SpecialResuscitationSituations特殊情况下的复苏术.pptVIP

* * note the apparently prolonged QT interval which is due to the fact that the T wave is actually a U wave with a flattened T wave merging into the following U wave * cardiac arrest from hypokalemia (ie, malignant ventricular arrhythmias): 2 mEq/min, followed by another 10 mEq IV over 5 to 10’ total body deficit: 150 to 400 mEq for every 1mEq ? serum K+ * * * * * * * * * * * * * * * * * * * * * Increased calcitriol production can occur in patients with chronic granulomatous diseases (eg, sarcoidosis) and in occasional patients with lymphoma: give glucocorticoid * * * * * 高血鎂 心電圖變化 PR、 QT 延長 QRS 變寬 P波電位變小 T波變高 Complete AV block、Asystole * 處置 補鈣離子 CaCl2 ( 5 to 10 mEq IV ) 可避免致命性心律不整 移除血鎂 血液透析 腎及心血管功能正常 IV N /S + furosemide 減少攝取 * 低血鎂 血鎂 1.3 mEq/L 比高血鎂症常見 吸收減少、流失增加所致 PTH或某些藥物 (eg, pentamidine, diuretics, alcohol) 補乳婦女:高危險 * 低血鎂 - 原因 * GI loss: bowel resection, pancreatitis, diarrhea Renal disease Starvation Drugs: diuretics, pentamidine, gentamicin, digoxin Alcohol Hypothermia Hypercalcemia Diabetic ketoacidosis Hyperthyroidism/hypothyroidism Phosphate deficiency Burns Sepsis Lactation 低血鎂 - 症狀 肌肉震顫、束顫或強直 眼球震顫 意識改變、運動失調、眩暈、抽搐、吞嚥困難 低血鈣、低血鉀 * 低血鎂 - 心電圖變化 QT延長 末段T波倒置 Heart blocks VF * 處置 Severe or symptomatic hypoMg 1 to 2 g IV MgSO4 over 15’ Torsades de pointes 2 g of MgSO4 over 1 - 2’ Seizures 2 g IV MgSO4 over 10’ Calcium gluconate (1 g) 大部分有 hypoCa 腎功能不全者小心補 * 鈣 1/2 Ca in the ECF: bound to alb Alkalosis: Ca-alb binding ? ? Ca2+? Acidosis ? Ca2+? serum alb ? 1 g/dL ? total serum Ca ? 0.8 mg/dL (Ca = Serum Ca + 0.8 * (4 - Albumin)) In hypoalb., Ca2+ may be normal Ca antagonizes K and Mg at the cell mem. Ca regulated by PTH and vit. D * 高血鈣 serum Ca 10.5 mEq/L or Ca2+ 4.8 mg/dL Primary hyperparathyroidism and malignancy account for 90% cases. * 高血鈣 -症狀 Total serum Ca ≧12 to 15 mg/dL Neuro. S/S: depression, weakness, fatigue, ,confusion (at lower levels) hallucination, disorientation, hypotonicity, coma (at highe