2020-07-06-noon-conference.md (1996B)
1 # Acute respiratory failure (most of this in Vandy handbook) 2 3 ## Modes of oxygen 4 5 - NC - up to ~6L, ~40% FiO2 6 - HFNC - up to ~15L, 80% FiO2 7 - Venti mask - not used often, controlled with attachable and switchable filters 8 - Non-rebreather - up to ~100% FiO2, turn flow up all the way, fill up reservoir first then apply 9 - bipap - usu ICU, careful with aspiration risk, can adjust insp/exp pressures, up to 100% FiO2 10 - optiflow - up to 60L, 100% FiO2, usu ICU 11 12 ## Get help 13 14 - Esp if res-interning, don't hesitate to call/ask nurse to call Rapid Response Team (1-1111) 15 16 ## Differential 17 18 (pt with known COPD desatting) 19 20 - Most likely: COPD; other most common: CHF; must not miss: PE 21 22 ## Order 23 24 - CXR, EKG, trop, BNP 25 - bipap (not available on regular nursing floors), duonebs, lasix 26 27 28 ## COPD exacerbation 29 30 - fairly algorithmic: 31 - bipap 32 - O2 for sat 90-94%, or >88% if on O2 at home 33 - Prednisone 40mg x 5d 34 - Albuterol/ipatropium q4-q6 35 - abx 36 37 38 ## LASIX 39 40 - feel free to give big push (e.g. 160) of lasix if any concern for volume overload 41 - even if AKI - oxygenation takes priority, can rehydrate kidneys later 42 43 ## Anaphylaxis 44 45 - call RRT (have friends - pt can need intubation, etc.) 46 - 0.3mg of 1mg/ml IM epinephrine (on crash carts) (if not responding, put on drip) 47 - O2 48 - stop offending meds/infusions 49 50 51 ## PE 52 53 - ddx: PE, pneumonia, STEMI, PTX (hence EKG, CTA or CXR if can't get CTA quickly, trop, BNP) 54 - if AKI: can get VQ scan instead of CTA, but if suspicion is high start treating 55 - massive (+hypotension): catheter-directed thrombolysis 56 - submassive (normotensive, RV dysfxn + inc trop or BNP): heparin gtt or lovenox (preferred if possible - therapeutic more quickly with less futzing) 57 58 ## Afib w RVR 59 60 - HR >120 and stable: IV metop 5mg (up to 3x @ 5min intervals) or dilt (avoid if reduced EF, and often don't know, so usu metop) 61 - HR <120 and stable: oral metop tartrate 25mg 62 - unstable: cardioversion 63 - also something about amio drip that I missed, usu done in MICU/CCU