Archive | March, 2016

EM PULMONOLOGY QUICK HITS

31 Mar

Submitted by Amit Kumar, M.D.

ABG vs VBG:

Due to the ease/lack of another stick, VBG often preferred and sufficient in ED.

Two main indications to get ABG for accurate results:

  • patient in severe shock,
  • VBG PCO2 >45mmHg

 

BPAP basics:

-EPAP = CPAP = PEEP

-IPAP = Pressure support (what makes BPAP > CPAP)
Respiratory Failure:

Type I respiratory failure:

  • O2 problem (hypoxia)
  • Ex: ARDS, pneumonia, pulmonary edema, CHF
  • Treatment: ? EPAP, start with FiO2 100%

Type 2 respiratory failure:

  • CO2 problem (hypercarbia)
  • Ex: COPD, asthma
  • Treatment: ? IPAP, may start with FiO2 ~40% (hypoxia not the problem)

 

Continuous EtCO2 uses in ED:

Definition: Partial pressure of CO2 in exhaled breath

-During procedural sedation: Measure of ventilation. Increase to >50mm Hg/>10mmHg from baseline usually indication of oncoming hypoxia (in theory, hypoventillation preceeds hypoxia)

-During CPR: Measure of cardiac output. <10 mmHg hints towards inadequate compressions –> switch. Sudden increase (to ~35-45 mmHg) is a sign of ROSC.

 

References:

EM: RAP (Resp Failure types)

http://www.alaskasleep.com/blog/what-is-bipap-therapy-machine-bilevel-positive-airway-pressure (BiPAP vs CPAP)

http://www.med.upenn.edu/emig/capnography%20for%20procedural%20sedation%20in%20the%20ED.pdf (EtCO2 + procedural sedation)

 

 

Advertisements