Rescue 7 · 16 min · ground
PALICC-2 · PALICC-2: 6–8 mL/kg if PIP ≤28 or ΔP ≤15 · Pplat ≤28 · ΔP ≤15 · SpO₂ 92–97 · PaCO2 ~35–45
Load card puts the starting breath on the box. Connect starts the clock. End whenever you want.
11-year-old, 38 kg, two days of viral wheeze, silent chest after three nebs and mag. RSI in the ED hallway.
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.
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.
PIP / Pplat ≤ 28 and ΔP ≤ 15
If pressures climb, cut VT toward 4–6, not a bigger Pinsp.
Let expiratory flow reach zero
Rate 12–16, short Ti. AutoPEEP is the enemy, not a pretty etCO2.
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