Pediatric emergency medicine trisk 2767 2767

Primary hypoxemia High-flow supplemental oxygen (e.g., nonrebreather mask nonrebreather mask or high flow nasal cannula), titrate for cyanosis, or by pulse oximetry or PaO 2 Use PEEP through CPAP or BiPAP to further improve oxygenation Consider endotracheal intubation when persistent hypoxemia on FIO >0.6 or when decreased lung compliance and FIO >0.4 Use assisted ventilation to improve gas exchange (increased inspiratory time, normal respiratory rates, tidal volume: 10–15 mL/kg; pressure cycle ventilation if wt 10 kg) If inspiratory pressure exceeds 40 cm H2 O, consider use of permissive hypercapnia to reduce barotrauma Treat underlying cause Primary Supplemental oxygen (as above) hypoventilation Support ventilation a Oral/nasal pharyngeal airway or endotracheal intubation to open the airway b Bag-mask ventilation with high-flow oxygen c Use assisted ventilation (normal to increased respiratory rates, increased expired time and increased flow rates with obstructive airway disease), BiPAP is favored over CPAP for noninvasive ventilation with primary hypoventilation d Use increased tidal volume (pressure) with atelectasis e Monitor carefully for side effects of ventilation Adjunctive therapy Intravenous fluid to achieve normal vascular volume (less fluid for child with interstitial lung disease) Diuretics such as furosemide (1 mg/kg) for acute pulmonary edema or fluid overload Sedatives/analgesics—morphine sulfate (0.1–0.2 mg/kg) every 1–2 hrs intravenously; midazolam (0.1– 0.2 mg/kg every 2–4 hrs intravenously); dexmedetomidine (dosing per institutional protocol)