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Common Respiratory Problems
In Children
Common Respiratory Problems
In Children
4 months old 4 months old
One day history of One day history of excessive cryingexcessive crying
Sent home with the Sent home with the diagnosis of windy diagnosis of windy colic with anti-colic with anti-spasmodicsspasmodics
Next day:Next day:– Grunting, respiratory Grunting, respiratory
distress, fever.distress, fever.– Admitted ,oxygen, IV Admitted ,oxygen, IV
ceftriaxone.ceftriaxone.
Case 1:
Case (contd)Case (contd)
Second day:Second day:– Mother felt better but Mother felt better but
continues to be continues to be tachypnoeic, chest tachypnoeic, chest indrawing, fever indrawing, fever persisting.persisting.
– Vancomycin added Vancomycin added with oxygenwith oxygen
Case (contd)Case (contd)
Third dayThird day– Severe respiratory Severe respiratory
distressdistress– Pus drained through water Pus drained through water
seal drainageseal drainage– Antibiotics contd.Antibiotics contd.– Discharged after 2 wk.Discharged after 2 wk.
Strepto.pneumoniae isolated
16 month old boy with wheeze
Initial Vitals: HR 160 RR 60
BP 88/50Temp 38O2sat on RA 89%
Case 2
You do your pediatric triage
Appearance Crying, distressed, lookingaround, moving all 4 limbs
Breathing (work of) Laboured, chest caving in, +++indrawing
Circulation Colour OK, N cap refill
What would you like to do now?
Oxygen by mask applied, IV attempt started and pt now on cardiac monitor
Airway No stridor audible, no obvious secretions
Breathing +++ wheeze with little air entry bilat(inspiratory AND expiratory)
Circulation Warm extrem, PPP, cap refill 2 secs
What would you like to do now?
Oxygen Salbutamol nebulizerIV Access established – orders?
CXR done / pending
ABG report
Venous Gas pH 7.35pCO2 38pO2 125
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
History:
Has had a “cold” for almost 2 days now(mild fever, decreased energy / appetite with cough
and runny nose) Started getting wheezy this morning No history of exposure to allergens, inhalants
or FB aspiration
Family History of Asthma / no smokers / no petsOtherwise healthy with no known allergies
Continuous Salbutamol nebulizer for 15 mins has little effect
Still indrawing RR 65 Still alert and looking around, crying
Additional treatment?
IV steroids Methylprednisolone 1 mg/kg IV / IMContinue SalbutamolConsider racemic Epinephrine (0.5 mls)
Repeat Venous Gas about 30 mins laterpH 7.15pCO2 55pO2 120
Eyes rolling back, little crying now …
What do you want to do?
Drugs? Tube Size?
Ketamine 1-2 mg/kg IV Atropine 0.01 mg/kg IV (min 0.1 mg)Succinyl 1 mg/kg IV
4 – 4.5 tube
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
Other Options
IV Magnesium 25 mg/kg (max 2 gm)
IV Epinephrine
IV Salbutamol
Inhalational Anesthetics
Methylxanthines
Heli - Ox
Differential Diagnosis of Wheezing
H + N Vocal cord dysfunction
Chest AsthmaBronchiolitis Foreign Body Aspiration
CVS Congestive Heart FailureVascular Rings
Pediatric Asthma Guidelines
MILD• Nocturnal cough• Exertional SOB• Increased Salbutamol use • Good response to Salbutamol
O2 sat > 95%PEF > 75% (predicted / personal best)
± O2SalbutamolConsider po Steroids
Symptoms
Pre - Treat
Treatment
MODERATE• Normal mental status• Abbreviated speech• SOB at rest• Partial relief with Salbutamol and required > than q 4h
O2 sat 92%-95%PEF 50-75% (predicted / personal best)
O2 100%SalbutamolSystemic corticosteroidsConsider anticholinergic
Symptoms
Pre - Treat
Treatment
Pediatric Asthma Guidelines
Asthma Guidelines SEVERE• Altered mental status• Difficulty speaking• Laboured respirations• Persistant tachycardia• No prehospital relief with usual dose Salbutamol
O2 saturation <92%PEF, FEV1 <50%
100% O2Continuous or frequent b-agonistsSystemic corticosteroids & magnesium sulfateConsider anticholinergic & / or methylxanthines
Symptoms
Pre - Treat
Treatment
Asthma Guidelines
Symptoms
Pre - Treat
Treatment
NEAR DEATH• Exhausted , Confused• Diaphoretic• Cyanotic, Decreased respiratory effort, APNEA• Falling heart rate
O2 saturation <80% (spirometry not indicated)
As above PLUS
IV SalbutamolInhalational anesthetic, aminophyllineEpinephrine
18 mo Girl with 24 hr Hx of coughing with drooling
Hx: Has had an URTI for about a week and was getting mildly better until yesterday. She developed a fever and the cough got harsher.
Still drinking but not interested in solids
Vomited once last night
Started drooling this morning
CASE 3
T39.1 degrees rectally, P170, R28, BP 100/66
Appearance alert, awake, not toxic, in no acute distressDid not appear to prefer upright or a forward leaning position
EENT Moist MM, slight erythema of oropharynx, nasal crusting, N TMs, no rash / petechiae, no droolingSupple neck
Chest Clear when restingMild inspiratory stridor with crying
Rest of the exam N
Physical Exam
DDx?
• Croup• Epiglottitis• Bacterial tracheitis• RetroPharygeal abcess• Foreign Body aspiration
Other things on DDx of Inspiratory Stridor
Laryngeal WebTEFDiptheriaAirway thermal injurySubglottic stenosisPeritonsillar abcessGERDEsophageal FBLaryngeal fractureLaryngeal cystLymphoma
Soft tissue lateral neck radiograph
Lymph nodes between the posterior pharyngeal wall and the prevertebral fascia
• gone by 3 – 4 yrs of life• drain portions of the nasopharynx and the posterior
nasal passages• may become infected and progress to breakdown of the nodes and to suppuration
Retropharyngeal Abscess
ETIOLOGY
Complication of bacterial pharyngitisLess frequently - extension of infection from vertebral osteomyelitis
Group A hemolytic streptococci, oral anaerobes, and S. aureus
Recent or current history of an acute URTI
Abrupt onset:
High fever with difficulty in swallowing
Refusal of feeding
Severe distress with throat pain
Hyperextension of the head
Noisy, often gurgling respirations
Drooling
Typically …
Soft Tissue Neck Film
Patient position – MILD EXTENSION
Positive Film - Retropharyngeal soft tissue > ½ the width of the adjacent vertebral body - may see air in the retropharynx
On Exam …
Nasopharynx Bulging forward of the soft palate and nasal obstruction
Oropharynx Bulging of posterior phyaryngeal wallor
Not visualized
Complications
Abscess rupture - aspiration of pus.
Lateral extension - present externally on the side of the neck
Dissection along fascial planes into the mediastinum
Death may occur with aspiration, airway obstruction, erosion into major blood vessels, or mediastinitis.
Treatment
Ceftriaxone 75mg/kg/day/divided Q 12 hrlyClindamycin 20-30 mg/kg/day divided Q8H (if pre-fluctuant phase)
Decadron 0.6 mg/kg
Airway management
Surgical decompression
17 month old male with a one-hour history of noisy and abnormal breathing
Normal now but at the time, parents thought he was quite distressed.
Now, he is able to speak and drink fluids without difficulty
CASE 4
VS T36.8, P200 (crying), R28 (crying), O2 sat 99%
Alert with no signs of respiratory distressAble to speak, had no cyanosis, no drooling,
no dyspnea
H+N No obvious swelling, bleeding, FB seen
Chest Mild wheezing with ? mild inspiratory stridor
What would you like to do now???
Soft TissueNeck View
CXR (PA)
Next?
ExpiratoryCXR
Inspiratory View Expiratory View
Right DecubView
Foreign Body Aspiration
More common with food than toys
Highest risk between 1 and 3 years old(immature dentition – no molars, poor food control)
Common foods = peanuts, grapes, hard candies
Some foods swell with prolonged aspiration(may even sprout)
Clinical Manifestations
Typically …Acute respiratory distress (now resolved or ongoing)
Witnessed choking period
Uncommonly …Cyanosis and resp arrest
Symptoms: cough, gag, stridor, wheeze, drool, muffled voice
Investigations
Xrays Lateral neck Chest – inspiratory, expiratory, decubitus views
Expiratory views
Overinflation (partial obstruction with inspiratory flow)
Volume loss with mediastinal shift towards obstructed side (partial obstruction with expiratory flow)
Atelectasis (complete obstruction)
Decubitus views
Normal Smaller volumes and elevated diaphragmon side down
Abnormal Hyperinflation or “normal” volumes indecub position
If suspected …Need a bronchoscope to rule out or
remove Foreign Body
CASE 5
2 yo Boy with Barky Cough for 2 days
Runny nose, decreased appetite Not himself
No PMHx / FHx of significanceShots UTD
Other sibs with similar URTIs
Temp 38.9HR 140O2 sat 98% (drops to 90% when he crys)RR 40 (mild indrawing)
On Exam …
Irritable, crying, good colour
H & N sl erythema of throat, no pusN TMs, small cervical nodes
Chest Barky cough, inspiratory stridorNo wheeze noted
Diagnosis?
Racemic Epinephrine 0.5 ml dose
? Dexamethasone now or later
Re – Assess in 30 minutesNo improvement with 1st dose of epinephrine
What would you like to do now?
IV Ceftriaxone PLUS Cloxacillin Consult Pediatric ICU / Pulmonary
for Bronch / Intubation
Re – ExamineOngoing Inspiratory StridorCries when trachea is examined
Bacterial tracheitis
An acute bacterial infection of the upper airway capable of causing life-threatening airway obstruction
Staph aureus most commonly (parainfluenza, Moraxella catarrhalis, H. influenzae, anearobes)
Most pts less than 3 years old
Usually follows an URTI (esp laryngotracheitis)
Mucosal swelling at the level of the cricoid cartilage, complicated by copious thick, purulent secretions
Brassy cough
High fever
“Toxicity" with respiratory distress (may occur immediately or after a few days of
apparent improvement)
Failed response to CROUP TREATMENT(mist, intravenous fluid, racemic epinephrine)
CLINICAL MANIFESTATIONS
Antibiotics (good Staph coverage)
Intubation or tracheostomy is usually necessary
? Decadron
Treatment
Pediatric Pneumonia
Neonate Bacteria more frequentE. coli, Grp B strep, Listeria, Kleb
1 – 3 mo Chlamydia trachomatis (unique)Commonly viral (RSV, etc.)B. Pertussis
1 – 24 mo S. pneumonia, Chlamydia pneumMycoplasma pneumonia
2 – 5 yrs RSVStrep pneumonia, Mycoplasma, Chlam
Severe Pneumonia:
Staph aureusStrep pneumoniaGrp. A strepHIBMycoplasma pneumonia
Pseudomonas if recently hospitalized
History:
Infants < 3 months Tachypnea, cough, retractions, grunting, isolated fever or hypothermia, vomiting, poor feeding, irritability, or lethargy
As age increases, symptoms are more specific
Fever and chills, headacheCough or wheezingChest pain, abdominal distress,
neck pain and stiffness
Physical Exam
Tachypnea is the best single indicator of pneumonia
Age in months Upper limit of Normal RR
< 2 60
2-12 50
> 12 40
Treatment
Neonates Ampicillin + Gentamycin / Cefotaxime
1 – 3 mo Erythromycin 10 mg/kg IV Q6H
1 – 24 mo Cefuroxime 50 mg/kg IV Q8H (not ICU)Ceftriaxone 50-75 mg/kg IV Q24H and Cloxacillin 50 mg/kg IV Q6H (ICU)
3 mo – 5 yrs Ceftriaxone / Erythro Clarithro / Azithro (outpt Tx)
Respiratory Failure in Respiratory Failure in ChildrenChildren
Respiratory failure: where is the Respiratory failure: where is the defect?defect?
Ventilation
DiffusionPerfusion
Abnormal oxygen carrying capacity
failure of cellular oxygen uptake
Types of Respiratory FailureTypes of Respiratory Failure
Type I failure, also Type I failure, also known as known as normocapnic or normocapnic or non-ventilatory non-ventilatory failure, is indicated failure, is indicated by hypoxemia (low by hypoxemia (low pO2 ) with a normal pO2 ) with a normal or low pCO2. or low pCO2.
It is commonly due to It is commonly due to ventilation/perfusion ventilation/perfusion (V/Q) abnormalities. (V/Q) abnormalities. Other causes include: Other causes include: impaired diffusion impaired diffusion across the alveolar-across the alveolar-capillary membrane capillary membrane (as occurs with (as occurs with pulmonary fibrosis pulmonary fibrosis and shunting) and shunting)
Type II failure:Type II failure:
An elevated pCO2 An elevated pCO2 is the hallmark , is the hallmark , also known as also known as ventilatory or ventilatory or hypercapnic hypercapnic failure. failure.
It is generally the It is generally the result of alveolar result of alveolar hypoventilation, hypoventilation, increased dead space increased dead space ventilation, or ventilation, or increased CO2 increased CO2 production. Other production. Other causes are factors causes are factors that impair the central that impair the central ventilatory drive in the ventilatory drive in the brainstem, restrict brainstem, restrict ventilation, or ventilation, or increase CO2 increase CO2 production.production.
Causes of Type I FailureCauses of Type I Failure
V/Q abnormaltitiesV/Q abnormaltities– Pneumonia, meconium Pneumonia, meconium
aspiraton, Pulmonary aspiraton, Pulmonary oedema.oedema.
Cyanotic heart Cyanotic heart diseasediseaseDiffusion Diffusion abnormalitiesabnormalities– Interstitial fibrosisInterstitial fibrosis
Inadequate systemic Inadequate systemic blood flowblood flow– ShockShock
Inadequate oxygen Inadequate oxygen carrying capacitycarrying capacity– Severe anemia, Severe anemia,
methhemoglobinemiamethhemoglobinemia
Inadequate cellular Inadequate cellular uptake:uptake:– Cyanide poisioningCyanide poisioning
Type II Failure: alveolar Type II Failure: alveolar hypoventialtionhypoventialtion
Neuromuscular:Neuromuscular:– CNS disease, GB CNS disease, GB
Syndrome.Syndrome.
Respiratory muscle Respiratory muscle disordersdisorders– Muscular dystrophyMuscular dystrophy
Chest wall / pleura:Chest wall / pleura:– Pliable chest, Pliable chest,
pneumothorax, pleural pneumothorax, pleural effusioneffusion
Airway disorders:Airway disorders:– Croup.Croup.
Pulmonary diseasePulmonary disease– Bronchiolitis, Bronchiolitis,
pneumonia, asthmapneumonia, asthma
Increased CO2 Increased CO2 production:production:– Sepsis, fever, burnSepsis, fever, burn
In children, respiratory failure most often is In children, respiratory failure most often is due to diseases of the lungs.due to diseases of the lungs.
CNS disorders that lead to respiratory CNS disorders that lead to respiratory failure are:failure are:
Control abnormalities that cause Type II Control abnormalities that cause Type II (hypercapnic) respiratory failure and (hypercapnic) respiratory failure and usually present without signs and usually present without signs and symptoms of respiratory distress (such as symptoms of respiratory distress (such as dyspnea, retractions, or tachypnea dyspnea, retractions, or tachypnea
A 16-year-old female arrives in the ED after A 16-year-old female arrives in the ED after the SLC result. No other history is available the SLC result. No other history is available because the friends who brought him to the because the friends who brought him to the ED left.ED left.
The vital signs are:The vital signs are:
Temperature (T) = 96°F; Temperature (T) = 96°F;
Pulse (P) = 90 beats/min; Pulse (P) = 90 beats/min;
Respiratory rate (R)Respiratory rate (R) = 6 breaths/min; = 6 breaths/min;
Blood pressure (BP) =120/80 mmHg; and Blood pressure (BP) =120/80 mmHg; and
Pulse oxygen saturation is 76% on room air. Pulse oxygen saturation is 76% on room air.
Arterial blood gas Arterial blood gas (ABG) is: pH = 7.13; (ABG) is: pH = 7.13; pO2 = 52; pCO2 = 81; pO2 = 52; pCO2 = 81; HCO3 = 26; and HCO3 = 26; and oxygen saturation = oxygen saturation = 75% on room air.75% on room air.
Glasgow coma scale: 4.Glasgow coma scale: 4.
Shallow respiration.Shallow respiration.
Pinpoint pupil.Pinpoint pupil.
Lungs and heart are Lungs and heart are normalnormal
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
ProblemProblem
This patient has hypercapnia and hypoxia.This patient has hypercapnia and hypoxia.
Of the physiologic events in respiration, Of the physiologic events in respiration, diffusion, transport, and the tissue/cellular diffusion, transport, and the tissue/cellular uptake of oxygen are normal, but uptake of oxygen are normal, but ventilation is impaired. ventilation is impaired.
Pin point pupil points to the poisoning Pin point pupil points to the poisoning probably narcotic drug.probably narcotic drug.
An 8-year-old male muscular An 8-year-old male muscular dystrophydystrophy
Eamination reveals Eamination reveals rhinorrhea and excessive rhinorrhea and excessive secretions in the secretions in the oropharynx. oropharynx. There are scattered There are scattered rhonchi in the lungs rhonchi in the lungs bilaterally. There is no bilaterally. There is no cyanosis. cyanosis. The neurologic exam is The neurologic exam is consistent with his consistent with his diagnosis of muscular diagnosis of muscular dystrophy with muscle dystrophy with muscle weakness weakness
His vital signs are:His vital signs are:T = 100.2°F; T = 100.2°F; P = 120 beats/min; P = 120 beats/min; R = 12 breaths/min; and R = 12 breaths/min; and BP = 100/70 mmHg; and BP = 100/70 mmHg; and Weight = 20 kg. Weight = 20 kg.
The ABG is: pH = 7.17; The ABG is: pH = 7.17; pO2 = 46; pCO2 = 78; pO2 = 46; pCO2 = 78; HCO3 = 32; and O2 HCO3 = 32; and O2 saturation = 71% on saturation = 71% on room air. room air.
This patient has Type This patient has Type II hypercapnic II hypercapnic respiratory failure respiratory failure secondary to failure of secondary to failure of the respiratory the respiratory muscles from a muscles from a primary muscle primary muscle disorder. disorder.
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
A 4-month-old female with A 4-month-old female with breathing difficulties.breathing difficulties.
Her vital signs are:Her vital signs are:T = 103.5° F; T = 103.5° F; P = 190 beats/min; P = 190 beats/min; R = 64 breaths/min; R = 64 breaths/min; BP = 80/50 mmHg; and BP = 80/50 mmHg; and Pulse oxygen saturation = Pulse oxygen saturation = 82% in room air82% in room air
Prematurity (30 weeks), Prematurity (30 weeks), respiratory distress respiratory distress syndrome requiring a syndrome requiring a ventilator. She also had a ventilator. She also had a congenital congenital gastrointestinal problem gastrointestinal problem requiring surgery at 6 requiring surgery at 6 weeks of age and has weeks of age and has continued to have continued to have gastrointestinal problems. gastrointestinal problems. She has She has bronchopulmonary bronchopulmonary dysplasiadysplasia
Small for her age. Small for her age. Respiratory distress with Respiratory distress with retractions, grunting, retractions, grunting, flaring, head nodding. flaring, head nodding. Skin is pale, sweaty, and Skin is pale, sweaty, and cyanotic with delayed cyanotic with delayed capillary fill. There are capillary fill. There are rales in both lung fields. rales in both lung fields. The chest roentgenogram The chest roentgenogram shows diffuse bilateral shows diffuse bilateral infiltrates.infiltrates.
The ABG on room air The ABG on room air is: pH = 7.61; pO2 = is: pH = 7.61; pO2 = 56; pCO2 = 24; HCO3 56; pCO2 = 24; HCO3 = 27; and oxygen = 27; and oxygen saturation is 78%.saturation is 78%.
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
A 2-month-old is brought to the ED with A 2-month-old is brought to the ED with a chief complaint of not eating for a chief complaint of not eating for
several days. several days.
Vital signs are:Vital signs are:
T = 36.8°C (R); T = 36.8°C (R);
P = 180 beats/min; P = 180 beats/min;
R = 58 breaths/min R = 58 breaths/min
BP = 55/30 mmHg; BP = 55/30 mmHg; and and
Pulse oxygen Pulse oxygen saturation is 78% on saturation is 78% on room air. room air.
O/E tachypnea, O/E tachypnea, retractions, and retractions, and cyanosis. The lungs cyanosis. The lungs are clear. The heart is are clear. The heart is tachycardic with no tachycardic with no murmurs. The liver murmurs. The liver edge is down 2 cm. edge is down 2 cm. The abdomen is non-The abdomen is non-tender. There is no tender. There is no edema and no rash. edema and no rash.
ABG drawn on 100% ABG drawn on 100% FiO2 shows FiO2 shows essentially no change essentially no change from the room air from the room air blood gas: pH = 7.48; blood gas: pH = 7.48; pO2 = 64; pCO2 = 35; pO2 = 64; pCO2 = 35; HCO3 = 23; and O2 HCO3 = 23; and O2 saturation is 79%. saturation is 79%.
An initial ABG An initial ABG reveals: pH = 7.48; reveals: pH = 7.48; pO2 = 62; pCO2 = 34; pO2 = 62; pCO2 = 34; and HCO3 = 23.and HCO3 = 23.
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of
35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
A 5-year-old male is seen for a cough of A 5-year-old male is seen for a cough of
several days duration that is not improvingseveral days duration that is not improving
O/E: sitting up and O/E: sitting up and leaning forward. leaning forward. wheezing bilaterally. wheezing bilaterally. Tachypnic with Tachypnic with intercostal retractions. intercostal retractions. Three continuous Three continuous salbutamol aerosols salbutamol aerosols were given by were given by nebuliser. nebuliser.
Vital signs are:Vital signs are:
T = 96.8°F (O); T = 96.8°F (O);
P = 170 beats/min; P = 170 beats/min;
R = 44 breaths/min; R = 44 breaths/min; and and
Pulse oximetry is 94% Pulse oximetry is 94% on room air. on room air.
His lungs are clear, His lungs are clear, no wheeze or rales, no wheeze or rales, and no retractions. He and no retractions. He has dry mucous has dry mucous membranes and pale membranes and pale skin with tenting. skin with tenting.
Vital signs are now:Vital signs are now:
T = 96.8°F (O); T = 96.8°F (O);
P = 102 beats/min; P = 102 beats/min;
R = 16 breaths/min; R = 16 breaths/min;
BP = 65/40 mmHg; BP = 65/40 mmHg; and and
Pulse oxygen Pulse oxygen saturation = 86% on saturation = 86% on room air. room air.
First ABG ; pH = 7.52; First ABG ; pH = 7.52; pO2 = 58; pCO2 = 24; pO2 = 58; pCO2 = 24; HCO3 = 14; and HCO3 = 14; and oxygen saturation = oxygen saturation = 88% on room air. 88% on room air.
The second ABG The second ABG shows: pH = 7.12; shows: pH = 7.12; pO2 = 68; pCO2 = 70; pO2 = 68; pCO2 = 70; HCO3 = 14; and HCO3 = 14; and oxygen saturation is oxygen saturation is 90% on 100% FiO2.90% on 100% FiO2.
Normal ABG values are: pO2 of 80-100 mmHg; pCO2 of 35-45 mmHg; pH of 7.35-7.45; and SaO2 of 95-100%
Treatment: Acute Respiratory FailureTreatment: Acute Respiratory Failure
Hypoxemia is more dangerous than hypercarbia.Hypoxemia is more dangerous than hypercarbia.
Administration of supplemental oxygenAdministration of supplemental oxygen
Ventilatory supportVentilatory support
Extracorporial Membrane Oxygenation (ECMO)Extracorporial Membrane Oxygenation (ECMO)
Never use bicarbonates unless lung can exhale Never use bicarbonates unless lung can exhale