TheDoll
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fixed:blush:
Panic Attack? That isn't supposed to happen.
- Thread starter MMiz
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Too much ventilation hence the term "hyperventilation". In many causes of hyperventilation and respiratory alkalosis, one may not have enough oxygenation. example; pulmonary emboli, pneumonia esp. PCP
Cases where we do have to take the PaCO2 levels down by a ventilator, we closely monitor the cerebral oxygenation by jugular oximetry to maintain adequate oxygentation. (traumatic brain injury, PPHN of newborn-but not with jugular ox)
Many of the physical symptoms are associated with the calcium drop in the blood. The "NRBM at 4 LPM" is a throw back to the 1980s (yes Rid the 80s were good) and the hospital version of a quick paper bag. Can be very dangerous if unsupervised as must be 1:1 observation. That is a rare staffing thing in a busy ER. It can also cause a mega increase in anxiety if pt senses the 4 LPM as not meeting their 18 LPM minute volume demand. Imagine finishing a foot race on a hot day and the water drinking fountain is on "trickle".
During the past five years we have been cautioned on the "anxiety" hyperventilation assumption in teen-agers and some adults. Diabetes that has not be diagnosed may present as hyperventilating, NO hx of DM, and anxious because they don't know what's wrong with them. They become more anxious when well meaning caregivers keep telling them to "slow down your breathing" and they can not control their breathing. Glucose levels are not always in the protocols for <18 y/o. What a surprise when the ABG is drawn and the pH is <7.0. I actually see this quite frequently now with the obesity issues. If it is psychogenic hyperventilation, the arterial stick may make or break that.<_<
There are also the Dive Masters who are too afraid to admit they took one too many dives. Between the fear of losing their jobs, career and disability, they can present pretty hysterical with classic hyperventilation signs. I've had to calm a few experienced divers down for the HBO chamber. The novice diver usually does not present as anxious. They usually don't know the seriousness like the experienced divers.
Let us not forget the people who are diagnosed with chroncic hyperventilation syndrome.
Acute and Chronic HVS
http://www.emedicine.com/emerg/topic270.htm
Quote from this article;
"Prehospital Care:
Because respiratory distress or chest pain has many potentially serious causes, this diagnosis should never be made in the field. Even when a patient carries a prior diagnosis of HVS, transporting patients with these complaints for a more complete evaluation than is available in the field is prudent.
Rebreathing into a paper bag is not recommended in the field. Rebreathing should not be initiated in the ED until after more serious etiologies have been excluded. Deaths have occurred in patients with acute myocardial infarction (MI), pneumothorax, or pulmonary embolism misdiagnosed as HVS and treated with paper bag rebreathing."
Good general articles on causes of respiratory alkalosis.
http://www.anaesthesiamcq.com/AcidBaseBook/ab6_2.php
Good e-Medicine article on respiratory alkalosis- although I disagree with the brown bag, it is used only after confirmation of psychogenic hyperventilation and other causes are excluded.
http://www.emedicine.com/med/topic2009.htm
quote from above article;
"The diagnosis of hyperventilation syndrome should be a diagnosis of exclusion. Rule out all organic medical conditions, including pulmonary embolism, cardiac ischemia, and hyperthyroidism, before establishing a diagnosis of hyperventilation syndrome."
Supportive care may not necessarily mean running a NRBM at 15 LPM but oxygen will not have a profound short term effect on acid/base. Rebreathing CO2 will have an immediate effect on pH. Lowering the pH by raising the CO2 may not be what the body wants at that particular time. (ex. DKA)
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if by fixed you mean you totally screwed it up and changed the meaning, then yea, it's fixed :sad: