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PED-EM-L  December 2015

PED-EM-L December 2015

Subject:

Re: Bipap and apnea

From:

Todd Zimmerman <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Thu, 17 Dec 2015 14:41:41 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (113 lines)

I think if you have the comfort and expertise for airway management, (and  
the time to sit there) a trial of Bi Pap is not unreasonable with good  
parameters as listed below. Not saying I would do, or not do that in that exact  
scenario as I was not there seeing what you saw exactly.
I have bagged and graduated to bi pap not exact, but similar pt.s in  the 
past, and we did not have to intubate.
 
Todd Z
 
 
In a message dated 12/17/2015 9:27:25 A.M. Central Standard Time,  
[log in to unmask] writes:

I have a  clinical scenario and a question to present:



A 10 year old girl  with spastic CP and seizure disorder presents with EMS 
receiving BVM secondary  to apnea following administration of rectal 
diazepam for seizure. On  presentation, she has spontaneous respiratory effort and 
is placed on NRB.  Shortly afterward, she is noted to have worsening 
hypopnea and additional  measures are required to assist ventilation. Is it 
appropriate to place a  patient who has true apnea for this (presumed) etiology on 
facemask BiPap for  a period? Is it OK if she is not overbreathing your set 
rate at all? Even if  the presumption is the benzo, and the assumption is 
that it will resolve  shortly, is true intubation mandated in this 
circumstance if it will be  required for a few hours? The clinical markers used to 
establish efficacy of  the intervention in this case are chest wall excursion, 
breath sounds, oxygen  sats, and nasal in-line end tidal CO2 (no blood gas is 
yet taken, but will be  done so to determine efficacy of intervention). I 
am curious as to your  opinions/experience and if there is any data that you 
are aware of on Bipap  for apnea other than OSA?



Thanks for your  thoughts.

Ethan





Ethan Wiener, MD

PEM,  Goryeb Children's Hospital

Morristown,  NJ



[log in to unmask]<mailto:[log in to unmask]>





****************************************************************************
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****************************************************************************
*************  Morristown Medical Center, located in Morristown, NJ, is a 
nationally-ranked  regional medical center and a recognized leader in 
cardiovascular medicine,  orthopedics and nursing. The hospital was recognized by 
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cardiac  program in the top two percent in the country. The Atlantic 
Orthopedic  Institute at Morristown Medical Center does the highest volume of joint 
and  spine surgeries in New Jersey. In 2014, the hospital was re-designated 
a  Magnet Hospital for Excellence in Nursing Service, the highest level of  
recognition by American Nurses Credentialing Center for facilities that  
provide acute care services, a distinction awarded to less than five percent  
of U.S. hospitals. Morristown Medical Center is certified as a Level I  
Regional Trauma Center by the American College of Surgeons, and designated a  
Level II Trauma Center by the state of New Jersey. Morristown Medical Center  
is part of Atlantic Health System, one of the largest non-profit health care 
 systems in New Jersey. Atlantic Health System has created a Trusted 
Network of  Caring™. Our promise to our communities is that anyone who enters our 
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Network of  Caring™ at Morristown Medical Center>  
http://www.atlantichealth.org/atlantic/about+atlantic+health/  
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