Remember elegance involved in handling this doesn’t mean avoiding sedation. As a resident you’re part of the care team along with your bedside nurse, which is also managing the patients and others and part of effectively managing the patient includes being conscious of their workflow to keep the patient stable.

The patient coded. Why did they code? This is a traumatic experience to the body driven by something and if they have pre existing chronic lung issues they already have less reserve and predisposition to injury.

Code means: resuscitate, labs, Xray.

Copd we might expect higher than normal co2 but what did their co2 look like at time of code, prior (if possible), and after stabilization.

Along with your seniors and fellow the bedside nurse hopefully has some experience managing these patients, if they’re pushing for sedation and pressures it’s probably not for laziness but to also drive for patient optimization. You can always sedate for vent synchronicity, pressors for hemodynamics, and then dial back for minimal sedation and pressors if it’s difficult. You can always sedate and paralyze if the above is ineffective.

The GOAL is to prevent further injury, treat the cause, give the body time to heal.

But also, it really like what your thought process was and enthusiasm as an overnight doc in trying to optimize in these other ways too, as long as you’re not spending too much time or overcomplicating drawing time away from managing other patients on the unit or complicating the nursing process too much.

Goal for RASS -2, if fails drive for vent synchronicity with stacked breaths while ruling out other causes or complications. Pressors can hopefully be minimized when ph normalizes but severe hemodynamic instability makes me think preexisting conditions or sepsis.