Thank you for a very good discussion. Would like to add the first blood gas shows a metabolic acidosis with inadequate respiratory compensation. For a bicarb of ~13, Pco2 should have been 26-30. Pco2 being 39 indicates he is unable to compensate secondary to likely Copd. Very important to use winters equation in any metabolic acidosis to pick up early respiratory failure. Would have intubated with that gas early.
Thank you for your kind words U r Absolutely correct about winters eqaution. Intubation is probably best decided at bedside in this. He has no hypoxia . pco2 has not increased despite being copd. there is significant acidosis as u mentioned and one likes to keep pH > 7.2. Before intubation Hco3 can probably be tried along with fluids since hypoprrfusion is contributing to acidosis by causing pre renal aki and LA
prophylactic anticoag with lmwh can be started at 24 hours post surgery if no usual contraindication. sepsis pts should be given thromboprophylaxis unless contraindicated.
Thank you for a very good discussion. Would like to add the first blood gas shows a metabolic acidosis with inadequate respiratory compensation. For a bicarb of ~13, Pco2 should have been 26-30. Pco2 being 39 indicates he is unable to compensate secondary to likely Copd. Very important to use winters equation in any metabolic acidosis to pick up early respiratory failure. Would have intubated with that gas early.
Thank you for your kind words
U r Absolutely correct about winters eqaution.
Intubation is probably best decided at bedside in this. He has no hypoxia . pco2 has not increased despite being copd. there is significant acidosis as u mentioned and one likes to keep pH > 7.2. Before intubation Hco3 can probably be tried along with fluids since hypoprrfusion is contributing to acidosis by causing pre renal aki and LA
Great discussion....👍👌
Thank u
Please give comment on use of anticoagulant
prophylactic anticoag with lmwh can be started at 24 hours post surgery if no usual contraindication. sepsis pts should be given thromboprophylaxis unless contraindicated.