儿科危重症识别与急救.ppt

? Palpation of peripheral pulses is an important part of the cardiovascular examination in diagnosing shock. ? Pulse quality reflects the adequacy of peripheral perfusion. ? Weak or absent pulses may indicate poor SV or increased SVR. ? Loss of perfusion in the hands and feet often precedes hypotension and critical loss of vital organ perfusion in shock. ? Hypotension often develops before loss of central pulses． ? Palpation of pulses can be used to evaluate HR, BP, CO, and SVR. ? Skin perfusion is compromised early in some forms of shock(eg, hypovolemic, cardiogenic). This loss of perfusion results from an increase in SVR and redistribution of blood flow to vital organs(brain, heart). Recall the graph showing reciprocal change between SVR and CO. ? Cool extremities suggest inadequate CO. ? Normal capillary refill should be less than 2 seconds if the ambient temperature is warm. ? Pink = normal perfusion ? Pale = ischemia ? Blue(cyanosis) = hypoxemia or inadequate perfusion with increased oxygen extraction ? Mottled = any of the above ? Two photos are shown to demonstrate a CRT of 10 seconds in a 3ms·old infant with shock and a systolic BP of 90 mmHg 1 hour before death. ? Capillary refill can be prolonged in cold ambient temperatures or when the patient is cold. ? Prolonged capillary refill is not an absolute sign of shock but it may be used in conjunction with other signs of shock. ? When evaluating capillary refill, elevate the extremity above the level of the heart to ensure that arterial(not venous) perfusion is observed. Evaluation of the child’s level of consciousness may enable evaluation of central nervous system(CNS) pedusion. ? Question participants：What are the CNS signs you might observe in a child in shock? Answer：Decreased level of consciousness ? Note the progression of deterioration with increasing perfusion impairment. ? Relate altered CNS function to inadequate cerebral oxygenation or perfusion. ? A urinary catheter enables continuous evalua