A 68 year-old man presents by squad with shortness of breath. He is noted to have a nearly quiet chest with very poor air movement, to be using accessory respiratory muscles, and to be slightly lethargic. Quick perusal of old records discloses a history of severe COPD, steroid and O2 dependence, HTN and ulcer disease. The squad reports that his O2 sat was 86% at the scene, improving to 92% on a NRBM and two nebs.
His vitals are: p 138, r 22 and labored, bp 156/96, O2 sat 92% on a high-flow NRBM. His POC renal returns with a pCO2 of 88. His estimated weight is about 175 lbs.
A decision is made to intubate.Read More