318 Mt. Rushmore Road, Suite E
Rapid City, South Dakota

1-800-761-5437 • 1-605-342-7004
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Christopher Seime, BS, RRT

Director of Clinical Services
Director of Respiratory Care
Registered Respiratory Therapist

Education:
• Bachelor of Science, North Dakota State University, Respiratory Care

Certifications:
• Registered Respiratory Therapist, National Board of Respiratory Care
• Certified Respiratory Therapist, National Board of Respiratory Care

Special Interests & Community Involvement:
• American Association of Respiratory Care, Member
• American Lung Association, Volunteer

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Christopher Fenster, BS, RRT

Registered Respiratory Therapist

Education:
• Bachelor of Science, University of Mary, North Dakota School of Respiratory Care

Certifications:
• Registered Respiratory Therapist, National Board of Respiratory Care
• Certified Respiratory Therapist, National Board of Respiratory Care

Special Interests & Community Involvement:
• American Association of Respiratory Care, Member
• American Lung Association, Volunteer
• National Board of Respiratory Care, Member
• Asthma Camp, Medical Staff

With all durable medical equipment, maintenance is essential for proper functioning, long unit life and client comfort. The care and maintenance required for PAP machines varies with the type and conditions of use, and are typically spelled out in a detailed instruction manual specific to the make and model.

Most manufacturers recommend weekly maintenance of respiratory units. Worn or frayed electrical connections may present a shock or fire hazard. Worn hoses and masks may reduce the effectiveness of the unit.

Most respiratory devices employ some type of filtration, and the filters must be cleaned or replaced on a regular schedule. Hoses and masks accumulate exfoliated skin, particulate matter, and can even develop mold. Humidification units must be kept free of mold and algae. Because units use substantial electrical power, housings must be cleaned without immersion.

The continual use of medical equipment is essential in the success of the respiratory therapy. PAP units are becoming lighter and more compact and often come with carrying cases for easy portability. Dual-voltage power supplies allow many units to be used internationally.

Air travel may present special considerations. Most airport security inspectors have seen the portable machines, so screening rarely presents a special problem. Increasingly, CPAP & Bi-level machines are capable of being powered by the 400 Hz power supply used on most commercial aircraft and include manual or automatic altitude adjustment.

A home ventilator is a respiratory device that mechanically breathes for clients who are physically unable to, or cannot sufficiently, breathe on their own.

Ventilators are used mainly in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine).

Modern ventilators are generally thought of as computerized machines, yet clients can be assisted with breathing indefinitely with a bag valve mask - a simple hand-operated machine.

Function

A modern ventilator consists of a compressible air reservoir, air and oxygen supplies, a set of valves and tubes, and a reusable "client circuit". The respiratory device uses pressure to blow air or, in most cases, an air/oxygen mixture into the lungs of the client.

The ventilator is programmed to breathe a set number of times a minute. The device can be set so the client can trigger the machine to blow air into the lungs, however, if the client fails to trigger it within a certain time the machine automatically blows air to keep the client breathing.

Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual client's needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the client.

The SeQual Eclipse™ Oxygen System provides continuous flow operation of up to 3 liters per minute in a lightweight portable unit to meet a client’s stationary and ambulatory needs.

The FAA’s approval of this all-in-one oxygen concentrator allows the more than 1 million Americans needing continuous oxygen flow to have respiratory therapy during travel as well as when they reach their ultimate destination.
Sequal Eclipse:

• Up to 3 LPM continuous flow oxygen for nocturnal use and exercise
• Pulse Settings 1 to 6
• Runs on house hold current, DC from an auto accessory plug outlet, and its own rechargable battery

• Size 19.3 H x 12.3 W x 7.1 D inches
• Weight with battery 17.4 lbs
• Power uses 48 watts@ 1.0 LPM 85 watts 6 pulse
• Oxygen concentration 91 to 93 %
• Operation temperature 50 F to 104 F
• Altitude operating range 0 to 13,123 Feet
• The Sequal Eclipse is equipped with a Oxygen Monitor

Designed to perform as both a stationary and portable oxygen source, the Inogen One defines a new category of home oxygen therapy devices. Not simply stationary, not simply portable - this new category was developed to achieve the independence that clients desire on a daily basis.

INOGEN CLIENT FAQ

A cough assisting device is a non-invasive therapy that safely and consistently removes secretions in clients with an ineffective ability to cough (peak cough flow < 270 l/m).

Typical cough assisting device clients include those with the following conditions:

• Amyotrophic lateral sclerosis
• Spinal muscular atrophy
• Muscular dystrophy
• Myasthenia gravis
• Spinal cord injuries

A cough assisting device is a respiratory therapy that gradually applies a positive pressure to the airway, then rapidly shifting to negative pressure. The rapid shift in pressure produces a high expiratory flow, simulating a natural cough.

Benefits of Cough Assisting Devices

• Removes secretions from the lungs
• Reduces the occurrence of respiratory infections
• Safe, noninvasive alternative to suctioning
• Easy for clients and caregivers to operate

Cough Assisting Device Flexibility

• Can be used with a face mask, mouthpiece or with an adapter to a client's endotracheal or tracheostomy tube.
• Approved for home use in adults and children.
• Available in automatic and manual models.

Continuous pressure devices (CPAP):

Once used solely as an at-home treatment for sleep apnea, continuous positive airway pressure (CPAP) machines are now widespread across intensive care units as a form of ventilation.

Sleep Apnea
Obstructive sleep apnea occurs when the upper airway becomes narrow as the muscles relax naturally during sleep. This reduces oxygen in the blood and causes arousal from sleep.

CPAP treatment can be highly effective in the treatment of obstructive sleep apnea. For some clients, the improvement in the quality of sleep and life due to these respiratory devices will be noticed after a single night’s use. The client’s sleep partner also achieves better sleep quality due to the improvement of the client’s loud snoring.

The CPAP machine stops this sleep disorder by delivering a stream of compressed air via a hose to a nasal pillow, nose or full-face CPAP mask, keeping the airway open under air pressure so that unobstructed breathing becomes possible.

Air prevention, not the movement of air, is what prevents the apneas. When the CPAP machine is turned on, and prior to being placed on the head, a flow of air comes through the respiratory care device. When the CPAP mask is put on, it is sealed to the face with no air flowing. At this point, it is the air pressure which produces positive results.

The CPAP machine blows the air at a prescribed, or titrated, pressure which is measured in centimeters of water. The necessary pressure is determined by a sleep physician after review of an overnight study in a sleep laboratory.

Sleep apnea is a chronic health issue and doesn't go away. Ongoing respiratory care is needed to maintain CPAP therapy. Ongoing chronic care management is the best way to help clients continue respiratory therapy by educating them on the health risks of sleep apnea and providing motivation and support.

Uncontrolled apnea over many years can lead to:

• Higher risks of heart disease
• High blood pressure
• Increased chance of strokes

Bi-level pressure devices

Bi-level Positive Airway Pressure (BPAP) is a respiratory device that helps people get more air into their lungs. The Bi-level provides two levels of pressure – Inspiratory Positive Airway Pressure (IPAP), for inhaling, and a lower Expiratory Positive Airway Pressure (EPAP) for exhaling.

The dual settings allow people to get more air in and out of the lungs without the natural muscular effort needed to do so.

There are three separate modes for the BPAP:

• S (Spontaneous) – In the spontaneous mode, the device triggers the inhale pressure when flow sensors detect spontaneous inspiratory effort and then cycles back to exhale pressure.
• T (Timed) – In timed mode, the inhale/exhale cycling is purely machine-triggered at a set rate which is typically expressed in breaths per minute.
• S/T (Spontaneous/Timed) – The device triggers to inhale pressure on client inspiratory effort, however, a backup rate is also set to ensure clients still receives a minimum number of breaths per minute if they fail to breathe spontaneously.

Variable Positive Airway Pressure (VPAP) Adapt SV: WestMed Rehab also carries the VPAP Adapt SV™ which is an adaptive servo-ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed.

The following are optional features to the CPAP and Bi-level respiratory devices provided by West MedRehab.

Heated water chamber can increase client comfort by eliminating the dryness of the compressed air. The temperature can usually be adjusted or turned off to act as a passive humidifier if desired. In general, a heated humidifier is either integrated into the unit or has a separate power source (i.e. plug).

Unheated water chamber is dependent on ambient air temperature. While not as effective as the heated, it can still increase client comfort by eliminating the dryness of the compressed air. In general, a passive humidifier is a separate unit and does not have a power source.

A ramp is used to temporarily lower the pressure to allow the user to fall asleep easier. The pressure gradually rises to the prescribed level over a period of time that can be adjusted by the client and/or the durable medical equipment provider.

Exhalation pressure relief gives a short drop in pressure during exhalation to reduce the effort required.

Flexible chin straps are used to help the client not breathe through the mouth, thereby keeping a closed pressure system. The straps are elastic enough that the client can easily open his mouth if he feels that he needs to.

Data logging records, basic compliance info or detailed event logging, allows the sleep physician and client to download and analyze data recorded by the machine to verify treatment effectiveness.