As a second year fellow, a 16 yo known asthmatic came to me at 8am with
'hyperventilation'. He was known to be quite an anxious young man.
Vitals weight = 60kg T=98, HR=90,RR=120 BP-normal. He was exchanging air
decently, and was wheezing a little. pulse ox = 100 on RA. ABG as I
recall was consistent with hyperventilation. CXR, EKG normal. I treated
him with high dose neb albuterol, and IV steroids and O2 for about 20
minutes. His wheezing lessened but nothing else changed, including his
RR of 120. I gave him Midazolam 1 mg IV, after which he became
completely apneic. I bag valve mask ventilated him for about 3 minutes
after which he awakened slowly. This cured his hyperventilation but did
not do much for my antrum. He continued to wheeze a bit and I admitted
A nice reference on this topic is: Callaham, M. Ann Emerg Med
1989;18:622. He describes three adults treated with the paper bag who
went on to die of hypoxemia related events.
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