Question: I work with MDs that routinely order bipap for floor patients without an ABG. As an RT, I'm uncomfortable with this situation. What are your thoughts?
Answer: I think it depends on the situation and the patient. If the patient is in respiratory distress, it is sometimes necessary to treat before test results are performed (i.e., before ABGs, x-rays, labs, etc.) For example, a patient in obvious heart failure may benefit from the decreased preload BiPAP can provide. For a COPD patient, the BiPAP can help witho oxygenation (FiO2 & EPAP) and ventilation (IPAP). Also, with noninvasive testing such as SpO2 and ETCOT, he could base his decision on those, as opposed to the ABG. Personally, I think ABGs are over ordered, and a VBG would be all that is necessary to get a pH.
I have had this happen where I work to, where the patient does not meet any of the above criteria. I have also had a physician, many times, order BiPAP just based on the ABG results, when there was no indication for BiPAP. For example, the CO2 is 50.
I provide this answer not knowing the assessment nor history of the patient. .