What would you have done?

[usalsfyre]

My only thought is why wasn't NTG at least tried, esp given the hx of CHF and CRF, crackles in the bases, mottling and air hunger. When you had the status change after movement I would have been throwing NTG at this guy. High dose NTG can VERY often save a tube/bridge to BiPAP. Just by chance, was he dangling his legs off something on arrival?

I don't disagree with the tube when you did it, but I think suboptimal management earlier in the call led to that point.

 

[Darrell]

I'm going to assume he's alive. Because of you.

You did your job to the best of your ability at that moment in time.

 

[usafmedic45]

I'm going to assume he's alive. Because of you.

That seems to be the gist of most of her posts.

 

[firetender]

Please file under...

That seems to be the gist of most of her posts.

...non-productive comment setting up future conflict.

 

[usafmedic45]

...non-productive comment setting up future conflict.

I really don't want to have conflict with her. It's a lot like beating my head against a brick wall: nothing meaningful is accomplished and it leaves me with a headache.

 

[AZnativeOne]

I would have sedated and intubated the pt.

 

[sihi]

Depends on if there is really an indication for it. His ETCO2/PaCO2 being elevated (and therefore his being acidotic) is not one. In fact, giving bicarbonate in that situation would possibly be a bad idea. The fix for acidosis due to respiratory failure is to ventilate the patient to "blow off" the CO2.

I said normooxemia + bicarbonate. Ofcourse NaBic without adequate ventilation would worse condition. Patiend must be intubated and mechanically ventilated.

 

[Simusid]

Just by chance, was he dangling his legs off something on arrival?

I'm a stupid newbie basic. Can you elaborate on this part for me?

 

[Farmer2DO]

Sat 93% is not so dramatic, it can by psychical probl.

Thanks hyperventilation his PaCO2 might became low - maybe this was a cause.
As I understand there wasnt episode of apnoe? Maybe unvisible convulsions?

I would intbate him if Sat would fall <90%

Have you ever heard the term treat teh PATIENT AND NOT THE MONITOR! His sats were 93% ON A NON-REBREATHER and he became unresponsive with gasping respirations from respiratory failure. I am going to repeat myself TREAT THE PATIENT AND NOT THE OXYGEN SATURATION MACHINE!!! and his end tidal CO2 was in the 70s!!

Happy

Can I just say that your posts come off as really self-righteous and rather obnoxious? Replying in all caps signifies yelling, and it appears that you are scolding a petulant 6 year old. Again, if you don't want to reply in a polite, professional manner, why ask at all?

That seems to be the gist of most of her posts.

...non-productive comment setting up future conflict.

Sorry, I have to agree with USAFMedic45 on this one. He's not the one who posted a scenario asking for input, then blasted someone (for who it appears English isn't even the first language, and probably uses different units than we do), responding to them like they were a child, and being the first one to actually start the non-productive comments. Perhaps an apology from her to Sihi would be appropriate?

Just my thoughts. I don't think USAFMedic45 is the bad guy here.

 

[firetender]

Just my thoughts. I don't think USAFMedic45 is the bad guy here.

No such thing as "bad guy" here. It' simply a request for course correction.

 

[MediMike]

my only thought is why wasn't ntg at least tried, esp given the hx of chf and crf, crackles in the bases, mottling and air hunger. When you had the status change after movement i would have been throwing ntg at this guy. High dose ntg can very often save a tube/bridge to bipap. Just by chance, was he dangling his legs off something on arrival?

I don't disagree with the tube when you did it, but i think suboptimal management earlier in the call led to that point.

(+1)

 

[squrt29batt12]

i think you did very well given the circumstances. tube was needed and if anything, the fact you tubed enabled you to give ppv and possibly push in some of that fluid from the bases

 

[usalsfyre]

PPV does a very poor job of moving fluid out of the alveoli, without PEEP the minimal amount of fluid moved will simply flow back in when the positive pressure subsides.

It's much better to reduce the hydrostatic pressure behind the fluid that's causing fluid to leak through the membranes in the first place.