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Ventilator Management of Adult Patients in the Emergency Department
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Publication Date: July 2020 (Volume 22, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 7/01/2023.

Author

Ryan Pedigo, MD
Director, Medical Student Education, Harbor-UCLA Medical Center; Assistant Professor of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

Peer Reviewers

William A. Knight, IV, MD, FACEP, FNCS
Associate Professor of Emergency Medicine and Neurosurgery, Medical Director, EM Advanced Practice Provider Program; Associate Medical Director, Neuroscience ICU, University of Cincinnati, Cincinnati, OH
Charles Stewart, MD, EMDM, MPH
Emergency Physician; Tulsa, OK; Visiting Professor, European Master Disaster Medicine Program

Abstract

There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. An update on managing COVID-19-associated acute respiratory distress syndrome is also included.

Excerpt From This Issue

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...

Halfway into your shift, a 21-year-old man with type 1 diabetes mellitus presents, obtunded, with Kussmaul breathing. You start your standard resuscitation, but the patient requires endotracheal intubation, as he is unresponsive to all stimuli. You consider whether you should use the bag-valve mask during the apneic period during rapid sequence intubation...

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