March 24, 2023

Contributor: Aaron Lessen, MD

This is the emergency medical minute sponsored by mile high ambulance hey emm we are excited to announce that we are now accepting applications for our second annual diversity and inclusion award the award is eligible to fourth year med students identifying as underrepresented in medicine and are applying to em residencies we are extending three two hundred dollar

Awards to selected individuals following a blinded review of all applications applications will be accepted through the end of november with winners being announced mid-december check out our website at www.emergency edi dash award for all the details and to access the free application or you can click on the link in our show notes thank you all

Right good morning everybody so um over the last couple weeks i’ve had a couple of sick patients who were cardiac arrest from the field in bad asthma patients so i just want to talk for a minute about kind of ventilator management specifically and bad asthmatics from patients who have bad asthma or copd have really bad bronchospasm and they’re on a ventilator it

Presents a whole set of challenges that we really have to kind of pay attention to asthma is not usually a problem of you know oxygenation or getting air in it’s a problem of ventilation and getting air out sometimes when they’re on a ventilator it can be very hard to get both air in and out and it can cause several problems so the first thing is when you have

Somebody on event we need to pay attention to the ventilator setting sometimes they’re a little different than usual first thing is kind of slow respiratory rates kind of lower tidal volumes and you talk about lots of expiratory time to give them time to get their air out of their lungs the problems are you know if you don’t let let them get the air out and just

Kind of keep bagging and bagging and bagging their chests just kind of fill up with you know air what’s called hyperinflation and what it can cause is barotrauma which is things like a pneumothorax you can actually just pop their lungs from putting too much air in and not letting the air go out and then you can also get basically cardiovascular collapse you can

Get really bad hypotension or even cardiac arrest because if their lungs are super full of air then there’s not enough room basically for blood venus returns to come back to the heart and they can get you know super hypotensive or even go into cardiac arrest so the couple things to kind of pay attention to is it seems like it’s getting harder and their pressures

Are getting higher then we need to back off on the respiratory rate lower their tidal volume and it’s okay efficients aren’t you know setting 100 if they’re down 87 88 that’s okay if their pco2 is high that’s okay also we really need to slow down their respiratory rate and lower their volumes another thing that you can do is if you find that someone’s getting more

Hypotensive things seem like they’re getting worse it’s actually just disconnect them from either the bag or the ventilator kind of push on their chest and give it time lots of time sometimes like 30 seconds to get all the air out and that can sometimes make things better we need to pay attention if things suddenly get worse do they have a pneumothorax do they

Need a chest tube or something to pay attention to and then you know in addition to paying close attention to the ventilator we need to remember these patients still need lots of albuterol sometimes continuous albuterol atrovent over and over and over again steroids magnesium sometimes if everything we’re doing is not working we’ll do things like heliox or they’ll

Even put the patients on a general anesthesia circuit in the operating room sometimes that helps but the bottom line is you know we need to pay really close attention it’s not you know basically just to put them on a ventilator and forget about it um it’s actually you need to pay super close attention to these patients when they’re on a ventilator because they can

Get sicker and sicker even when they’re on a ventilator all right thanks guys we’d like to thank our sponsor health1 continental division and swedish medical center for their financial contributions to the emm donations from them and listeners like you make it possible for us to fulfill our mission of producing and spreading free medical education to the masses

If you enjoy our show please consider making a one-time or reoccurring donation to help cover our operational costs and keep the emm awesome click on the link in our show notes to make a donation thank you for listening

Transcribed from video
Podcast 816: Ventilator Management in Asthmatics By Emergency Medical Minute