Hypoxia,RespiratoryFailureandAlteredMentalStatus[缺氧，呼吸衰竭和精神状态改变](PPT-58).pptVIP

Hypoxia, Respiratory Failure and Altered Mental Status Alicia M. Mohr, MD Surgical Fundamentals Session 2 July 21, 2006 Objectives To learn a logical method for determining the nature of respiratory failure and its treatment To determine if a patient requires intubation and ventilation To learn the differential diagnosis and treatment of altered mental status History History Can’t catch my breath Lightedheadedness Usually acute onset Minimal symptoms Physical Exam Findings Physical Exam Findings Tachypnea Dyspnea Retractions Nasal flaring Grunting Diaphoresis Tachycardia Hypertension Case Study #1 59 year old man underwent a Whipple two days ago. You are called because he developed a sudden onset of dyspnea and he desaturated. His temp is 37.3o, his HR is 120, RR 24 and BP 80/50. He is anxious with decreased breath sounds at bilateral bases. Case Study #1 Signs of respiratory distress Nasal flaring Sternal retractions Tripoding Use of accessory muscles Tachypnea Cyanotic Anxiety, restlessness Case Study #1 His CBC and lytes are normal ABG pH 7.45 PaCO2 28 mmHg PaO2 72 mmHg CXR shows mild left lower lobe atelectasis Indications for Intubation Indications for Intubation Airway protection Loss of gag reflex, GCS 8 Massive facial trauma 2. Failure to ventilate Increased work of breathing PaCO2 55 mm Hg 3. Failure to oxygenate Hypoxemia or PaO2 60 mm Hg Severe metabolic acidosis or shock Need for bronchopulmonary toilet Case Study #1 His CBC and lytes are normal ABG pH 7.45 PaCO2 28 mmHg PaO2 72 mmHg CXR shows mild left lower lobe atelectasis Pathophysiology of Respiratory Failure Due to mismatch of ventilation and perfusion in lung units Case Study #2 22 year old man was admitted five days ago after an MVC. He sustained a left rib fractures, a left pneumothorax and a left femur fracture. The nurse states the patient is short of breath. His temp is 37.1o, his HR is 95, RR 30 and BP 120/70. His saturation on room air is 85% Differential