Acute dyspnea[急性呼吸困难].pptVIP

99 100 102 103 101 4 8 75 98 DyspneaDyspnea * April, 99 Ultrasonography Echocardiography Next lecture TEE = transesophagyl echocardiogram (TEE) is 90% sensitive for large clots, very specific. This, we can’t do yet. TTE = TransThoracic echocardiogram: aortic dissection, cardiac tamponade, acute valvular lesion. This, we can do. DyspneaDyspnea * Specific entities: Asthma Pneumonia Acute Pulmonary Edema Pulmonary Embolism Emphysema Pneumo / hemothorax Carbon Monoxide (CO) Cyanide poisoning DyspneaDyspnea * Asthma: Reversible bronchoconstrictuion Air blocked between the large airways to the alveoli. Alveoli may collapse. Treatment: open the airways, prevent stacking (time enough for exhalation). Keep O2 high enough to keep patient’s brain alive. Consider steroids, permissive hypercarbia. DyspneaDyspnea * Pulmonary edema: Basic problem: Heart stretches so far it can’t contract well. (Falls off Frank Starling Curve) Cardiac oxygen demand exceeds availability. Air can’t cross the air-blood interface. Fluid seeps from the blood into the alveoli. Surfactant gets diluted. Caused by cardiac and vascular derangements. Vicious cycle. DyspneaDyspnea * Pulmonary edema: Symptoms: Sudden onset; respiratory distress, Rales, ronchi. Foamy sputum. Sometimes blood tinged. Blood pressure high (vasoconstriction) usually 240/120. If onset between 4 pm and 8 pm, likely to be associated with acute MI. DyspneaDyspnea * Pulmonary edema Treatment: increase airway pressure, to force fluids back into the vascular system, (BVM with patient effort, CPAP or intubation) increase FiO2, dilate blood vessels and reduce systemic blood pressure (which reduces the work of the heart and reduces oxygen demand). Get excess fluid off via kidneys (if working), via bleeding (bloodletting) or sequester fluid (tourniquets). DyspneaDyspnea * Diabetic KetoAcidosis DKA Tachypnea often without Air hunger metabolic derangement: blood is too acid. Respiratory system tries to compensate, gets overwhelmed. D