Eagle 3 · 28 min · fixed

ICH — CO2 is ICP

BTF 4th ed. · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 35–45 (BTF)

68-year-old woman, sudden headache, GCS 6, blown left pupil after CTA. ICH with 8 mm shift. Fixed-wing, cabin will be ~8,000 ft unless you ask for sea-level.

Handoff

Head of bed 30, 3% saline hanging. Last gas 7.38 / 36 / 148 on 40%. Sending wants 35–38. BTF is 35–45. Do not hyperventilate her into ischemia.

1
Hold PaCO2 35–45 (BTF)
39 is not a fail. ≤25 is. Rate is the knob. Draw a gas.
2
Avoid hypoxia and hyperoxia (trainer 92–96)
BTF cares about PaCO2 35–45. Sat: raise FiO2 or ask for cabin before 8,000 ft. Wean off 100%.
3
Defend CPP — MAP ≥ 80
High PEEP is not free in a tight brain.

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