hypoxia,respiratoryfailureandalteredmentalstatus[缺氧，呼吸衰竭和精神狀態(tài)改變](ppt-58)(已修改)
2025-01-24 07:14 本頁(yè)面
【正文】 Hypoxia, Respiratory Failure and Altered Mental Status Alicia M. Mohr, MD Surgical Fundamentals Session 2 July 21, 2022 Objectives ? To learn a logical method for determining the nature of respiratory failure and its treatment ? To determine if a patient requires intubation and ventilation ? To learn the differential diagnosis and treatment of altered mental status History and Physical Exam Diagnosis Operation performed CoMorbidities Age Chest Xray Lab Electrolytes Arterial Blood Gass Pulse Oximetry Sa02 90% Sa02 90% Remains agitated and risk for withdrawal (alcohol +/or drug) May sedate with Shortacting benzodiazepine or haldol Step 1 Assess Airway Step 2 Step 3 Assess Circulation Intubated Not intubated ETT good position Check CXR (go to step 2) Reintubate intubate Hemodynamically stable Assess Breathing Hemodynamically unstable with ? breath sounds Check CXR, ABG Tube thoracostomy Pulses absent ACLS protocol Pulses present Assess cardiac status ie. arrythmias Labs amp。 ABG normal ETT dislodged Minineuro exam Review chart for medications Consider need for CTH Call for Altered Mental Status Desaturation or Respiratory distress ASSESS PATIENT History History ? Can’t catch my breath ? Lightedheadedness ? Usually acute onset ? Minimal symptoms Physical Exam Findings Physical Exam Findings ? Tachypnea ? Dyspnea ? Retractions ? Nasal flaring ? Grunting ? Diaphoresis ? Tachycardia ? Hypertension ? Altered mental status ? Confusion ? Agitation ? Restlessness ? Somnolence ? Cyanosis (need 5mg/dl of unoxygenated blood) 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. His temp is , his HR is 120, RR 24 and BP 80/50. He is anxious with decreased breath sounds at bilateral bases. A Airway B Breathing C Circulation Oxygen delivery to tissues Carbon dioxide removal from tissues Assess, change, reassess Case Study 1 Signs of respiratory distress Nasal flaring Sternal retractions Tripoding Use of accessory muscles Tachypnea Cyanotic Anxiety, restlessness Case Study 1 ? His CBC and lytes are normal ? ABG pH PaCO2 28 mmHg PaO2 72 mmHg ? CXR shows mild left lower lobe atelectasis Indications for Intubation Indications for Intubation 1. Airway protection Loss of gag reflex, GCS 8 Massive facial trauma 2. Failure to ventilate Increased work of breathing PaCO2 55 mm Hg 3. Failure to oxygenate Hypoxemia or PaO2 60 mm Hg Severe metabolic acidosis or shock Need for bronchopulmona
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