הנשמה - האיגוד הישראלי לרפואה דחופה

הנשמה - האיגוד הישראלי לרפואה דחופה

By הנשמה – האיגוד הישראלי לרפואה דחופהMedicineHealth & Fitness
Download on the App Store

הנשמה - האיגוד הישראלי לרפואה דחופה episodes

  • PODCAST: Face mask ventilation is one of those skills that can easily be overlooked.

    Face mask ventilation is one of those skills that can easily be overlooked. It's often seen as the simple bit of airway management — something that sits below the glamour of videolaryngoscopy, fibre-optics and endotracheal intubation. But the reality is that excellent face mask ventilation is one of the most important airway skills we have.

    In this episode, we take a deep dive into bag-valve-mask ventilation and airway adjuncts, exploring why this is far more than just putting a mask on a face and squeezing a bag. We discuss when facemask ventilation is indicated, how to identify patients who may be difficult to ventilate, and the practical steps that can dramatically improve success rates.

    We cover positioning, airway opening manoeuvres, mask seal techniques, the role of airway adjuncts and how to recognise whether your ventilations are actually working. We also look at troubleshooting common problems, the evidence comparing bag-mask ventilation with supraglottic airways and endotracheal intubation, and how to decide when it's time to move to another airway strategy.

    Whether you're working in the emergency department, prehospital environment or critical care, this episode is packed with practical tips, cognitive aids and evidence-based advice to help you deliver facemask ventilation with confidence and excellence.

    Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

    Simon. Rob & James

    The post PODCAST: Face mask ventilation is one of those skills that can easily be overlooked. first appeared on האיגוד הישראלי לרפואה דחופה.

    1 hr
  • PODCAST: Demystifying Non-Invasive Ventilation & HiFlow
    • 🚀 High-Flow Nasal Cannula (HFNC)

      🗝️ Key Points
      • 💨 NIV = Support without a tube: CPAP, BiPAP, and HFNC improve oxygenation and reduce the work of breathing.
      • 🫁 CPAP = Continuous pressure: Best for hypoxemic patients (e.g., pulmonary edema, OSA).
      • ⚖️ BiPAP = Two pressures (IPAP/EPAP): Great for hypercapnic failure (e.g., COPD, obesity hypoventilation).
      • 🌬️ HFNC = Heated, humidified high flow: Reduces effort, improves comfort, and enhances oxygen delivery.
      • 🩺 Supportive, not definitive: NIV stabilizes patients while the underlying cause is treated.

        • 📝 Introduction

        Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal intubation. The most common modalities include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC). These therapies aim to improve oxygenation, reduce the work of breathing, and potentially prevent invasive mechanical ventilation.

        💨 CPAP and BiPAP
        • CPAP delivers a single, continuous pressure during inspiration and expiration. This pressure (commonly 5–10 cm H₂O) helps recruit atelectatic alveoli, reduce shunt, and improve oxygenation. It is commonly used for conditions like pulmonary edema, obstructive sleep apnea, or mild hypoxemia without significant ventilatory failure.
        • BiPAP alternates between two pressures:
          • Inspiratory positive airway pressure (IPAP), augments tidal volume and unloads inspiratory muscles.
          • Expiratory positive airway pressure (EPAP), maintains alveolar recruitment and improves oxygenation.
            • The differential between IPAP and EPAP is critical for reducing hypercapnia in patients with COPD exacerbations or acute hypercapnic respiratory failure.
          • Indications
            • CPAP: hypoxemia without major ventilatory failure (e.g., cardiogenic pulmonary edema, atelectasis, OSA).
            • BiPAP: hypercapnia with increased work of breathing (e.g., COPD exacerbation, neuromuscular weakness, obesity hypoventilation).
            • A helpful way to conceptualize CPAP and BiPAP is through the hairdryer analogy. Imagine placing a hairdryer in your mouth:

              • 🩺 Clinical Considerations
              • Masks can be uncomfortable, impair secretion clearance, and limit oral intake.
              • Some patients require sedation to tolerate NIV, but this carries risks in patients with unprotected airways.
              • NIV is thus a high-stakes intervention requiring close monitoring.
              • Common starting dose to understand titration, but start at the level appropriate for your patient:  IPAP 10 cm H₂O / EPAP 5 cm H₂O (“10/5”) and are titrated:
                • Increase IPAP to improve tidal volume and CO₂ clearance.
                • Increase EPAP to recruit alveoli and improve oxygenation.
                • Both may be raised simultaneously if the patient is both hypoxemic and hypercapnic.

                  • 🚀 High-Flow Nasal Cannula (HFNC)
                  • H: Heated & humidified – improves mucociliary clearance, prevents airway drying, and enhances tolerance. I: Inspiratory flow – high flow meets or exceeds patient demand, reducing respiratory rate and effort.
                  • F: Functional residual capacity – modest generation of positive end-expiratory pressure (PEEP), promoting alveolar recruitment.
                  • L: Lighter – generally more comfortable and less restrictive than mask-based NIV.
                  • O: Oxygen dilution – minimizes entrainment of room air, delivering higher and more predictable FiO₂.
                  • W: Washout – flushes anatomical dead space, reducing CO₂ rebreathing.
                  • HFNC delivers heated, humidified oxygen at high flow rates (30–60 L/min) through wide-bore nasal prongs. A mnemonic, H-I-F-L-O-W, helps summarize its mechanisms:
                  • Indications: Traditionally used for acute hypoxemic respiratory failure (e.g., pneumonia), HFNC is increasingly studied for hypercapnic failure as well, with trials suggesting non-inferiority to BiPAP in select populations.

                    • The post PODCAST: Demystifying Non-Invasive Ventilation & HiFlow first appeared on האיגוד הישראלי לרפואה דחופה.

                    24 min
                  • PODCAST: Airway to Heaven- A Primer on Mechanical Ventilation for Emergency Providers
                    Saturday Jul 05, 2025

                    Dr. Harish Kinni, a triple-board-certified emergency medicine and critical care physician and assistant professor at the Mayo Clinic, provides an overview of the fundamentals of ventilator care for emergency department professionals. We will review key modes that we should know, the variables to set, how to adjust them for your patient’s needs, and provide troubleshooting tips and tricks for when things suddenly go awry. This is sure to be one of the most helpful chapters of Always on EM, but don’t let it take your breath away!

                    CONTACTS

                    X – @AlwaysOnEM; @VenkBellamkonda

                    YouTube – @AlwaysOnEM; @VenkBellamkonda

                    Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch

                    REFERENCES & LINKS

                    • Swart P, Nijbroek SGLH, Paulus F, Neto AS, Schultz MJ. Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19-Insights From the PRoVENT-COVID Study. Front Med (Lausanne). 2022 Jan 3;8:780005. doi: 10.3389/fmed.2021.780005. PMID: 35300177; PMCID: PMC8923734.
                    • McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S, Bellani G, Brochard L, Laffey JG; LUNG SAFE Investigators and the ESICM Trials Group. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J. 2019 Oct 17;54(4):1900609. doi: 10.1183/13993003.00609-2019. PMID: 31346004.
                    • Swart P, Deliberato RO, Johnson AEW, Pollard TJ, Bulgarelli L, Pelosi P, de Abreu MG, Schultz MJ, Neto AS. Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts. PLoS One. 2021 Jul 14;16(7):e0253933. doi: 10.1371/journal.pone.0253933. PMID: 34260619; PMCID: PMC8279424.
                    • Evans, Laura1; Rhodes, Andrew2; Alhazzani, Waleed3; Antonelli, Massimo4; Coopersmith, Craig M.5; French, Craig6; Machado, Flávia R.7; Mcintyre, Lauralyn8; Ostermann, Marlies9; Prescott, Hallie C.10; Schorr, Christa11; Simpson, Steven12; Wiersinga, W. Joost13; Alshamsi, Fayez14; Angus, Derek C.15; Arabi, Yaseen16; Azevedo, Luciano17; Beale, Richard18; Beilman, Gregory19; Belley-Cote, Emilie20; Burry, Lisa21; Cecconi, Maurizio22; Centofanti, John23; Coz Yataco, Angel24; De Waele, Jan25; Dellinger, R. Phillip26; Doi, Kent27; Du, Bin28; Estenssoro, Elisa29; Ferrer, Ricard30; Gomersall, Charles31; Hodgson, Carol32; Hylander Møller, Morten33; Iwashyna, Theodore34; Jacob, Shevin35; Kleinpell, Ruth36; Klompas, Michael37; Koh, Younsuck38; Kumar, Anand39; Kwizera, Arthur40; Lobo, Suzana41; Masur, Henry42; McGloughlin, Steven43; Mehta, Sangeeta44; Mehta, Yatin45; Mer, Mervyn46; Nunnally, Mark47; Oczkowski, Simon48; Osborn, Tiffany49; Papathanassoglou, Elizabeth50; Perner, Anders51; Puskarich, Michael52; Roberts, Jason53; Schweickert, William54; Seckel, Maureen55; Sevransky, Jonathan56; Sprung, Charles L.57; Welte, Tobias58; Zimmerman, Janice59; Levy, Mitchell60. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337
                    • Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. doi: 10.1164/rccm.201703-0548ST. Erratum in: Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum. PMID: 28459336.
                    • Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363. PMID: 32224769; PMCID: PMC7176264.
                    • Wang W, Scharfstein D, Wang C, Daniels C, Needham D, Brower R, NHLBI ARDS Clinical Network. Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury. J R Stat Soc Ser C Appl Stat. 2011. PMC: PMC3197806
                    • Brower RG, Thompson BT, NIH/NHLBI/ARDSNetwork. Tidal volumes in acute respiratory distress syndrome–one size does not fit all. Crit Care Med. 2006.
                    • Hager DN, Krishman JA, Hayden D, Brower RG, ARDSNet NIH / NHLBI. Tidal Volume Reduction in Patients with acute Lung Injury When Plateau Pressures Are Not High. Am J Resp Crit Care Med. 2005.
                    • Rubenfeld GD, Cooper C, Carter G, Thompson BT, Hudson LD. Barriers to providing lung protective ventilation to patients with acute lung injury. Crit Care Med. 2004.
                    • Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care. 2014 Nov;59(11):1747-63. doi: 10.4187/respcare.03057. Epub 2014 Aug 12. PMID: 25118309.
                    • Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, Wu A, Tong H, Wang Y, Wang C, Li E. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care. 2016 Jul 22;20(1):226. doi: 10.1186/s13054-016-1396-0. PMID: 27448995; PMCID: PMC4957383.
                    • Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB, NIH NHLBI ARDS Network. Comparison of the Sp02/FI02 Ratio and the PaO 2/FI02 in Patients with Acute Lung Injury or ARDS. Chest. 2007.
                    • Zhang G, Burla MJ, Caesar BB, Falank CR, Kyros P, Zucco VC, Strumilowska A, Cullinane DC, Sheppard FR. Emergency Department SpO2/FiO2 Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients. West J Emerg Med. 2024 May;25(3):325-331. doi: 10.5811/westjem.17975. PMID: 38801037; PMCID: PMC11112664.

                      • The post PODCAST: Airway to Heaven- A Primer on Mechanical Ventilation for Emergency Providers first appeared on האיגוד הישראלי לרפואה דחופה.

                      1 hr 14 min

                    About הנשמה - האיגוד הישראלי לרפואה דחופה

                    From the publisher's feed

                    The Israel Association for Emergency Medicine