An in-depth look at the management of hyponatraemia, with special attention to a new concept called the “dDAVP clamp.”
– only treat hyponatraemia if symptoms are severe – coma, seizures or severe delirium
– use 3% saline 100ml, up to three doses
– consider giving dDAVP to prevent a rapid climb in the serum sodium
– aim to correct the serum sodium by only 3-6mmol/L in the first 24 hours
A BVM (with PEEP valve) will provide better pre-oxygenation than a NRBM (non-rebreather) AS LONG AS THERE IS A GOOD SEAL.
Adding nasal cannulae may worsen pre-oxygenation a little, likely more than offset by the additional benefit of apnoeic oxygenation.
For me, the problem with a BVM is that the airway practitioner isn’t solely focused on achieving a good seal during pre-oxygenation. They’re doing other things – prepping the eam/patient/equipment etc. Therefore, I’d suggest NRBM and NPs as routine, especially for more inexperienced practitioners. If using a BVM (with PEEP valve), the airway practitioners sole focus needs to be on maintaining a seal.
Also, remember to sit the patient up and use CPAP if necessary.