小儿急症.pptVIP

The Sick Child Beverly Young, MD 2010 The Warren Alpert Medical School of Brown University Have you seen children die?你见过儿童死亡吗？Discuss with your partner:与你周围的人讨论： What was the cause of death? 死因是什么？ What treatment did the child receive? 孩子接受过什么治疗？ What worked, and what didn’t? 哪些治疗有效，哪些无效？ Children die in 2 ways:儿童死亡的两个原因： Respiratory failure 呼吸衰竭 Inadequate tissue perfusion 体液丢失 3 causes for inadequate tissue perfusion体液缺乏的3个因素: Hypovolemia 血容量不足 Poor distribution of body fluids 体液分布异常 Heart dysfunction 心脏功能障碍 Major causes of child death儿童死亡的主要原因: Cardiac Dysfunction 心脏功能障碍 Congenital heart disease 先天性心脏病 Myocarditis 心肌炎 Respiratory Failure呼吸衰竭 Inadequate Perfusion体液不足 Blockage of major airways 气管堵塞 Choking 气管异物 - Epiglottitis 会厌炎 Abscess 脓肿 Mass 肿块 Blockage of small Airways 小气道堵塞 Asthma 哮喘 Bronchiolitis 支气管炎 Lung disease 肺疾病 Pneumonia 肺炎 Heart disease 心脏疾病 Hypovolemia 血容量不足 * Most common* Hemorrhage 出血 Dehydration 脱水 Maldistributionof body fluids 体液分布不良 Massive infection 肿块感染 (septic shock感染性休克) Anaphylaxis 过敏反应 Severe burns 烧伤 Children’s Respiratory Rate儿童呼吸频率 The younger the child, the faster the respiratory rate.孩子越小，呼吸频率越快 Fast breathing is a sign of respiratory distress or other illness.呼吸加快是呼吸窘迫或其它疾病的迹象 If a sick child’s respiratory rate drops, it may signal impending respiratory failure.如果患儿的呼吸频率急速下跌，可能预示着即将发生呼吸衰竭。 Age 0 – 1 岁year 2 – 4 岁years 4 – 10 岁years 10岁 years Normal Respiratory Rate 20 - 40 20 - 30 20 - 25 12 - 20 Identifying Respiratory Distress判断呼吸窘迫 Increased respiratory rate 呼吸频率加快 Nasal flaring 鼻翼扇动 Retractions – above the sternal notch, below the ribs凹陷—胸骨上窝，膈肌凹陷 Decreased air movement on auscultation 听诊呼吸音减弱 Wheezing, crackles on auscultation 哮鸣音、湿啰音 Lethargy 嗜睡 Cyanosis 紫绀 Sometimes there is an obvious cause – choking, history of asthma, known pneumonia or heart disease 有时会有一个明显的病因—窒息、哮喘史、肺炎或心脏疾病 Identifying Inadequate Perfusion辨认体液不足 Heart Rate 心率 Systemic Perfusion 体循环 Blood Pressure 血压 Children’s Heart