Mike is joined by FOAMfrat's own Austin Brook. We hope you enjoy getting to know him a bit better. Please keep your questions coming! If your question wasn't answered this time we haven't forgotten you, don't worry. The die hard fans can also find us on YouTube with video!
1) Hey, I am new to the flight world, less than a 1yr of experience and I had an interesting case that I wanted to pick y'alls brain on. 60s male, dx with COVID, intubated 10hrs prior to flight crew with Roc and Etomidate. Post RSI patient was placed on 4mg/hr versed, 50mcg/hr fentanyl and then placed on a vecuronium because the patient was fighting the vent/tube. We ended up picking this patient up from another flight crew who had maintained all the rural hospitals drips and vent settings. Vent settings: TV 350, rate 30, fio2 100%, PEEP of 10. PIP and Pplats where less than 30. However patient was hypertensive, tachycardic and hypercarbic to the 60s. I guess most people's initial though would be to increase rate to blow off more Etco2, I just felt like that rate was super high for this patient. The other thought was that this patient was under sedated and over paralyzed. I was going off of an IBW of 73kg. Anyway, how would you all approach this case? I ended up turning off vecuronium, dropping the I time to allow longer exhalation and increased TV to increase vte. Seemed to help. Having racked my brain after the fact, it seemed I should have have upped his sedation, dropped his rate and upped is TV further. Being new to flight I have been told when you change things, try not to change to many things and only change one thing at a time. This was messing with me during the flight I think. Wanted to give this guy a clean slate and start over with vent settings and drips, but felt I couldn't change much. Just wanted to see what y'alls thoughts were on this? And if you have or would touch on vecuronium as a topic? Our medical director said that it may have the potential to increase Etco2 and wondered if you'd heard that and what the mechanism is? Just haven't had many patients on continued paralysis. Understand its needed sometime, but thought it was excessive in this situation. Anyway, thank you for your time!
2) Had a patient in paroxysmal VT. With HR of 144. 40s YO male makes his own supplement drink, metabolic steroid use in past, been less active and increase alcohol use this last year. He remained in VT and radial pulse matched monitor. Later in call he was still in VT but radial pulse was 48. Is it still safe to continue Amiodarone? He remained stable throughout call.
3) My service implemented a checklist for RSI and I am totally onboard. Some of my more “seasoned” partners have been slow adopters. Do you have any suggestions on helping them get onboard with the changes?
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