Pre-retrieval care package for respiratory failure
All patients should be taken to an agreed area for retrieval when initial resuscitation has been done
Ventilation
- Nasal endotracheal tube if possible
- End-tidal CO2 monitoring
- Insert orogastric tube
- CXR to confirm ETT position
- Mechanical ventilation with lowest appropriate FiO2
- Aim for tidal volumes of approximately 6-8 ml/kg or until appreciation of adequate chest wall movements if there is no facility to measure tidal volumes.
- Set respiratory rate according to age
- Minimum PEEP of 5 cm H2O
- Increase PEEP to an appropriate level if necessary to improve oxygenation. Sometimes a PEEP up to 15cmH2O is required.
- Adjust ventilation according to arterial or capillary blood gases
Circulation
- IV access x 2
- Consider arterial line
- Initiate fluids 0.45% sodium chloride + 5% dextrose at 80% maintenance.
Sedation/Analgesia
- Morphine 10-20 mcg/kg/hr and midazolam 100-200 mcg/kg/hr
Antibiotics
- Administer appropriate antibiotics if indicated and record dose and time of administration
Gastric prophylaxis
- Consider Ranitidine 1mg/kg stress ulcer prophylactic dose.
Lab investigations
- Blood gases and electrolytes
- Glucose, FBC
- Mg, Ca, PO4
Documentation
- Clear history
- Copy of all notes, medication and observations charts
- Xray investigations available to transfer with patient .