1/7. halothane, an effective infrequently used drug, in the treatment of pediatric status asthmaticus: a case report.Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7). halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
2/7. Respiratory failure.patients with respiratory failure should be approached in a systematic way, with emphasis both in diagnosis and treatment on arterial blood gases. The intelligent assessment of oxygenation, ventilation and acid-base balance, based on physiologic principles, can make the management of these patients very rewarding. The physiologic principles outlined here should be well understood by anyone entrusted with the care of these patients. They provide the cornerstone of diagnosis and management, and will remain valid long after current clinical dogma has been revised.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
3/7. Chronic mountain sickness at an elevation of 2,000 meters.A resident living at Lake Tahoe, Calif, at an elevation of 2,000 meters, had fatigue, edema, and erythrocythemia. hematocrit was 63 percent, and arterial blood gas values revealed hypoxemia and respiratory acidosis. Results of pulmonary function tests, sleep study, and thyroid function all were normal. Erythrocytosis, cor pulmonale, and respiratory acidosis resolved after the patient moved to sea level. This patient suffered from chronic mountain sickness. Her symptoms resolved with relief of hypoxia.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
4/7. carbon dioxide toxicity related to a laparoscopic procedure.laparoscopy has become a routine part of many major and minor surgical procedures. During laparoscopic procedures, carbon dioxide (CO2) is insufflated into the peritoneal cavity to allow visualization of the abdominal viscera. Delay in the elimination of CO2 during the intraoperative and postoperative phases of a laparoscopic procedure has recently been identified. This case study discusses a patient with CO2 toxicity related to the insufflation of CO2 during a laparoscopic procedure. nurses in the PACU must be alert to the signs of CO2 toxicity after a laparoscopic procedure and be able to correctly interpret arterial blood gases.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
5/7. Heliox inhalation in status asthmaticus and respiratory acidemia: a brief report.A 28-year-old woman in status asthmaticus and respiratory acidemia refused orotracheal intubation and mechanical ventilation in the emergency department. In view of this situation, a mixture of helium-oxygen gas (heliox) was initiated with a nonrebreathing oxygen mask. Within 2 hours of treatment, the patient's respiratory acidemia had been corrected, and heliox inhalation therapy was discontinued without further incident.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
6/7. Hypercapnic respiratory acidosis precipitated by hypercaloric carbohydrate infusion in resolving septic acute respiratory distress syndrome: a case report.Complications may occur when nutritional support is administered either parenterally or enterally. Inappropriate nutritional formulas with high carbohydrate loads can precipitate respiratory failure in patients with compromised lung function, induce respiratory distress which manifests as dyspnea and tachypnea in an originally normal lung condition, produce hypercapnic acidosis in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) as well as patients recovering from acute respiratory distress syndrome (ARDS) without chronic lung disease, or result in difficult weaning. Hypercaloric mixed substrates administered either parenterally or enterally can also have profound impacts on gas exchange and energy expenditure. This report describes a patient who experienced exacerbation of respiratory distress and hypercapnic acidosis during recovery from septic ARDS as the result of a nutritionally-related increase in CO2 production. As carbohydrate calories were decreased, CO2 production diminished and the hypercapnia was resolved. The importance of indirect calorimetry cannot be overemphasized during tailoring of nutritional support for the critically ill patients.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
7/7. Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman.OBJECTIVE: We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol. SETTING: Prehospital Emergency Medical Service and Pulmonary intensive care Unit in a university hospital. PATIENT: A 35-year-old female developed an acute asthma attack while at home, which required advanced life support. INTERVENTION: On hospital admission, arterial blood gases revealed a PaCO2 of 208 mmHg. hypercapnia persisted with a PaCO2 of more than 190 mmHg for 10 h, with pH always less than 7.00. The patient was finally discharged after 26 days without sequelae. CONCLUSION: This case illustrates the cerebral and cardiovascular tolerance of severe and prolonged hypercapnia associated with major acidosis.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |