课件：昏迷抢救.ppt

Differentiate diagnosis 晕厥 突然发生，短暂的意识丧失状态，是由于大脑一时性供血不足所致。 癔症性昏睡 表现为卧床不语、双目紧闭，对针刺无反应，但翻开其眼睑可见眼球转动。生命体征平稳。 木僵状态 表现为不动不语，不进饮食，对外界刺激无反应，甚至可出现瞳孔改变、尿潴留等症状，无意识障碍。 闭锁综合征 表现为四肢瘫痪，不能张口、不能言语、眼球不能向两侧转动，但意识尚清。 Is there any treatment? Once an individual is out of immediate danger, the medical care team focuses on preventing infections and maintaining a healthy physical state. This will often include preventing pneumonia and bedsores（褥疮） and providing balanced nutrition. Physical therapy may also be used to prevent contractures（挛缩）(permanent muscular contractions) and deformities （畸形）of the bones, joints, and muscles that would limit recovery for those who emerge from coma. Nursing observation 1. 病情严重者每15～30分钟监测一次生命体征 2. 病情稳定者每4小时一次 Keep airway open Keep balance of water/electrolytes/acid-basse Nursing 对症处理 1. 消除脑水肿：应用高渗溶液脱水 2.促进脑功能恢复 3.保持有效低温冬眠疗效 有效标志：镇静好、但呼之能应、病人对物理降温无御寒反应，体温控制在预定范围。 降温的要求：早、低、足、稳、缓 Nursing Etiology treatment 1. 颅内占位病变 2. 脑中风 3. 药物中毒 4. 一氧化碳中毒、放射损伤 5. 颅内感染或全身感染 6. 低血糖性昏迷、高血糖性昏迷 7. 肝昏迷 8. 纠正休克 Nursing Preventing complications 1. 口腔护理 2. 防止坠积性肺炎 3. 预防褥疮 4. 做好留置尿管的护理 What is the prognosis? The outcome for coma and persistent vegetative state depends on the cause, severity, and site of neurological damage. Individuals may emerge from coma with a combination of physical, intellectual, and psychological difficulties that need special attention. Recovery usually occurs gradually, with some acquiring more and more ability to respond. Some individuals never progress beyond very basic responses, but many recover full awareness. Individuals recovering from coma require close medical supervision. A coma rarely lasts more than 2 to 4 weeks. Some patients may regain a degree of awareness after persistent vegetative state. Others may remain in that state for years or even decades. The most common cause of death for someone in a persistent vegetative state is infection, such as pneumonia. 转运途中注意事项 （1）病人平卧，头侧向一侧，保持呼吸道通顺。 （2）病人有活动性假牙，应立即取出以防误入气管