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Bad Lungs Bad Transfer


DartmouthDave

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Old thread, but.... sounds like this kid is headed for v/v ecmo at the big house. Clearly unstable for transport currently.

Optimize ventilation... how much of a leak is coming from the chest tubes at current tidal volume? This is not a situation where normal tidal volumes based on predicted body weight will do. No mention of peep, but 6- 10 for starters with total paralysis.... lots of things to unpack there, but moving on...

If she doesn't have an A line, she needs one and pulse pressure variation guided volume replacement started. She's in shock. Potassium should be antagonized with a gram of calcium chloride. K will probably fall with volume resuscitation, tho, no mention of glucose, a little insulin if appropriate. Norepi as required once adequate volume resuscitation underway for MAP of 65.

The CO2 is the least of my worries. Optimize oxygenation and perfusion and transport.

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