Comments on: EMCrit Podcast 3-Intubating the patient with Severe Metabolic Acidosis http://emcrit.org/podcasts/tube-severe-acidosis/ Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 17 May 2012 06:35:19 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: emcrit http://emcrit.org/podcasts/tube-severe-acidosis/#comment-6842 emcrit Mon, 16 Jan 2012 01:55:05 +0000 http://emcrit.org/?p=37#comment-6842 You absolutely can, but you are balancing additional breath-induced gastric insufflation with the need to keep down CO2. You can make a determination on a per-patient basis. You absolutely can, but you are balancing additional breath-induced gastric insufflation with the need to keep down CO2. You can make a determination on a per-patient basis.

]]> By: rich http://emcrit.org/podcasts/tube-severe-acidosis/#comment-6828 rich Sun, 15 Jan 2012 07:03:56 +0000 http://emcrit.org/?p=37#comment-6828 Hey Scott, Very cool concept! One question ....any attempts in the past taking the rate beyond 12 during the "pseudo NIV" phase??? thanks!! Hey Scott,

Very cool concept! One question ….any attempts in the past taking the rate beyond 12 during the “pseudo NIV” phase???

thanks!!

]]> By: emcrit http://emcrit.org/podcasts/tube-severe-acidosis/#comment-6821 emcrit Sat, 14 Jan 2012 19:06:36 +0000 http://emcrit.org/?p=37#comment-6821 BVM is almost always a flail. BVM at high rates is just plain dangerous. PRVC would be fine but it is a more complex mode than straight SIMV, and I try to keep vent stuff as easy as possible. There will be no inherent advantage to PRVC. BVM is almost always a flail. BVM at high rates is just plain dangerous. PRVC would be fine but it is a more complex mode than straight SIMV, and I try to keep vent stuff as easy as possible. There will be no inherent advantage to PRVC.

]]> By: Scott Weingart http://emcrit.org/podcasts/tube-severe-acidosis/#comment-6778 Scott Weingart Fri, 13 Jan 2012 23:54:14 +0000 http://emcrit.org/?p=37#comment-6778 Scott- We discussed this recently and the question of why SIMV came up? Could you explain your take on SIMV vs. PRVC or even BVM in this situation? Thanks! Scott-

We discussed this recently and the question of why SIMV came up? Could you explain your take on SIMV vs. PRVC or even BVM in this situation?

Thanks!

]]> By: emcrit http://emcrit.org/podcasts/tube-severe-acidosis/#comment-3620 emcrit Mon, 27 Dec 2010 00:19:47 +0000 http://emcrit.org/?p=37#comment-3620 Mike only disadvantage is the patient may not tolerate the machine breaths, otherwise no problem. i don't generally use simv once the pt is intubated, my take on vent management is in two of the later podcasts. just search the site for "dominating the vent." Scott Mike

only disadvantage is the patient may not tolerate the machine breaths, otherwise no problem. i don’t generally use simv once the pt is intubated, my take on vent management is in two of the later podcasts. just search the site for “dominating the vent.”

Scott

]]> By: Mike http://emcrit.org/podcasts/tube-severe-acidosis/#comment-3619 Mike Sun, 26 Dec 2010 21:51:55 +0000 http://emcrit.org/?p=37#comment-3619 Great podcast, and I really like the idea of using a regular ventilator in a non-invasive way. Occasionally, I have two or more people requiring BiPap at the same time with only one BiPap machine available. What would the disadvantage of setting the initial respiratory rate to 12 breaths per minute using the NIV mask and using this to pre-oxygenate the patient? Certainly the SIMV mode would allow spontaneous breaths, and you wouldn't have to remember to change the rate once you've paralyzed the patient. Also, do you generally leave the vent mode on SIMV once the patient is intubated, with the settings you mentioned above? Thanks! Great podcast, and I really like the idea of using a regular ventilator in a non-invasive way. Occasionally, I have two or more people requiring BiPap at the same time with only one BiPap machine available.

What would the disadvantage of setting the initial respiratory rate to 12 breaths per minute using the NIV mask and using this to pre-oxygenate the patient? Certainly the SIMV mode would allow spontaneous breaths, and you wouldn’t have to remember to change the rate once you’ve paralyzed the patient.

Also, do you generally leave the vent mode on SIMV once the patient is intubated, with the settings you mentioned above?

Thanks!

]]> By: emcrit http://emcrit.org/podcasts/tube-severe-acidosis/#comment-517 emcrit Sat, 16 Jan 2010 22:07:38 +0000 http://emcrit.org/?p=37#comment-517 You can definitely manage without quantitative, in which case you just have to go by the 240 ml/kg/min, which translates to 30 breaths per minute if you set the tidal volume to 8 ml/kg. Just make sure to get the post-tube abg with alacrity. You can definitely manage without quantitative, in which case you just have to go by the 240 ml/kg/min, which translates to 30 breaths per minute if you set the tidal volume to 8 ml/kg. Just make sure to get the post-tube abg with alacrity.

]]> By: Stand http://emcrit.org/podcasts/tube-severe-acidosis/#comment-513 Stand Fri, 15 Jan 2010 06:43:36 +0000 http://emcrit.org/?p=37#comment-513 It would be interesting to have this great approach modified if ED has no quantitative ETCO2. Thanks. It would be interesting to have this great approach modified if ED has no quantitative ETCO2. Thanks.

]]> By: JamesD http://emcrit.org/podcasts/tube-severe-acidosis/#comment-11 JamesD Thu, 11 Jun 2009 09:23:13 +0000 http://emcrit.org/?p=37#comment-11 Thanks for the useful info. It's so interesting Thanks for the useful info. It’s so interesting

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