Intubation & Ventilation Scenario 13

The recovery room nightmare!

Solution

This is a common scenario, and indicate any number possible causes of hypoxemia, and is thus an excellent exhibition case. Does he have ventilatory failure? Quite possibly – he may be narcosed from excessive interoperative opioids. He may be hypoventilating due to splinting (upper abdominal pain due to surgical incision) or persistent partial neuromuscular blockade. He may have upper airway obstruction, due to loss of pharyngeal tone, obstruction with a bite block, laryngeal edema or laryngospasm. He may have severe bronchospasm, and inhaled foreign object (such as a tooth) obstructing a major bronchus, or the presence of blood or gastric contents aspirated from the upper airway. He may have lower airway collapse due to hypoventilation and or absorption atelectasis, diffusion hypoxia (due to oxygen being displaced by nitrous oxide in the alveoli) or alveolar fluid, due to excessive intravenous administration.