For the students:

11 yr old male inpatient presents for G-J tube placement because of increased reflux from G-tube, and aspiration risk.

He rolls up to interventional radiology in a bed. You notice, from a distance, that he's on bipap. Upon further examination, you note his scoliosis. After reading the chart and talking with the dad, your information is as follows:

PMH
-severe scoliosis (100 degrees per dad)
-moderate restrictive lung disease - requires bipap at night and usually can go periodically throughout the day off the bipap for a few hours. setting are 18/6. (is on bipap at home)
-mitochondrial disorder - has had anesthesia in the past without incident
-pt is non-verbal, groans when in pain, is somewhat contracted, but freely moveable, and does not follow commands of any sort.

MEDICAL THERAPY
-on TPN and lipids
-on bipap

Transport monitor shows:
BP 130s/60s
HR 60-70s NSR
Sat 98-100% on 2lpm via bipap
Vt 300-400s
PiPs 18
RR low-mid 20s

This add-on case is "booked" for an hour or so.
No further work up is possible at this time.

What do you want to do for this kid?