cache
Forum Guru
Topics: 130
Posts: 275
|
a man with COPD has an infective exacerbation and recd 28% oxygen. he became drowsy and the ABG was Pa CO2 61, Pa O2 68. what should be the initial management be?
a. immediate intubation and ventilation
b. decrease the O2 and repeat assessment / ABG 30mts later
c. give immed antibiotic cover against gram negative
d. give higher oxygen concentrations
e. start an Aminophylline IV infusion
|
| dr.shar
Forum Elite
Topics: 38
Posts: 236
|
a. immediate intubation and ventilation
|
| tuesday
Forum Senior
Topics: 7
Posts: 207
|
A- airway first
|
| tasneembanu
Forum Guru
Topics: 96
Posts: 545
|
D- to give higher percentage O2
|
| dimps
Forum Guru
Topics: 63
Posts: 446
|
Is it C
___________________
hi how r u
|
| dimps
Forum Guru
Topics: 63
Posts: 446
|
Is it C
___________________
hi how r u
|
| merrk
Forum Elite
Topics: 27
Posts: 280
|
B.
COPDers depend on their hypoxic drive. Lower the O2 to 24%
Indications for Intubation and ventilation are:
cannot protect airway (unconscious)
xcessive work of breathing
paO2 <55 despite suppl O2
progrgressive acidosis: pCO2 > 50, pH <7.3
RR >35
___________________
It is not your aptitude but your attitude that determines your altitude in life
|
| daira
Forum Senior
Topics: 29
Posts: 138
|
right, the pt is hypoventilating and retaining CO2, so dec O2 is first step. others may be done later.
___________________
Roz barhta hoon jahan se aagey
lout kar phir waheen aa jata hoon
baaraha tor chuka hoon jinko
phir unhin dewaroon se takrata hoon...
|
| Dot
Forum Senior
Topics: 1
Posts: 168
|
:shock: go for option A if u wanna safe patient
___________________
have fun
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
either b or c?
|
| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
|
I d go for decrease O2 and reassessment in 30 min. As Merrk described, this pt does not fit in to intubation profile...only pO2 limit is 50 despite O2 provision.
___________________
"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson
|
| luckiest
Forum Senior
Topics: 12
Posts: 82
|
I think the patient has ventilatory failure ,so should
we intubate?
I agree with decrease O2 too but how can we be so sure the patient has CO2narcosis?
The q doesn't give RR ,the CO2 trapping could happen in COPD patien too?may be not from hypoventilate.
|
| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
|
Vent failure defined as PCO2 of over 50.
___________________
"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson
|
| vermdocamit
Forum Newbie
Topics: 1
Posts: 23
|
Drowsy is the keyword here.
CO2 retention + infection ------> needs intubation and ventilation
___________________
<---- Jump first ----then think.----->
|
| md2besoon
Forum Elite
Topics: 33
Posts: 228
|
this patient is in respiratory failure (PCO2>50 mm Hg), and first step is 24-28% oxygen by nasal canula or mask. 1st indication for tracheal intubation is hypoxemia despite supplemental oxygen, so in this case
---> intubation and ventilation
___________________
Service to others is the rent that you pay for your room here on earth.
|
| miky
Forum Senior
Topics: 16
Posts: 99
|
I'd like to remind you that the mith of giving low conc O2 to a pt. with COPD is no longer standing up. It has been proven that the pts with COPD must be given O2 in the same conc as in any pt with acute resp. failure.
Reason: if you give low conc O2 in a pts who is already severely hypoxemic, you will not increase the chances of a better oxygenation of the tissues. Remember that the PO2 of pts with long-standing COPD is commonly 50-55. In case these pts develop acute RF (of any cause), the PO2 can dangerously drop to 30-40 with impending respiratory arrest. So, if you give these pts low conc O2, you will deprive the pt. of O2 necessary for tissue survival hence you will not significantly increase the chances of recovery.
The theory stating that you will remove the chronic drive for ventilation in pts with COPD by giving high O2 conc is no longer accepted. Please consult up-to-date medical references for a better understaning of this.
Hope it helped.
___________________
always happy and ready to serve and help my friends and patients as well.
|
|
| |
| | | | | | | | | | | | | | | | |
