Ventway Sparrow controls, delivered breath checks, oxygenation, pressure limits and power management in ACM Extended.
Open printable ventilator chart
In gameWhat Simple Ventilator Mode changes
Simple Ventilator Mode keeps the selected rate with automatic supporting settings. It still models airway and lung problems, perfusion, power and circuit failures. Advanced values remain stored when simple mode is enabled.
These are the current fallback settings when a stored advanced value is absent. They are separate from the injury examples below. The ventilator uses its selected weight for mL/kg calculations.
The advanced default pressure limit of 40 cmH2O is above the default 35 cmH2O injury threshold. A breath can stay within that limit and still accumulate pressure injury.
Simple mode: selected rate, VTi 500 mL, FiO2 95%, PEEP 5, I:E 1:2 and pressure limit 35 cmH2O. During arrest, its automatic VTi becomes 420 mL and PEEP becomes 0. Advanced CPR mode has its own defaults in the card below.
What you will see
Assess Pupils can show nystagmus when deep ketamine sedation is present. With plain descriptors, the report says the eyes are rapidly and involuntarily moving. With clinical descriptors, it adds “Nystagmus.”
When nystagmus appears
The finding requires a living, unconscious patient who is not in cardiac arrest or under rocuronium paralysis. Current ketamine effect must reach the induction normalized threshold of 1 and exceed propofol plus midazolam effects combined. Analgesic ketamine alone does not meet this threshold.
CautionHow to interpret an absent finding
This is a useful in game confirmation of ketamine dominant deep sedation when present. Its absence does not establish inadequate sedation: another sedative may dominate, or paralysis may suppress this observation. Continue assessing medication effect and ventilation. Existing injury related pupil findings remain in the same report.
Pupil finding checked in the current game assessment and sedation model.
| Mode | What is set | What to monitor |
|---|---|---|
SIMV VC PS | Mandatory rate and tidal volume target, plus support for eligible spontaneous breaths | Airway pressure and delivered volume. The pressure limit can reduce delivery below the target |
SIMV PC | Mandatory rate and inspiratory pressure target, with pressure support for eligible spontaneous breaths | Delivered volume and minute ventilation as compliance changes |
CPAP PS HF | Spontaneous breathing with pressure support and PEEP | Respiratory effort and effective ventilation. The current model provides backup mandatory breaths if the patient cannot trigger |
IMV VC (CPR) | Dedicated unsynchronized CPR ventilation | Effective breaths during compressions; reassess mode and respiratory effort after ROSC |
In gameDuring compressions
The CPR setting prevents compression related triggering from being treated as normal patient effort. Other modes can accumulate a CPR ventilation penalty during compressions. A connected ventilator still requires active assessment of the patient.
Choose the card that matches the lung problem, then check what the ventilator actually delivers. These are example starting points for the game, except the CPR card’s configured defaults. Reassess oxygenation, ventilation, pressure and perfusion after each change.
Why: mandatory breaths support reduced drive. A lung with little shunt needs less recruitment; extra FiO2 does not correct inadequate air movement or blood loss.
Watch: delivered VTe, minute ventilation and patient effort. A pressure limit can prevent the full VTi target from being delivered.
Why: PEEP reduces the edema related shunt by recruiting lung units. FiO2 enriches gas reaching the remaining working lung. CPAP support is another option when using the supported spontaneous breathing path.
Watch: SpO2 benefit against falling perfusion, higher PIP and reduced VTe. Treat the underlying fluid problem; PEEP does not remove the excess volume.
Why: pressure targeting makes the pressure setting explicit while the injured lung’s compliance changes. Set PInsp by the resulting delivered volume; a mode label alone does not provide enough ventilation.
Watch: VTe, minute ventilation, PIP and SpO2. Healing depends on effective support, FiO2 and pressure. Pressure control is a starting choice, not an exclusive healing requirement.
Why: pleural air compresses the lung. PEEP cannot clear that fixed shunt, and positive pressure can increase the air leak.
Watch: drainage, recurrent chest findings, pressure and perfusion. These example numbers do not make an undrained leak safe. See chest procedures.
Why: PEEP does not drain pleural blood. The casualty also needs assessment of blood loss and oxygen delivery.
Watch: chest findings, SpO2, delivered volume and perfusion. Drainage and blood volume replacement solve different parts of the problem.
Why: the dedicated mode avoids interpreting compressions as spontaneous breathing. Default rate and mL/kg can change with mission settings.
Watch: effective breaths during compressions. After ROSC, reassess the mode, effort and delivered ventilation.
Set and reassess the rate
Rate is a separate control. The injury cards do not supply a fixed rate prescription. Use the delivered minute ventilation, EtCO2 trend and patient state to reassess it.
Effective ventilation and oxygen delivery help the acute injury resolve. Follow delivered breaths, EtCO₂, pulse, volume status and pressure together. Normal SpO₂ alone cannot clear a delivery deficit from hemorrhage.
Hypoventilation can raise ICP through CO₂ retention. Excessive hyperventilation can lower ICP while adding ischemic injury. PEEP and dyssynchrony between the patient and ventilator have separate mechanical ICP effects, so reassess the response after changing support. Use the TBI recovery and ventilation guide for the current game thresholds and severity dependent pressure requirements.
TBI update checked at ACM Extended dev revision 98d18bb: ventilation, mechanical effects and recovery.
These three support checks work together. See the complete blast lung treatment ladder.
| Pattern | Starting reference | Reassess |
|---|---|---|
Healthy lung requiring support | PEEP 5; VTi 6–8 mL/kg; FiO2 21–40%; I:E 1:2 | Oxygen requirement, drive and delivered ventilation |
Pulmonary edema | PEEP 10–15; VTi 6–8 mL/kg; FiO2 40–60% | Recruitment benefit against reduced perfusion and increasing pressure |
Blast lung / ARDS | Pressure control reference; PEEP 5–8; delivered VTe about 5–6 mL/kg; FiO2 60–95% | Actual volume, minute ventilation and pressure. The healing gate is based on effective support, not a mode label |
Pneumothorax | Assess and treat indicated pleural drainage; use controlled pressure and reassess | Persistent air leak and loss of drainage can worsen under positive pressure |
Hemothorax | Assess drainage and lost circulating volume; support breathing as needed | PEEP does not remove pleural blood; blood volume replacement is a separate task |
Compare inspired and expired volume
VTi goes in; VTe comes back. Compare both when checking a breath. In the game, leak reduces expired volume relative to inspired volume, and delivered minute ventilation uses the expired volumes. Check the capnography patterns alongside these readings.
| Control or reading | How to use it |
|---|---|
VTi target, delivered VTi and VTe | VTi refers to inspired tidal volume. The setting is the inspiratory target; delivered VTi is the volume actually sent into the circuit, while VTe is the expired volume returning from the patient. Pressure limits can reduce inspired delivery, and a leak can reduce VTe further |
Minute volume | Use delivered ventilation to assess support. The display needs time to settle after connection |
PInsp | In the game’s pressure control formula, delivered volume depends on PInsp minus PEEP and effective compliance |
P. SUPPORT | Adds support to eligible spontaneous breaths |
FiO2 | Enriches inspired gas. It cannot fully overcome the ceiling from residual shunt |
PEEP | Can recruit edema- or blast related shunt, but can reduce perfusion and worsen pressure related problems |
I:E and rate | Together determine expiratory time. More time for expiration helps clear gas trapping |
Pressure limit | Caps delivered pressure and can reduce volume below the set target |
Trigger sensitivity | Determines whether spontaneous effort triggers supported breaths |
The diagram below illustrates pressure and flow phases. Interpret it alongside the delivered measurements. A higher pressure requirement at unchanged target volume can reflect reduced compliance; changing mode or the pressure limit also changes the trace.
For the EMMA capnograph, see the implemented waveform conditions. Its CO2 waveform is a different measurement from the ventilator’s pressure trace.
Recruitable and fixed shunt
Edema and blast lung create recruitable shunt. PEEP and inspiratory recruitment reduce that component. Pneumothorax and hemothorax create a fixed component that PEEP does not clear.
In gameRecruitment and overdistension
PEEP recruitment scales across 4–15 cmH2O. Above 16 cmH2O, an overdistension term grows toward its maximum at 24 cmH2O. FiO2 improves oxygenation toward the remaining shunt ceiling; it does not erase the shunt itself. At altitude, reduced ambient pressure also affects the calculation.
Edema and blast lung: PEEP and inspiratory recruitment reduce the part of the shunt the game can reopen.
Pleural air and blood: assess decompression or drainage. Turning up PEEP does not remove these causes.
FiO2: raises oxygenation toward the remaining shunt ceiling. A saturation plateau can mean the cause still needs treatment.
Use oxygen delivery and flight physiology alongside the saturation reading.
Effective compliance
Base compliance ranges from 1.0 down to 0.20 after the following injury contributions. A separate compliance multiplier, including one lung ventilation, can reduce effective compliance to 0.10.
| Insult | Compliance cost | At |
|---|---|---|
Blast lung | up to 0.62 | full severity |
Fluid overload | up to 0.45 | 1.6 L over |
Ventilator induced injury | up to 0.30 | accumulated |
up to 0.25 | state 3 | |
up to 0.20 | 1500 mL |
Pressure needed for volume
A lower compliance means more pressure is needed to move the same target volume. The following estimate applies before auto-PEEP and pressure limiting.
PIP = 8 + [12 × (set VTi ÷ 500) ÷ effective compliance]
A lower pressure limit can reduce the delivered volume. This is the requested pressure estimate, not a guaranteed delivered breath.
| Set VTi | Comp 1.00 | Comp 0.70 | Comp 0.50 | Comp 0.35 | Comp 0.20 |
|---|---|---|---|---|---|
400 mL | 18 | 22 | 27 | 35 | 56 |
500 mL | 20 | 25 | 32 | 42 | 68 |
600 mL | 22 | 29 | 37 | 49 | 80 |
700 mL | 25 | 32 | 42 | 56 | 92 |
Pressure control response
In pressure control, the same pressure difference moves less gas as compliance falls. Raising PEEP while holding PInsp fixed also narrows that difference.
VTi = 500 × [(PInsp − PEEP) ÷ 15] × effective compliance
This is the base mandatory volume estimate. The complete delivery model applies bounds, circuit and airway effects. Confirm the displayed VTe.
CautionPressure thresholds
The pressure gauge enters caution at 30 cmH2O. Sustained PIP above the default 35 cmH2O danger threshold accumulates a barotrauma dose.
The following times assume a constant pressure and no prior accumulated dose.
| Sustained PIP | Dose rate | Time to an injury event |
|---|---|---|
36 | 0.0054 /s | 3.1 min |
40 | 0.0078 /s | 2.1 min |
45 | 0.0108 /s | 1.5 min |
50 | 0.0138 /s | 1.2 min |
55 and above | 0.0168 /s | 1.0 min |
After reducing pressure
Below the danger threshold, dose decays at 0.004 per second. Reducing pressure stops further accumulation; it does not automatically reverse existing injury.
| Effect | Amount | Consequence |
|---|---|---|
Lung injury | +0.20 | Stiffens the lung, which raises PIP, which accrues dose faster |
Pneumothorax roll | 55% | A new one on a chest with no prior injury. 100% if one already exists |
Pain | +0.25 | Barotrauma hurts |
CautionVolume related injury
High delivered volume can add stretch injury independently of the pressure dose branch. The calculation begins above 8 mL/kg when effective compliance is below 0.80 and scales with volume and compliance deficit. Reassess volume, pressure, obstruction and drainage together.
Accumulation and clearance
The game compares expiratory time with an emptying time estimate of 1.8 seconds × effective compliance. Insufficient expiration accumulates auto-PEEP at up to 0.9 cmH2O per second. Adequate expiration clears it at 1.2 cmH2O per second.
CautionAlarm and response
The default auto-PEEP ceiling is 20 cmH2O and the GAS TRAPPING alarm threshold is 4 cmH2O. Auto-PEEP adds to pressure and can affect pressure limiting. Increase the expiratory share of I:E, lower rate when appropriate, and recheck delivered ventilation.
Air, oxygen and power
The turbine uses ambient air to ventilate; supplemental oxygen enriches the gas mixture. When battery drain is enabled, electrical charge limits operation.
| Settings | Load | Runtime |
|---|---|---|
PEEP 5, RR 12, PIP 20 | 1.02x | 54 min |
PEEP 10, RR 18, PIP 30 | 1.39x | 40 min |
PEEP 15, RR 24, PIP 40 | 1.82x | 30 min |
PEEP 20, RR 35, PIP 50 | 2.46x | 22 min |
Battery limits and exchange
On the panel, open MENU > ADV. SETTINGS > BRIGHTNESS and use the dial. This changes the device display independently of the wiki’s night control.
| Panel level | Configured display output | Behavior |
|---|---|---|
1 / Night | 5.5% | Very dim without goggles. The configured output becomes 85% under image intensifiers. |
2 | 45% | Reduced brightness |
3 | 72% | Startup default |
4 | 100% | Full brightness |
In gameBrightness and alarm volume
These percentages are game display multipliers. Selecting night brightness also lowers alarm volume once; the volume can then be adjusted separately.
InventoryHow the unit reads in your kit. 22kg empty, 40kg with a battery
BootShown while it starts. Replays if the unit is moved or reloaded
AlarmOpens the alarm window. Carries the active count
SilencedAudible muted, the alarm itself is still active
GraphsPressure and flow traces
BreathOne breath at the current settings
MenuStop vent, new patient, adv. settings
ConfirmCommits the value under the dial
CancelDrops the edit and leaves the value alone
BackPrevious screen in the setup sequence
HomeStraight back to LIVE
NextAdvances once the current screen is satisfied
On batteryDraining. Fill shows what is left
PluggedOn vehicle power, drain stopped
ChargingRefilling. Full from empty in about 90 minGame mechanics checked against ACM Extended source 4848f63. The injury cards are guide starting points; explicitly labeled defaults can change with mission settings. Delivery and injury · Mode settings · Shunt and oxygen · Power · Display configuration
Inspired/expired volume terminology checked at ACM Extended 21f8694: VTi, VTe, leak and delivered minute ventilation. Earlier game mechanics references retain their stated revisions.