ANAESTHETICS AND AIRWAY
INDUCTION IN METABOLIC ACIDOSIS
PromptOutline measures you would take to prevent cardiovascular collapse in induction, intubation and ventilation of patient with severe metabolic acidosis
ResponsePatients typically have respiratory compensation +++. Need to match their minute volume. Poor myocardial contractility, peri-intubation period, or acidosis precipitously worsens >> diminished catecholamine responsiveness.
Pre-oxygenation with ther spontaneous respiration (or NIV assisted at matching RR), note the patients ETCO2 (And try not to let it climb)
RSI but with breaths delivered throughout indiuction phase (no apnoea)
Rapid intubation
Match previous minute volume (may be impractical to match TV or RR but match minute volume)
Long and short of it - Ventilate through induction to avoid worsening asidosis
Pre-oxygenation with ther spontaneous respiration (or NIV assisted at matching RR), note the patients ETCO2 (And try not to let it climb)
RSI but with breaths delivered throughout indiuction phase (no apnoea)
Rapid intubation
Match previous minute volume (may be impractical to match TV or RR but match minute volume)
Long and short of it - Ventilate through induction to avoid worsening asidosis