1/ Good morning, #medtwitter! This 1 goes out 2 everyone who hasn’t had to interpret a blood gas since Steps, prelim year or their last episode of ER ( @DGlaucomflecken).

FYI: this ain’t a course on Winter’s Formula. We’re talking practical vent adjustments today. #covid4MDs
2/ There are 4 variables we might want to adjust on the vent based on our ABG results: PEEP, FiO2, RR and Vt. The first two we adjust to achieve appropriate oxygenation while the latter two we adjust to achieve adequate ventilation.
3/ Now that we’ve had that brief review, take a look at the following gases. What’s the problem, and how might you fix it?

Keep scrolling through the thread for the answers!
4/ 1: pH low & pCO2 high - respiratory acidosis. We’re not ventilating well, so we need to increase the minute ventilation (=RRxVt). Increasing either variable will get us what we need.

2: Too much O2! Time to bust out your @ArdsNetwork ladder and come down a rung or two.
5/ 3: Respiratory acidosis AND low pAO2. We need to ⬆️the FiO2 or PEEP AND ⬆️ the minute ventilation.

4: Respiratory alkalosis and hyperoxemia. ⬇️ PEEP/FiO2 AND minute ventilation. This often happens due to overbreathing - so make sure your patient is adequately sedated!
6/ That’s all for today! A huge thanks to all y’all who have stepped out of your comfort zone and are in the trenches with us. Let us know if this is helpful and what else you might like to see from @COREIMpodcast #COVIDedition.

You can follow @COREIMpodcast.
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