课件：风湿病急危重症.ppt

* * * * As always, it is vital to treat the cause as supportive therapy is futile if the underlying problem is not corrected. Supportive treatment consists of oxygen therapy, CPAP and mechanical ventilation. Click on a button to select a topic or click on the return button to return to the main menu * Oxygen delivery devices can be divided into fixed performance devices and variable performance devices * Other oxygen delivery devices include reservoir face masks which deliver up to 70% oxygen depending on the oxygen flow rate and bag valve resuscitators which 100% oxygen if applied tightly to the face. It is important to realise that patients can breath spontaneously through a bag valve resuscitator. * For patients with respiratory failure which is predominantly due to shunting CPAP may improve oxygenation dramatically by re-opening and keeping open collapsed alveoli * The decision whether or not to ventilate a patient is a complex decision which takes into account many factors and as a result there are no simple rules for when to ventilate a patient. * Non-respiratory indications for intubation. For example the patient may require intubation and mechanical ventilation for surgery, * 现在可以对呼吸衰竭患者进行无创的机械通气。因此，呼吸衰竭本身不再是气管内插管的绝对指征。 气管插管应用举例： 气道梗阻 意识障碍（由于自身的软组织造成气道梗阻等） 气道梗阻（由于过敏反应引起肿胀，血肿造成外压等所致） 严重的代谢性酸中毒(exhaustion expected？) 需要高呼气末正压的机械通气或呼吸肌麻痹的患者需机械通气 成人呼吸窘迫综合症、大量误吸 需要气道吸引的患者 肌无力、重症肌无力、大颗粒物吸入等 * Major factors to be considered include severity of respiratory failure * These principles are best illustrated by clinical examples. The first is a 43 year old male with community acquired pneumonia who was started on appropriate antibiotics the previous day. On 15 l/min of oxygen via a reservoir facemask his arterial blood gases show a Po2 of 8 kPa, Pco2 of 4 kpa and a pH of 7.15, his respiratory rate is 35/min and he is agitated. Should he be ventilated? * The patient is hypoxaemic * Despite near maximal oxygen therapy by facemask * His tachypnoea also indicates that his r