Pediatric emergency medicine trisk 2765 2765

conditions, but >90% is an appropriate initial goal for most patients While some patients with cardiac disease may not tolerate high amounts of supplemental oxygen depending on their physiology, in general, immediate lifesaving efforts should include provision of supplemental oxygen while further details of the condition are sought and risks of hyperoxygenation are considered Clinicians should be adept at assessing airway patency and performing emergency maneuvers to optimize oxygen delivery and assisted ventilation Use of a flow-inflating resuscitation bag (aka “anesthesia bag”) can deliver 100% oxygen and continuous positive airway pressure (CPAP) Positive-pressure breaths utilizing a self-inflating or flow-inflating bag will further increase oxygen delivery Importantly, CPAP cannot be delivered though a self-inflating (Ambu) bag High-flow nasal cannula (HFNC) has gained popularity in the treatment of respiratory distress and failure As equipment has become more widely available and indications for use have grown, many patients are now initiated on HFNC in the ED It is easy to apply and well tolerated by most patients Noninvasive ventilation with CPAP and BPAP may also be used to provide ongoing respiratory support in appropriate patients in whom respiratory drive and airway protection are not compromised Success hinges on finding an appropriate interface to generate a good seal, and patient compliance with this mode of ventilation Endotracheal intubation provides the most effective means of increasing PaO2 and is required for patients with persistent hypoxemia despite other interventions, or patients with hypercarbia and signs of respiratory failure such as tiring or altered mental status As mentioned, support of ventilation is indicated if adequate oxygen saturation cannot be maintained in spontaneously breathing patients despite 100% oxygen delivery Assisted ventilation may also be required to correct alveolar hypoventilation despite adequate oxygen saturation Adequacy of ventilation should be assessed clinically by chest wall expansion with further data from either ETCO2 or blood gas analysis of PCO2 Goal tidal volumes are usually to 10 mL/kg, although this will vary based on lung compliance and underlying disease (e.g., as low as to mL/kg in ARDS)