Posted 21 October 2008 - 01:10 PM
[quote name='MSDeltaFlt' post='13675' date='Oct 20 2008, 10:36 PM']High flow O2 does not exist with NRM in any situation regardless of liter flow. You might be giving her 60%, more than likely 40% FiO2. Nebs are not likely going to work on that mass. She needs oxygen but she has an obstruction. Sats are now 90% rolled over as apposed to their original 89% sitting up. On a pulse ox? It's semantics. Plus she's already lethargic; i.e.: limp, and you're still going to sedate her?!?[/quote]
The neb. With stridor and probably some other underlying sounds I can't absolutely rule out other things, and yes it would be more or less trivial, and no it wouldn't help with the suspected obstruction, but I don't see it hurting (except maybe driving up the need for O2, then no we shouldn't if HR climbs more than what I would like to see). Sedate her if she needs it, that is if her mental status is driving up her need for O2. If she's limp and whatever and doesn't appear to need it, well no of course. I would like to give her a moment to see if her mental status rebounds, not long though. With the flow and mask augmentation, for me that would be for a small amount of airway pressure/resistance (tight mask and coaching). Or you could tube her, I'd like to see her response for a bit though (just to know where we stand, the suspected dx is just a suspect right now).
[quote]Now you can guarrantee her the O2 she needs by either giving her the 200-250 L/m of O2 she needs (impossible in an aircraft), or tube her. You go small. One whole size. Maybe one and a half size smaller than her body calls for. If her body size calls for a 6.0, go with a 5.0; maybe 4.5. At that short length of tube, you'll have to bury it deep. But it is feasible.[/quote]
If you wanted to tube her now I would most definitely wouldn't argue with you. I really wouldn't expect anything but a normal intubation?
[quote]By the way, if we go with the prone thing-a-ma-bob and the fecal matter hits the rotary oscillator, how fast can you spin a limp 13 y/o around in an aircraft cot who is still strapped down with 3, maybe 5 point straps? Remember your FAR's.[/quote]
I guess I missed a post or two, didn't realize she was lethargic; yes tube her if she's not improving pretty quickly. If she's awake and able to talk, moving air OK, and on and on; I wouldn't be afraid to carry a normal size 13 y/o girl prone with the plan of flipping her if she deteriorated again. I'm sure I could do it within the confines of a part 135 flight (within reason secondary to her size of which I can't see in this simulation). I've done it before at the site of erupting vomitus.
Mike Williams CCEMT-P/FP-C