----- Original Message -----
From
> Dr Francis J Andrews FFAEM
> Lecturer in Intensive Care Medicine
> Department of Medicine
> University of Liverpool
> The underlying reason for the cardiac arrest in the
> asthmatic patient described by Dave is probably air
> trapping, it is not consolidation
> The management of a patient with deteriorating asthma/COPD
> who arrests should include consideration of allowing a
> prolonged exhalation to allow alveolar emptying (up to 20
> seconds and applying a physical squeeze to the chest if
> necessary)-this alone will sometimes restore cardiac
> output
Yes, I was always aware of these patients' prolonged expiratory phase, and
the consequent need to reduce their I/E ratio considerably to allow for
this...I just didn't realise this was an important aetiology for cardiac
arrest - I simply thought these patients were hypoxic. Has it been studied
anywhere? I presume hypoxia plays a role in such arrests but your point
about ventilation strategies is nonetheless very valid.
> I'll post up some references on asthma and
> cardiac arrest in the next few days if anyone wants
Yes please...and while you're at it, what do intensivists like to use to
bronchodilate such patients?
Regards
Adrian Fogarty
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