Rescue 7 · 16 min · ground

Pediatric status asthmaticus

PALICC-2 · 92–97% (PALICC-2; 88–92% ok in severe PARDS if PEEP is optimized) · PALICC-2: 6–8 mL/kg if PIP ≤28 or ΔP ≤15; 4–6 if pressures high · Pplat ≤28 · ΔP ≤15 (trainer) · PaCO2 ~35–45

11-year-old, 38 kg, two days of viral wheeze, silent chest after three nebs and mag. RSI in the ED hallway. 5.5 cuffed tube. You can feel the bag fight you on the way out.

Handoff

pH 7.14 / PaCO2 76 on the bag. They were squeezing 20 times a minute. That is how you stack a child. Empty the lung. PALICC-2: 6–8 mL/kg if PIP ≤28 or ΔP ≤15; 4–6 if not. Permit the CO2 if pH holds. PICU is 16 minutes.

1
VT 6–8 mL/kg if pressures allow (about 230–300 mL on 38 kg)
PALICC-2. Cut to 4–6 mL/kg if PIP >28 or ΔP >15. Adult 500 mL will volutrauma this chest.
2
PIP / Pplat ≤ 28 and ΔP ≤ 15
If pressures climb, cut VT toward 4–6, not a bigger Pinsp.
3
Let expiratory flow reach zero
Rate 12–16, short Ti. AutoPEEP is the enemy, not a pretty etCO2.

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