急诊学教学课件：Mechanical Ventilation.ppt

I am not inflating pump plus computer * Radiograph of a patient with a large spontaneous tension pneumothorax. Immediately place the patient on 100% oxygen, ventilate the patient if necessary, and evaluate the patient for evidence of respiratory compromise, hemodynamic instability, or clinical deterioration.?The basic principle for emergent needle decompression is to introduce a catheter into the pleural space, thus producing a pathway for the air to escape and relieving the built-up pressure. Although this procedure is not the definitive treatment for tension pneumothorax, emergent needle decompression does arrest its progression and serves to restore cardiopulmonary function slightly. Needle length in persons with large pectoral muscles may be an issue, and long needles or angiocatheters may be necessary.[1, 2, 3]?Essentially, a large-bore (16 or 18 gauge) angiocatheter is introduced in the midclavicular line at the second or third intercostal space. Use large-bore catheters, because hemothorax can be associated with pneumothorax, and the patient may, therefore, require immediate intravenous (IV) infusion. Upright positioning, if not inappropriate due to cervical spine or trauma concerns, may be beneficial. This serves as a bridge until the definitive treatment of tube thoracostomy. The catheter is left in place until the chest tube is placed.?The procedure is as follows: * * 羊水栓塞后 vt 12-15ml/kg 峰值压力 50-70cm FIO2 0.8 -1.0 8周后 肺大泡明显 The patient had undergone mechanical ventilation for eight weeks with tidal volumes of 12 to 15 ml per kilogram of body weight, peak airway pressures of 50 to 70 cm of water, positive end-expiratory pressures of 10 to 15 cm of water, and a fractional inspired oxygen concentration of 0.80 to 1.00 in order to achieve a partial pressure of carbon dioxide that was less than 50 mm Hg and a partial pressure of oxygen that was 80 mm Hg or higher. Computed tomography (CT) performed two days before the patient died revealed a paramediastin