Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Acid-Base Disturbances: An Emergency Department Approach right.
Case Presentation: Ventilator Management of Adult Patients in the Emergency Department
Your very first patient is wheeled into the resuscitation bay as you are walking through the doors to start your shift. A 30-year-old woman (5?3? tall, 120 kg) is in respiratory failure from an acute asthma exacerbation and requires a crash airway despite your best efforts to avoid endotracheal intubation. After intubation, the respiratory therapist asks for initial ventilator settings. You recall that these patients are at risk for breath-stacking and you start to devise your ventilator strategy…
The 30-year-old woman was intubated for her acute asthma exacerbation. You noted that her PBW was 52 kg for her height of 5’3″, and based on this weight, you set the tidal volume at 312 mL at 6 mL/kg (volume mode). You started initially at a low respiratory rate of 10 breaths/min and watched closely for breath-stacking. You confirmed that the flow went to zero at the end of each breath, and with intensive treatment, you slowly increased the respiratory rate. The peak pressures remained high due to bronchospasm, but you checked a plateau pressure, which was normal. The patient was extubated uneventfully 2 days later.