Weinmann MEDUMAT Standard2 User manual

• Start ventilation by height
• NIV therapy
• Resuscitation (CPR)
• Anesthesia induction (RSI)
MEDUMAT Standard2
Step-by-step instructions
Important:
This document
does not replace the
instructions for use.
Complete information
can be found in the
instructions for use.

Operating steps
21
Switch on ventilator Select "New patient"
3 4
Select patient height and gender Select "next"
5 6
Select the ventilation mode and check
the displayed ventilation parameters
Start ventilation

Use presets and work according to guidelines
By using the setting option of the Vt/kg body weight (BW) 4-10ml/kg BW to be
applied, you will be working according to guidelines
ii
and determining the calculated
tidal volume for volume-controlled ventilation.
The ideal body weight and thus the tidal volume to be applied are calculated
differently for male and female patients. The following formula is used for this:
For a 185-cm-tall male patient and a setting of 6ml/kg BW, the following tidal
volume results:
The Vt is obtained accordingly: Vt = 80kgx6ml/kg = 480ml
= 79.51kg ~ 80kgIBW (in kg) = 50 + 2.3 x 185
2.54 - 60
IBW female (in kg) = 45 + 2.3 x Height in cm
2.54
iii
-60
IBW male (in kg) = 50 + 2.3 x Height in cm
2.54
iii
-60
Start faster and ventilate more precisely
From now on, you will not need to spend a long time considering which tidal
volume (Vt) is the most appropriate for your patient. With MEDUMAT Standard
2
,
you can now initiate ventilation even more precisely and even faster. By entering the
patient’s height and gender, your ventilator automatically calculates all the ventilation
parameters for the ideal body weight (IBW). The IBW serves as an important indicator
when setting the ventilation parameters
i
. MEDUMAT Standard
2
allows you to start
ventilation faster and far more precisely– giving you more time for all the other
important tasks.
Start ventilation by height
iGajic, O. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of
mechanical ventilation. Critical care medicine, 2004, No. 32, P. 1817-1824.
iiDeakin, C. D. et al. Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)
Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council. Notfall +
Rettungsmedizin, 2010, No. 7, P. 578.
iiiDevine, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy. 1974, 8. Jg., No. 11, P. 650-655.

NIV therapy
Switch on ventilator
Select "New patient" in the start
menu.
Set the patient’s height and gender or
select the appropriate patient group:
Adult, Child, Infant
1
2
3

Select the desired CPAP therapy using
the navigation button: PEEP, pMax,
ΔpASB. After adjusting the values,
begin the ventilation via "start".
Select one of the following ventilation
modes: CPAP* or CPAP + ASB (if
available).
*pure CPAP is the ventilation form
CPAP+ ASB with a ΔpASB of 0mbar
Now connect the patient to MEDUMAT
Standard². It is possible to adjust the
values using the navigation button
while the ventilation is running. You
can nd other ventilation parameters in
the user menu on the right navigation
button. If it is necessary to change the
ventilation mode, this is done using the
"user menu" function button on the
right side.
5
6
4

Modied by Prof. Dr. med. Thoralf Kerner
Logistical requirements
Oxygen supply: at least a 2-l bottle, lled ....................................................... Check
Emergency medical team familiar with NIV..................................................... Check
Clinical requirements
alert, cooperative (GCS >12) ......................................................................... Check
breathing spontaneously................................................................................ Check
if applicable, light sedation of agitated patients e.g. morphine
(5-10 mg i.v. titrated) or a short-acting benzodiazepine.
Indications
Dyspnea......................................................................................................... Check
Respiratory rate >25/min (count!) ................................................................. Check
SpO2 <90% despite O2administration ........................................................... Check
Contraindications
Absolute contraindications:............................................................................ Check
absence of spontaneous respiration, gasping, airway obstruction,
gastrointestinal bleeding or ileus
Relative contraindications:.............................................................................. Check
Coma, massive agitation, hemodynamic instability, severe hypoxemia
(SpO2 <75% despite O2), problems with airway access, status post
gastrointestinal surgery
Pulmonary edema
Primary device settings
Ventilation mode: ............................................................................................CPAP
PEEP (according to comfort and oxygenation): ......................................5/7/10mbar
FiO2:..............................................................................................Air Mix or 100%
Aim and success criteria
Target SpO2: >90%....................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Falling respiratory and heart rate.................................................................... Check
If applicable, improved vigilance..................................................................... Check
NIV sequence: Set the device, place the mask on the patient’s face (explain the
measure!), connect the mask to the hose system while the device is running. Aim:
Synchronization of patient and device
SOP
(Standard Operating Procedure)
Non-invasive ventilation (NIV) by the emergency medical
services

Exacerbated COPD
Escalation levels
In the event of imminent respiratory muscle fatigue, set pressure support (ASB).
Immediate intubation in the absence of clinical improvement or the occurrence of
contraindications!
Caution
• Continuous clinical observation and close patient contact
• No delay in pharmacological therapy or necessary intubation
• Prepared for intubation at any time
• Timely advance information to the receiving hospital
Primary device settings
Ventilation mode: ................................................................................. CPAP + ASB
PEEP: .........................................................................................................3/6mbar
∆pASB (according to comfort and oxygenation):.................................5/10/15mbar
Peak pressure (pMax): ........................................................................ max. 25mbar
Inspiration trigger: ........................................................................as low as possible
Pressure ramp: .................................................................................................steep
FiO2:..............................................................................................Air Mix or 100%
Aim and success criteria
Target SpO2: >85%....................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Falling respiratory and heart rate.................................................................... Check
If applicable, improved vigilance..................................................................... Check
Escalation levels
In the event of imminent respiratory fatigue, if available, set ventilation mode
BiLevel + ASB (e.g. PEEP: 5mbar, pInsp: 20mbar).
Immediate intubation in the absence of clinical improvement or the occurrence of
contraindications!
Caution
• Continuous clinical observation and close patient contact
• No delay in pharmacological therapy or necessary intubation
• Prepared for intubation at any time
• Timely advance information to the receiving hospital

Inspiratory trigger
The inspiratory trigger triggers a pressure support or a mechanical breath as soon as
inhalation effort is detected.
Trigger level Corresponding unit value
Level 1 (sensitive) Approx. 3l/min
Level 2 (medium) Approx. 6l/min
Level 3 (insensitive) Approx. 10l/min
Setting the levels of the inspiration trigger:
(If "3 levels" has been chosen as the trigger setting in the operator menu)
1l/min
Very sensitive
5l/min
sensitive
10l/min
insensitive
15l/min
Very insensitive
Trigger sensitivity: 1l/
min-15l/min
Flow

Pressure support and the
expiration trigger
Pressure support ΔpASB
The pressure support is always given as a value above PEEP. In addition to the set
PEEP, a patient receives this as soon as the inspiration trigger has been detected.
Example calculation:
PEEP = 5mbar, ΔpASB = 10mbar inspiration pressure in the inhalation phase = 15mbar
Trigger level Corresponding unit value
Level 1 (long) Approx. 10% Flow max
Level 2 (medium) Approx. 35% Flow max
Level 3 (Short) Approx. 70% Flow max
Expiratory trigger
Initiate expiration as soon as the ow to the patient is only the set value (in %) with
respect to the maximum ow. The length of the pressure support is set with the
expiratory trigger.
Trigger sensitivity: 5-80% of max. ow. In principle, the following applies: the smaller
the % value, the longer the pressure support lasts.
Pressure
PEEP
ΔpASB
Time
Time
Max. 4s
Flow
80% Flowmax
0%
100%
5%
5% Flowmax
Setting the levels of the expiration trigger:
(If "3 levels" has been chosen as the trigger setting in the operator menu)

Pressure ramp (pressure increase time)
A pressure ramp (or the pressure increase time) denes the time in which the pressure
increases from the PEEP to the inspiration pressure. This pressure increase time can
be set by the shape of the ramp: at, medium and steep.
<0.2seconds: steep Approx. 0.2seconds: medium Approx. 0.4seconds: at
Pressure ramps using the example of a BiLevel + ASB curve
Pressure
Time
TI = Tinsp
∆pASB
1/Freq.
(spontaneous)
1/Freq. (set)
Pmax
Pinsp
Pressure
ramp dP
dT
PEEP
assisted spontaneous
respiration
mechanical
ventilation
dP
dT

Resuscitation (CPR)
Switch on the device
Press the CPR button and select the
patient group
Check the ventilation parameters. In
the ventilation phase of 30:2 or 15:2
resuscitation, press the mask with the
"Double C grip" over the patient’s
mouth and nose.
Then hold down the MEDUtrigger key
until two mechanical breaths have been
administered.
1
2
3

Following successful intubation, change
to continuous ventilation and check the
ventilation parameters
During the cardiac rhythm analysis or
debrillation, select "pause" to pause
the ventilation.
• No movement artifacts
• Reduction of thoracic impedance
• No oxygen enrichment of ambient
air
Following successful debrillation, if
applicable, press "pause" again to
restart the ventilation. The ventilation
will start automatically after at most
50seconds.
Once ROSC is achieved, press the CPR
key again to exit the CPR mode. Then
check the ventilation parameters and
select, if applicable, the Air Mix key to
lower the FiO2 to <1.0.
4
5
6

Advanced Life Support
https://cprguidelines.eu/
European Resuscitation Council Guidelines for Resuscitation 2015
Monsieurs, Koenraad G.Khalifa, Gamal Eldin Abbas et al. Resuscitation , Volume 95 , 1 - 80
© 2015 European Resuscitation Council. Published by Elsevier Ireland Ltd. All rights reserved.

Anesthesia induction (RSI)
Switch on the device
Select "New patient" on the home
screen and set the patient’s height
and gender. Or select the appropriate
patient group: Adult, Child, Infant.
Select "RSI" in the "mode" submenu
MEDUMAT Standard² begins the
therapy in demand mode. In this mode,
the spontaneously breathing patient is
pre-oxygenated. The total RSI time and
the time since the last spontaneous
breath are shown on the display.
2
1
3
4

To check the tube position following
successful intubation or as a fallback
position for a difcult airway, change to
the manual mode.
Check the ventilation parameters.
Connect the patient hose system
to the tube or press the mask
with the "Double C grip" over the
patient’s mouth and nose and trigger
the mechanical breath with the
Following successful intubation, change
to continuous ventilation to ventilate
the patient in a controlled manner.
The device changes to controlled IPPV
or BiLevel + ASB ventilation depending
on availability and setting. Please check
the ventilation parameters and adjust
them if necessary.
5
6
7
8

Excerpt from the S1 guideline
"Pre-hospital emergency anesthesia in adults" of the German
Association for Anesthesiology and Intensive Care Medicine (DGAI)
Indications for pre-hospital emergency anesthesia
• Acute respiratory insufciency (hypoxia and/or respiratory rate* <6 or >29/min)
and contraindications for or failure of non-invasive ventilation (NIV)
• Loss of consciousness/neurological decit with risk of aspiration
• Multiple trauma/severe trauma with
i) hemodynamic instability, systolic BP <90mmHg or
ii) hypoxia with SpO2 <90% despite = 2l/min O2administration or
iii) traumatic brain injury with GCS <9
* in the presence of not rapidly reversible causes
if required
Management of complications
Indication: patient, application and user-related factors, experience of the
emergency medical team, situation at the scene, transport times, air and ground
rescue
Communication in the team: Site of anesthesia induction, clear allocation of
tasks, selection of medicines, other important notes and agreements
Optimal positioning: "Light, space, warmth" concept, ideal for upper
body elevation in the ambulance (caution: not with spinal immobilization or
hemodynamically unstable patients), head in "snifng" position.
Pre-oxygenation:
For a spontaneously breathing
patient, at least 3-4 min O
2
insufation with 12-15l/min via a
face mask with reservoir or demand
valve, if applicable, NIV or mask
ventilation
parallel
Standardized preparation:
Anesthetic and emergency medicine,
alternative airways, suction, capnography.
Monitoring: Pulse oximetry, ECG, blood
pressure, capnography
Two peripheral venous accesses: In case
of difcult puncture conditions, consider in-
traosseous puncture in a time-critical manner.
Rapid Sequence Induction (RSI)
Continuous monitoring: Anesthesia management and monitoring

Rapid Sequence Induction (RSI)
• If applicable, remove the cervical spine immobilization and begin manual in-line
stabilization
• Announcement of the anesthetic medicine with active substance and dosage,
step-by-step application
• Wait for loss of consciousness and relaxation effect
• Airway management without intermediate ventilation in normoxic patients*
• Tube position check (capnography, auscultation, insertion depth)
• If applicable, stop manual in-line stabilization and close the cervical spine
immobilization brace again
* In individual cases, despite the increased risk of aspiration, intermediate ventilation may be necessary in
order to maintain oxygenation.
Please note that these are excerpts from the S1guideline "Pre-hospital emergency anesthesia in adults".
Source: Anästh Intensivmed 2015;56:317-335 Aktiv Druck & Verlag GmbH

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