Albuterol for CHF

[usalsfyre]

Could be ARDS caused by septicemia.

Pretty much what I was thinking. At the BLS level transport to a tertiary facility post-haste.

ALS means intubation and very likely high levels of PEEP, fluid resuscitation, and supporting their pressure with pressors.

Likely outcome? Not good...

 

[Journey]

Could be ARDS caused by septicemia.

ARDS: a very overused and misused word.

The scenario presented a significant SpO2 increase by repositioning, O2 and one neb.

There were not many other details such as BP or other factors that can determine Qs/Qt.

Pretty much what I was thinking. At the BLS level transport to a tertiary facility post-haste.

ALS means intubation and very likely high levels of PEEP, fluid resuscitation, and supporting their pressure with pressors.

Likely outcome? Not good...

I would not recommend "high" levels of PEEP used by EMS unless they are fully capable of achieving an acceptable MAP on the BP with fluids and the appropriate pressors. In an older patient this could be a delicate balance and if the SpO2 remained at 94%, I would hold off on cranking the PEEP knob to "high" levels. Some do not understand how PEEP works and believe the results should be instant and end up demolishing any resuscitative progress. There are other factors to also consider for oxygenation which are also reasons for the fluids and the pressors.

 

[usalsfyre]

ARDS: a very overused and misused word.

The scenario presented a significant SpO2 increase by repositioning, O2 and one neb.

There were not many other details such as BP or other factors that can determine Qs/Qt.




I would not recommend "high" levels of PEEP used by EMS unless they are fully capable of achieving an acceptable MAP on the BP with fluids and the appropriate pressors. In an older patient this could be a delicate balance and if the SpO2 remained at 94%, I would hold off on cranking the PEEP knob to "high" levels. Some do not understand how PEEP works and believe the results should be instant and end up demolishing any resuscitative progress. There are other factors to also consider for oxygenation which are also reasons for the fluids and the pressors.

Some of us have a full array of pressors and fluids at our disposal and have a grasp of volume resuscitation and how it affects oxygenation.

Perhaps "high" was a poor choice of words. "Appropriate" might have been better.