儿科危重症识别与急救.ppt

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2024-05-10 发布于广东
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儿科危重症识别与急救.ppt

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**?Answers：AssessmentoftheABCsrevealschatthephysiologicstatusiscardiorespiratoryfailure.Initialinterventionsareto-Deliveroxygen-Assistventilations-Monitorheartrate-Assessthepatient’sresponse,particularlynotingchangesinHR，color,andrespiratoryeffort-Oxygenationmaybeevaluatedwithpulseoximetry.**?TheABCsrevealthatthephysiologicstatusisdecompensatedshock.?Probablecause，byhistoryisdehydration(hypovolemic).?Thenextstepistoobtainvascularaccessrapidlyifthishasnotbeenachieved.?Question：Whatisthenextstepintherapy?Answer：Fluidbolus**?Thisinfanthadongoingfluidlossesduetodiarrheaduringtheresuscitationandrequired100ml/kgofvolumeexpansionduringthefirst4hoursofhospitalization.**?Notenormalheartsizeandabsenceofpulmonaryedemaonchestx-raydespiteadministrationof100ml/kg.?Chestfilmsarenotindicatedtomonitorfluidadministrationbutmaybehelpful.**?Thephysiologicstatusiscardiopulmonaryfailure．?Thefirstinterventionistodeliverahighconcentrationofoxygenasyouassistventilations，thenreassess.**?Thephysiologicstatusisdecompensatedshock.?ThenextinterventionistomonitortheHR,intubate,ventilate，andobtainvascularaccess.?Question：Whatisthenextstep?Answer：Administeronefluidbolus.?Theinfantfailstorespondtofluidbolus.Question:Whatisthenextstep?Answer:Historydoesnotsuggesthypovolemia.Cardiogenicshockshouldbeconsidered,andachestX-rayshouldbeevaluated.Istheliverenlarged?**?Cardiomegalyonchestx-rayobtainedafter20ml/kgofnormalsalinepointstocardiogenicshock.?Treatmentofcardiogenicshockisdiscussedlaterinthiscourse；thekeyistoimprovecardiacfunctionanddecreasedemandontheheart.**?Tachypneaisoftenthefirstsignofrespiratorydistress.ARRofmorethan60breathsperminisabnormalinallagegroups.Asloworirregu