Thread by @rabihmgeha

A 4-step dance.

But first, a short story.

Breeze
Hop on the ramp
& then whatever you do, DON'T
Wheeze

The wind in your lungs brings you oxygen and helps you bid farewell to CO2.

Your muscles, and pleura, listen your brain (respiratory rate) and pull in the breeze (tidal volume)

Carbon dioxide hops on the ramp, and unless you wheeze, say peace to CO2.

No ramp?
That's what we call dead space, friends.

What the heck was that, Rabih?

Hmm...no idea, really.

But let's keep playing.

Time for the dance.
4 key steps, remember.

The patient is somnolent.

ABG - pH 7.0, PCO 89.

Your first move?

The monitor.

(1) A low respiratory rate?
Grab the naloxone, but you know that's not the whole list.

(2) Marked hypoxemia?
The CO2 ramp is probably not working.
A common cause of marked dead space issues - ARDS

Respiratory rate 12.
O2 sat 96% RA.

The answer isn't on the monitor.

Time to listen for music.
No wheezing?
Hmm..

Sometimes, though, the obstruction can bad enough to cause a "silent"chest.

Nope.
Not that either.

🤔

Is that atrophy of the dorsal interosseous muscles?

Yeah...on both sides.

Hmmm...some tongue fasciculations there too.

I wonder what the reflex exam will show.
What do you think, #medtwitter?

Is that the end of the story?
Never.

Especially not if your patient just came out of the OR.

Yup.

In some scenarios, namely post-op, there's one most step to this dance.

Thanks for hanging, friends.
❤️