Pulmonary Disorders I
Patient Cases
6. A 55-year-old man (weight 75 kg) is admitted to the burn ICU after a 65% total body surface area burn to the
abdomen, back, and lower extremities from a house fire. He is unconscious and unable to protect his airway.
His medical history is significant for hypertension and hyperlipidemia. He is currently receiving high-dose
norepinephrine and vasopressin to maintain a MAP of 65 mm Hg. His current laboratory test results show
the following: sodium (Na) 130 mEq/L, potassium (K) 5.9 mEq/L, chloride (Cl) 122 mEq/L, carbon dioxide
(CO2) 15 mg/dL, blood urea nitrogen (BUN) 10 mg/dL, and serum creatinine (SCr) 1.3 mg/dL. Which group
of medications would be most appropriate for RSI?
Fentanyl, ketamine, succinylcholine.
7. A 39-year-old homeless man (weight 70 kg) was admitted to the neurosciences ICU with a traumatic head
injury after falling off a 3-ft ladder while intoxicated. Imaging reveals a subdural hematoma. The team
decides to intubate this patient. His current laboratory values are as follows: Na 133 mEq/L, K 4.5 mEq/L,
Cl 97 mEq/L, CO2 28 mg/dL, BUN 13 mg/dL, SCr 0.7 mg/dL, and glucose 140 mg/dL. Which induction
medication would be most appropriate to use for RSI?
Propofol 90 mg intravenous push.
Ketamine 100 mg intravenous push.
III. MECHANICAL VENTILATION
respiratory physiology
will help determine the cause of respiratory failure. (Table 10 provides the context for normal oxygenation
and ventilation values.)
Assist control (AC) ventilation
Volume control (VC)
The patient receives a predetermined respiratory rate and tidal volume, with additional patient-
initiated breaths provided at the preset tidal volume. Patient-initiated respiration generates a
negative pressure within the ventilator circuit, which is sensed by the ventilator, and a full tidal
volume breath is provided.
ii.
Potential for ventilator dyssynchrony, “double-stacking,” and respiratory alkalosis
iii.
Mode used in the ARDSNet trial of tidal volume strategy to limit spontaneous tidal volumes
Pressure control
The patient will receive a breath at a fixed rate until a predetermined peak pressure limit is
reached. The tidal volume is variable and limited by the peak pressure limit.
ii.
Not ideal for patients with low minute ventilation and may lead to hypoventilation and further
hypoxia