Pulmonary Emergencies

My “first 10 minute” approach to a sick patient with undifferentiated difficulty breathing is focused on rapidly finding the right therapy, but not necessarily on finding the right diagnosis. I find that this simplifies my thinking - Justin Morgenstern

Pulmonary Emergencies

image by: NIH National Heart, Lung and Blood Institute

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Crashing Patient on a Ventilator

A truism in resuscitation is to always rule out the easily correctable causes immediately. In this case, it means removing the complexity of the ventilator and making things as idiot-proof as possible. Once you’ve ruled out the life threats like pneumothorax, tube displacement, and vent malfunction, you can try to bring their sats up by bagging. Just make sure that you have an appropriately adjusted PEEP valve attached to your BVM for your ARDS patients; the patient who was just requiring a PEEP of 15 isn’t going to improve with you bagging away with a PEEP of 5.

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 Crashing Patient on a Ventilator

The frequency with which our ventilated patients stay with us in the ED has been increasing for years and will likely continue to do so1. This means that managing both acute decompensation and refractory hypoxemia needs to be in our wheelhouse.

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