HypoxiaRespiratoryFailureandAlteredMentalStatus缺氧呼吸衰竭和精神状态改变.pptxVIP

会计学1HypoxiaRespiratoryFailureandAlteredMentalStatus缺氧呼吸衰竭和精神状态改变 ObjectivesTo learn a logical method for determining the nature of respiratory failure and its treatmentTo determine if a patient requires intubation and ventilationTo learn the differential diagnosis and treatment of altered mental status第1页/共58页 第2页/共58页 History and Physical Exam Diagnosis Operation performed Co-Morbidities AgeChest X-rayLab Electrolytes Arterial Blood GassPulse OximetrySa02 90%Sa02 90%Remains agitatedand risk for withdrawal(alcohol +/or drug)May sedate withShort-acting benzodiazepine or haldolStep 1Assess AirwayStep 2Step 3Assess CirculationIntubatedNot intubatedETT good positionCheck CXR(go to step 2)Re-intubateintubateHemodynamically stableAssess BreathingHemodynamicallyunstable with ? breath soundsCheck CXR, ABGTubethoracostomyPulses absentACLS protocolPulses presentAssess cardiacstatus- ie.arrythmiasLabs ABG normalETTdislodgedMini-neuro examReview chart for medicationsConsider need for CTHCall for Altered Mental StatusDesaturation or Respiratory distressASSESS PATIENT第3页/共58页 History??第4页/共58页 HistoryCan’t catch my breathLightedheadednessUsually acute onsetMinimal symptoms第5页/共58页 Physical Exam Findings??第6页/共58页 Physical Exam FindingsTachypneaDyspneaRetractionsNasal flaringGruntingDiaphoresisTachycardiaHypertensionAltered mental statusConfusionAgitationRestlessnessSomnolenceCyanosis (need 5mg/dl of unoxygenated blood) 第7页/共58页 Case Study #1 59 year old man underwent a Whipple two days ago. You are called because he developed a sudden onset of dyspnea and he desaturated.o, his HR is 120, RR 24 and BP 80/50. He is anxious with decreased breath sounds at bilateral bases. 第8页/共58页 A - AirwayB - BreathingC - CirculationOxygen delivery to tissuesCarbon dioxide removal from tissuesAssess, change, reassess第9页/共58页 Case Study #1Signs of respiratory distressNasal flaringSternal retractionsTripodingUse of accessory musclesTachypneaCyanoticAnxiety, restlessness第10页/共58页 Case S