Hey so had a kinda interesting call today where i second guessed myself and wanted to share i guess.
80 something yo f, A&0X4 GCS15 transfer for +Flu, CHF new onset, NSTEMI , Pneumonia. pt came in originallly for difficulty breathing, transfer for higher level of care. in er pt decomps on NRB @ 15lpm and placed on bipap at like 7mm/h20.
Placed pt on cpap at 10lpm or about 8mm/h20, She tolerates fine. BP maintains in 130's roughly. Sinus in 80's to 90's.sp02 ranges from 94 to 96% at best. pt is just chilling with no pain, resp complaints. Skins pink/warm/dry with cap refill about 2 seconds, No labored breathing. She IS tachypnic in high 20's to low 30's but this is baseline since picking her up. Pt has NO complaints of breathing while on mask.....When pt has to transfer off mask she'll immediately decomp to Low 80's SP02 but aside from this she's FINE.
I check an ETC02 and she's acidotic from the get go at around 15 to 20 the whole time......
So i treated the pt and not the monitor.....she maintained find at the rate of cpap she was on and checked her frequently, all vitals maintained and she has no complaints. Even though she's tachypnic theres no accessory muscle use and she even starts sleeping near end of transport.
Who here would have increased cpap to a max setting? Or done something differently to try to lower her resp rate and hopefully her acidotic nature? Or would increasing the cpap rate of even DONE anything except possibly tank her bp? guess im just looking for some reassurance. Lol.
80 something yo f, A&0X4 GCS15 transfer for +Flu, CHF new onset, NSTEMI , Pneumonia. pt came in originallly for difficulty breathing, transfer for higher level of care. in er pt decomps on NRB @ 15lpm and placed on bipap at like 7mm/h20.
Placed pt on cpap at 10lpm or about 8mm/h20, She tolerates fine. BP maintains in 130's roughly. Sinus in 80's to 90's.sp02 ranges from 94 to 96% at best. pt is just chilling with no pain, resp complaints. Skins pink/warm/dry with cap refill about 2 seconds, No labored breathing. She IS tachypnic in high 20's to low 30's but this is baseline since picking her up. Pt has NO complaints of breathing while on mask.....When pt has to transfer off mask she'll immediately decomp to Low 80's SP02 but aside from this she's FINE.
I check an ETC02 and she's acidotic from the get go at around 15 to 20 the whole time......
So i treated the pt and not the monitor.....she maintained find at the rate of cpap she was on and checked her frequently, all vitals maintained and she has no complaints. Even though she's tachypnic theres no accessory muscle use and she even starts sleeping near end of transport.
Who here would have increased cpap to a max setting? Or done something differently to try to lower her resp rate and hopefully her acidotic nature? Or would increasing the cpap rate of even DONE anything except possibly tank her bp? guess im just looking for some reassurance. Lol.