Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update - $49.00
Publication Date: January 2017 (Volume 19, Number 2)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits.
Excerpt From This Issue
Just as you are able to sit down for the first time in hours in the ED, a colleague walks by and says, “I don’t know what’s going on with your new patient, but she doesn’t look good.” You hurry to find a frail, elderly woman sitting upright, mouth agape. She is tachypneic, with a respiratory rate of 40 breaths/min, and is using accessory respiratory muscles. According to EMS, her pulse oximetry reading improved from 67% on 2-L nasal cannula to 80% on a 15-L nonrebreather mask. She has virtually no breath sounds on lung auscultation except for occasional faint wheezing. You initiate bilevel noninvasive ventilation (NIV), and inline continuous nebulizer treatments are started. The respiratory therapist suggests endotracheal intubation, and you suspect that extubation in the ICU will be difficult, further along the treatment course. As the respiratory therapist sets the bilevel NIV at a PIP 12 over PEEP 5, she asks you, “What parameters would make you decide to proceed with endotracheal intubation?”