, just bubble the gas through 37-40C water.

notes

optiflow Creates aerosols. All CoV patients are to be ventilated via ET tube, mostly because of ARDS and the complexities of gas exchange and lung compliance in these patients and partially to protect staff. Nasal high flow is available and very cheap compared to a invasive ventilator.

het type beademing hangt dus af van waar de infectie zit (anatomisch phenotype) en dat stel je vast met een CT-thorax of met bloedwaardes dus niet even slangetje en pompje in iemands longen duwen

https://emcrit.org/pulmcrit/split-ventilators/