Episode Description

In this powerful and highly practical episode, Eric Bauer is joined by Dr. Scott Weingart for a deep dive into mechanical ventilation strategy, critical thinking in metabolic acidosis, and the nuanced management of obstructive lung disease. You’ll hear honest, experience-driven insights that challenge outdated protocols and provide a real-world framework for decision-making in high-acuity transport and emergency environments.

Together, Eric and Scott unpack what matters when setting minute ventilation for acidotic patients, when and why to abandon rigid tidal volume formulas, and how to navigate the delicate dance of airway management without causing more harm than good. You’ll also hear an unfiltered discussion about ventilation in DKA, PEEP misconceptions, and how to safely manage the crashing COPD or asthmatic patient when time and tolerance are in short supply.

Key Takeaways

• Minute ventilation must be tailored to context: “one-size-fits-all” protocols often fail in real-world acidotic patients.
• A tidal volume of 8–10 mL/kg is not only SAFE, it’s often necessary in early transport, especially when facing deadly acidosis.
• Not all PEEP is good PEEP! Learn when zero is the right number.
• In obstructive lung patients, the “expiratory phase” isn’t the whole story. Inspiratory flow rate and sedation play crucial roles.
• End-tidal CO₂ readings must be interpreted in a clinical context. Chasing normalization can kill.
• Sometimes the best vent setting… is no vent at all. Preserving spontaneous respiration in compensated DKA may save lives.
• DON'T default to 100% FiO₂. Understand how oxygen strategy influences alveolar recruitment and long-term outcomes.

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