Aldonga ED Tutes and Tips

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Ventilation in asthma

Slide show from session on ventilating in asthma.

Ventilating asthmatics

Essentials:

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

https://www.smashwords.com/extreader/read/277513/1/the-vortex-approach-management-of-the-unanticipated-difficult-airway

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

IMG_0644PA CXR

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?