Podcast 84 - Cold Reads & Ventilation (Part 1)

The Dreaded Cold Read

Does anyone ever send you a cold read? A cold read is when you get a piece of information, but really no context. An example of this would be the ECG or lab panel that you get sent you with the predictable question: "What would you do?" This is a difficult question to answer, because the person is generally asking you to make a treatment decision based on only one part of the story (whatever they sent you). This really isn't the way we make informed treatment decisions in real life situations - we take the whole patient into account. When we get an ECG, we like to know if the patient has chest pain, a cardiac history, if they're diaphoretic, if there is pulmonary edema, and so on to infinity. How does this apply to the ventilator?

Whenever discussing ventilator strategies, I feel like the discussion is a bit of a cold read whenever the waveforms are not taken into account. The waveforms tell you what the flow, volume, and pressure are doing over time - and they're extremely helpful in managing a patient. I realize that some of you do not have waveforms on your ventilators. If you don't have waveforms on your ventilator, when you do retrievals from outlying hospitals, examining the waveforms on their ventilator will help you set up a care plan for the transport. If you do have waveforms on your ventilator, you've very fortunate - because they can help you set up a precise strategy to fine-tune your settings.