Aldonga ED Tutes and Tips

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Ventilation in asthma

Slide show from session on ventilating in asthma.

Ventilating asthmatics


1. Low respiratory rate 6-10/min.

2. Tolerate hypercapnia and consequent respiratory acidosis to > 7.1

3. Maximise I:E ratio – 1:4 – 1:5

4. Reduce your inspiratory time by increasing your flow – 80-90 L/min if you can

5. Watch you plateau pressure NOT your peak inspiratory pressure – aim <30

6. Reduce FiO2 to achieve sats >90%

7. ZEEP – zero PEEP – see the accompanying article for more information

image of CC 2005 ventilation in severe asthma- clinical review CC 2005

Difficult airways – remember ‘THE VORTEX’

Following on from teaching this week – follow the link for more information on  ‘the Vortex’.

A new ‘algorithm’ for managing an airway during RSI for managing unanticipated difficult airway.

vortex image

From The Vortex Approach by Nicholas Chrimes and Peter Fritz

Blood Gas tutorial

Use and utility of VBG in the ED

Here is a tute from last week on why we use a VBG in the ED rather than an ABG, how to analyse it and a few unworked examples.

Feel free to post your answers.

24 year old male with shortness of breath


This young man presents with a short history of dyspnoea but no pain. Observations are normal.

How is optimally managed?

He gets referred to the surgical team – how do they manage him?