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I haven't had this scenario in a pediatric patient but in adults I have
seen benzo (and other tox) related apnea.  In such circumstances BVM to a
definitive airway (not BiPAP) were used.

Liz Haines
Icahn School of Medicine at Mount Sinai

On Thu, Dec 17, 2015 at 9:35 AM, Wiener, Ethan Dr <
[log in to unmask]> wrote:

> 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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