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I think I would hold tight. If he is alert as you say, aggressive
intervention, oxygen, antibiotics, IVFs, fever control, maybe some albuterol
could really turn this child around.He isn't acidotic, oxygenation not
ventilation, is the primary problem here. So far everything is going ok; not
to say you may in a very different place very quickly. What are the repeat
VS after this intervention. That would push me one way or another before the
gas. Just my 0.02 worth. I am always surprised who does ok and who buys a
tube.
Michelle Rubinstein
PEM, Henry Ford
Detroit, MI
 ----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, December 30, 1999 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?
>
> For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html