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 From your description, intubation probably would not have occured to me. O2
sat a little low, but no >wob, retractions, accessory muscle use, <LOC,
>CRT, etc. Since 02 brought his sats back up, seems lit youre sitting
pretty. Unless there was something else not mentioned.

IMHO.

Guy

Guy H. Haskell, Ph.D., NREMT-P
Associate Professor, Director
Emergency Medical Services
Quinsigamond College
Worcester, MA

-----Original Message-----
From: [log in to unmask]
To: [log in to unmask]
Sent: 12/30/99 11:44 AM
Subject: A case of Respiratory Failure

Just wondering how people on the list would manage the airway/breathing
of
this child:

18 month old Hispanic male brought in from triage with fever, vomitting
and
cough for three days. Patient looks tired but alert, breathing 80
breaths/min, mild retractions, temp 102.8 F, HR 180, BP 98/68. O2 sats
79% on
RA. Lungs are clear on auscultation, cardiac exam normal, no meningeal
signs
and except for a whopping otitis on one side he has a normal exam.
Mother
gives a vague hx of wheezing but no other past Medical history. Seen in
the
ED 36 hours prior with Viral Syndrome and dehydration, given IV
hydration for
4 hours and sent home. WBC on prior visit 10.2, lytes not remarkable and
O2
Sats 98% RA.

While the nurses set up oxygen, I rushed a RA ABG : 7.40/PCO2
=39/PAO2=46/HCO3=20. Accucheck 76, stat portable CXR shows early RLL
infiltrate. Patient now on 40% O2 via mask, IV hydration and Antibiotics
in,
20 mins into arrival, still very tachypneic, tired but alert. O2 sats
96% on
O2.

Question : Would you intubate immediately or would you wait?

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