(精选)Shortness of breath教学课件.pptVIP

Shortness of breath PGY 2 - Jude Khatib Learning objectives 1) Initial approach to a patient with acute SOB (within seconds)Stabilizing the patient 2) Evaluation of a patient in SOB, DDxWhy is this patient SOB? 3) Management options in acute SOB How can I fix this? Case #1 You are the intern on NF, you get a page on the Hellerstein pager. You call the nurse back and she tells you that “Mr. K looks like he is struggling to breathe, he doesn’t look good. I’m worried” …Next question?  VITALS! Initial approach (seconds/minutes) 1)Vitals : Stable/unstable –sick? HR tachycardia (arrhythmia, ST 2/2 edema or PE, SIRS/sepsis) BP Severe HTN (flash pulmonary edema), hypotension (large PE, MI, sepsis) Temp Fever: PNA, VTE O2 Sats Current/baseline Oxygen requirement Is pt supposed to be on 4L at baseline and currently on RA? Supposed to be on BiPap but not? Simple fix! Patient’s appearance/mental status/new complaints (eg emesis, CP) Hypercapnia, hypoventilation, aspiration event Recent meds/transfusions/IV fluids Consider narcotics?hypoventilation, TRALI, continuous IV fluids w/pulmonary edema More information Mr. K’s Vitals: HR 110, BP:180/90, Sat 78% on 4L NC (baseline 94% 2L prior to this event), T:37.0 Next steps?... Go see the patient!! Think about stabilizing patient (more oxygen?)/Treat easily identifiable reversible cause (read your signout), check code status On your way Mr K is a 75 yo M with severe III COPD (on home 2L), HFrEF (EF20% in 03/2016), CAD (s/p PCI to LAD) who is presenting with weight gain, worsening SOB likely 2/2 to volume overload on a background of running out of his furosemide tabs, plan is to optimize volume status and continue diuresis. Code status: Full code At the bedside Mr. K’s Vitals: HR 110, BP:190/90, Sat 75% on 4L NC (baseline 94% 2L prior to this event), T:37.0 -Next step?.. -Stabilize: More 02??Nasal cannula -Face Mask -Non rebreather- NIPPV (MICU) - Intubation (MICU) --Recheck: HR 100, BP:170/80, Sat 90% on venti mask