Respiratory Distress

Dr. Seth Assar joins us to discuss the SMOG Respiratory Distress guideline. This is a wide-ranging discussion that covers many of the differential diagnoses for a patient who is having difficulty breathing. Listen closely for a use of Ketamine that you may be less familiar with.

Dr. Assar points out the inherent risks of intubation and mentions a study identifying a real risk of mortality with the procedure:

• Schwartz, D. E., Matthay, M. A., & Cohen, N. H. (1995). Death and other complications of emergency airway management in critically ill adults: a prospective investigation of 297 tracheal intubations. The Journal of the American Society of Anesthesiologists, 82(2), 367-376.

The risk is further increased in patients in hemorrhagic shock and an article in the last JSOM makes this clear. See:

• Thompson, P., Hudson, A. J., Convertino, V. A., Bjerkvig, C., Eliassen, H. S., Eastridge, B. J., ... & Rappold, J. F. (2020). Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals, 20(3), 97-102.

Finally, be on the lookout for Dr. Assar's forthcoming article in the JSOM on mechanical ventilation.

This episode relates to TC 8-800, Table II and IV.