Bipap anxiety

This is really common. As for morphine and benzos I use both. Start low and titrate to effect. They have to be maintaining their airway to do Bipap.

When you have the situation where they were really down and they come up and then get agitated you should see if they still need the Bipap. Give them a try off the mask and check a gas. If they can fly great. If they still need the Bipap put it back on and sedate as needed. If you wind up having to tube them then so be it. If you titrate up with the meds judiciously you won't be doing it unnecissarily.

docB said:

This is really common. As for morphine and benzos I use both. Start low and titrate to effect. They have to be maintaining their airway to do Bipap.

When you have the situation where they were really down and they come up and then get agitated you should see if they still need the Bipap. Give them a try off the mask and check a gas. If they can fly great. If they still need the Bipap put it back on and sedate as needed. If you wind up having to tube them then so be it. If you titrate up with the meds judiciously you won't be doing it unnecissarily.

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Agreed. I usually give morphine 2 mg IV and diazepam 2-5 mg IV on my SOB pt's that are rocking-and-rolling. If it's pulmonary edema and I'm without a line, I'll often give ntg and captopril SL to boot while I'm waiting for respiratory to get their stuff in play, and the RN to establish access. I usually let the ntg loosen things up for 15-20 minutes before I give lasix which can cause temporary vasoconstriction. Some pulmonary edema folks don't even need the lasix as the ntg can allow them to auto-diurese. But then again, this thread isn't about pulmonary edema...I digress.

Will