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Slide Notes

Hypercapnia is a frequent cause of AMS in the emergency department. Today we are going to bust a few myths and address of some of the common pitfalls in the management of these very sick patients. Let's get started.
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The Hypoxic Drive & Other Science Fictions In Hypercapnia

Published on Aug 08, 2017

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PRESENTATION OUTLINE

The Hypoxic Drive

& Other Science Fictions of Hypercapnia
Hypercapnia is a frequent cause of AMS in the emergency department. Today we are going to bust a few myths and address of some of the common pitfalls in the management of these very sick patients. Let's get started.

& Other Scientific Fictions

Hypercapnia is a frequent cause of AMS in the emergency department. Today we are going to bust a few myths and address of some of the common pitfalls in the management of these very sick patients. Let's get started.

Untitled Slide

During 15 minutes of high oxygen administration, an initial decrease in minute ventilation, which recovers substantially, is seen in patients with acute exacerbation of chronic obstructive ...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682248/

Oxygen

A Reluctance to Give
The consequence of this myth is that providers are often reluctant to give supplemental oxygen to a patient with COPD and CO2 retention because they are afraid of inhibiting the patient's "hypoxic drive" and further worsening their condition.
Photo by Jo Naylor

Doing the Math

PaCO2 = 40 mmHg

We can see here for a healthy adult the mm

PaCO2 = 110mmHg

PaCO2 = 110mmHg

PaCO2 = 110mmHg

PaO2 WITH 50% FiO2 AND PaCO2 = 110mmHg

Get Worse?

So When We Give Oxygen Why Can Hypercarbia
Photo by Leo Reynolds

Dead Space

Hypoxic Vasoconstriction &
Photo by Niklas

Untitled Slide

Untitled Slide

The Haldane Effect

Haldane Effect

Oxygen

Give Appropriately Titrated
The consequence of this myth is that providers are often reluctant to give supplemental oxygen to a patient with COPD and CO2 retention because they are afraid of inhibiting the patient's "hypoxic drive" and further worsening their condition.
Photo by Jo Naylor

Giving Titrated O2

The Effect of

When To Intubate

Untitled Slide

Impaired Consciousness

-agitation
-somnolence
-uncooperative

NIPPV Contraindications:

- Inability to protect airway or clear secretions.
- Impaired level of consciousness
- Cardiac or respiratory arrest.
- Hemodynamic instability.
- Facial surgery/trauma/deformity.
- Pneumothorax.
- Upper airway obstruction.
- Complicated multi-organ failure.
- Recent esophageal anastomosis.

For NIV

We Need to Intubate!! This Patient Is Too Sick

Hypercapnic encephalopathy may be an exception to the rule that severely impaired consciousness is a contraindication to NIV

How do we monitor our NIV trial?

ABG & VBG

Using Them Correctly

Be With You

May the Forced Expiratory Volume
Hypercapnia is a frequent cause of AMS in the emergency department. Today we are going to bust a few myths and address of some of the common pitfalls in the management of these very sick patients. Let's get started.