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Bad Lungs Bad Transfer

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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.

Edited by Off Label

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