Search the Community

This is not a test, just looking for credible opinions. Obvioustlythere are a few things I would change. *Medication doses are non-negotiable* 78 Y/o COPD patient in bronchospasm. Grey looking, obvious distress. Home 02 at 4lt. Tripoding, 3 word sentences. Resp rate 34, BP160/90. HR120 SpO2 90% on NRB by first responders. EtC02 68 Been SOB for 5hrs Initial treatment *5mg salbutamol w/500mcg Atrovent *Dexamethasone 8mg IM *2gm MgS04 *500ml NaCl through 2 18G IV. No real improvement *Start 2nd Neb with same breathing treatment as before. *CPAP applied Reassess: After 5min of CPAP, pt improving. Color better, Sp02 97%, EtCo2 50. About this time the patient reaches up and breaks the CPAP port off (hard to explain.... if you request I'll explain) Anyway..... CPAP mask removed & Nebulizer re-applied. Reassess: (this is now 1min post removing CPAP) BP:160/108 HR170, Sp02 97%, EtC02 80, colour GREY. Pt lying head on pillow c/o fatigue. Noted decrease in Resp rate. Sedate Pt w/1.5mg/kg Ketamine and pass #7tube. Confirm via visualization, EtC02, auscultation. Ventilation difficult - Parilize with 1mg/kg Rocuronium. BTW: I have a 40min transport to nearest ER. Continue sedation with .5mg/kg ketamine, and paralysis with Roc. Ventilated EtCo2 50. Sp02 98. Colour pretty good. Stop in at local ER for more drugs, foley, blood gas, chest x-ray, and back on the road. Continue as before, as well as MDI ventolin q20min About 45min later, noticing the pt becoming hyper dynamic (tachycardia at 130, BP 140/96) obvioustly resedation attempted x2 but no effect. So I thought perhaps it was all the freaking ketamine he has been having all day! Started a Versed drip at 5mg/min after a 5mg Bolus. Fentanyl 100mcg PRN To b continued.... sorry gotta run