First Things First (assess & treat for the following)

• Is pt able to adequately ventilate?
  • Spontaneously breathing pt should be intubated if
    • New or worsening respiratory acidosis
    • Unable to handle respiratory secretions
    • Increased & unsustainable work of breathing: rapid shallow breathing, tachycardia, accessory muscle use, abdominal paradox
  • Mechanically ventilated pt should have weaning trial interrupted or ventilatory support otherwise increased if
    • Tachypnea
    • Diminishing tidal volume on spontaneous breaths
    • Tachycardia otherwise unexplained
    • Hypoxia & respiratory acidosis late signs
• Is there a reversible explanation for apparent weakness?
  • Receiving narcotics, benzodiazepines, other sedatives
  • Presence of any focal neuro abnormalities warrants urgent evaluation for new CNS injury or insult.
  • Electrolyte, calcium, magnesium, or phosphorus deficiency
  • Rule out causes of increased minute ventilation due to increased CO2 production (sepsis, fever, overfeeding carbohydrates) or increased dead space.