Squad 2 · 16 min · ground

Farmhouse asthma

BTS — asthma is not a retainer · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · Permit CO2 if pH ≥7.15–7.20 — empty the lung

52-year-old woman, three days of viral prodrome, now silent chest. RSI after NIV fail. ETCO2 78 on the bag. You can hear wheeze through the tube.

Handoff

Ketamine still on board. Last ABG pH 7.12 / 82 / 61. They want her at the ICU in 16 minutes. If you chase a normal CO2 you will stack autoPEEP and drop her pressure.

1
Dump the lung — AutoPEEP < 8
Rate 8–14, I:E 1:4. Flow must reach zero.
2
Permit hypercapnia, defend pH ≥ 7.15
Slow is safer than stacked.
3
Don't cause obstructive shock
Disconnect and decompress if MAP tanks with a quiet bag.

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