Sincere apologies for the delay in this post. To summarize Case 2, we have a 50 year old woman with ovarian cancer who is extremely hypoxemic despite supplemental oxygen and positive pressure ventilation is being considered. I’d like to use this post to introduce a couple of other great #FOAMed resources.
The questions to think about were..
1) What is your approach to undifferentiated hypoxemia?
A recent post found here by Mark Yoffe on his website does a great job reviewing a general approach to hypoxemia.
In this lady with an oncologic diagnosis, pulmonary embolus is high on the differential. However, shunting due to pneumonia and/or ARDS should also be considered.
2) Who would be a candidate for non-invasive ventilation?
Stay tuned for a comprehensive review on this topic!
3) How would you approach intubation in a severely hypoxemic patient?
Scott Weingart of EMCrit‘s article in the Annals of Emergency Medicine, found here, is a fantastic review on preoxygenation and prevention of desaturation during intubation.
I’m interested in whether people would consider non-invasive ventilation in this patient. Would you? Discuss with #icurounds on twitter.