| Hypoventilation | - Inadequate ventilation for sufficient gas exchange (PaCO2 high and respiratory acidosis)
| Residual muscle relaxant | Administer ACh inhibitor |
| Opioid overdose | Consider 20–40 μg naloxone IV |
| Residual inhaled/IV anesthetic | Arouse patient |
| Tight abdominal binder | Release binder |
| OSA/obesity | - Reposition patient
- CPAP/BiPAP
|
| Splinting (due to pain) | Pain control |
| Premature infants/neonates | Avoid opioids, alternative techniques |
| Upper airway obstruction/stridor | - Edema/trauma, VC paralysis, arytenoid dislocation
- Secretions (blood/fluid)
- (Suspected) foreign body
| - Humidified air, steroids, racemic epinephrine aerosol
- Suction secretions/glycopyrrolate (drying agent)
- Reintubation for severe edema/trauma
- ENT consult for VC paralysis/arytenoid dislocation/foreign body removal
|
| Asthma/COPD exacerbation | | - Albuterol/Atrovent nebulizers, steroids, cromolyn sodium, aminophylline, epinephrine as last resort
- CPAP/BiPAP, reintubation for severe bronchospasm
|
| Laryngospasm | - Involuntary tightening laryngeal constrictor muscles and vocal cords
- Risk factors: young age, URI, GERD, OSA/obesity, ENT surgery
| - Positive-pressure ventilation
- If severe propofol (10–20 mg) or succinylcholine (0.1 mg/kg)
- Watch for negative pressure pulmonary edema (4% patients)
|
| Atelectasis | - Decreased breath sounds, opacification on CXR
| - Incentive spirometry
- Reposition patient
- Inhaled N-acetylcysteine, chest PT
- CPAP/BiPAP
|
| Pulmonary embolism | - ECG (S1Q3T3)
- Lower extremity Doppler
- TTE/TEE
- CT angiogram of chest
- VQ scan (if high probability)
| - Cautious fluids, invasive monitoring, consider inotropes/pressors
- Consider anticoagulation, IVC filter
- Consider embolectomy/lysis
|
- ALI/ARDS
- Transfusion-related ALI (TRALI)
| - Acute respiratory failure without cardiac failure
- Bilateral fluffy infiltrates on CXR
- ALI Pao2/FiO2 ratio <200 versus ARDS <300
| - Lung-protective ventilation (tidal volume 5–7 mL/kg)
- Treat underlying cause
|
| Pneumothorax/hemothorax, pleural effusion | | - Needle decompression, chest tube
- Surgical exploration if large hemothorax
|
| Anxiety stridor (Munchausen stridor) | - Episodic inspiratory stridor with normal flow loops
- Risk factors: female, anxiety, GERD, type A personality
| |