课件：小儿急症.ppt

The Sick Child Beverly Young, MD 2010 The Warren Alpert Medical School of Brown University * Have you seen children die?你见过儿童死亡吗？Discuss with your partner:与你周围的人讨论： What was the cause of death? 死因是什么？ What treatment did the child receive? 孩子接受过什么治疗？ What worked, and what didn’t? 哪些治疗有效，哪些无效？ * Children die in 2 ways:儿童死亡的两个原因： Respiratory failure 呼吸衰竭 Inadequate tissue perfusion 体液丢失 * 3 causes for inadequate tissue perfusion体液缺乏的3个因素: Hypovolemia 血容量不足 Poor distribution of body fluids 体液分布异常 Heart dysfunction 心脏功能障碍 * Major causes of child death儿童死亡的主要原因: Cardiac Dysfunction 心脏功能障碍 Congenital heart disease 先天性心脏病 Myocarditis 心肌炎 Respiratory Failure呼吸衰竭 Inadequate Perfusion体液不足 Blockage of major airways 气管堵塞 Choking 气管异物 - Epiglottitis 会厌炎 Abscess 脓肿 Mass 肿块 Blockage of small Airways 小气道堵塞 Asthma 哮喘 Bronchiolitis 支气管炎 Lung disease 肺疾病 Pneumonia 肺炎 Heart disease 心脏疾病 Hypovolemia 血容量不足 * Most common* Hemorrhage 出血 Dehydration 脱水 Maldistributionof body fluids 体液分布不良 Massive infection 肿块感染 (septic shock感染性休克) Anaphylaxis 过敏反应 Severe burns 烧伤 * Children’s Respiratory Rate儿童呼吸频率 The younger the child, the faster the respiratory rate.孩子越小，呼吸频率越快 Fast breathing is a sign of respiratory distress or other illness.呼吸加快是呼吸窘迫或其它疾病的迹象 If a sick child’s respiratory rate drops, it may signal impending respiratory failure.如果患儿的呼吸频率急速下跌，可能预示着即将发生呼吸衰竭。 Age 0 – 1 岁year 2 – 4 岁years 4 – 10 岁years 10岁 years Normal Respiratory Rate 20 - 40 20 - 30 20 - 25 12 - 20 * Identifying Respiratory Distress判断呼吸窘迫 Increased respiratory rate 呼吸频率加快 Nasal flaring 鼻翼扇动 Retractions – above the sternal notch, below the ribs凹陷—胸骨上窝，膈肌凹陷 Decreased air movement on auscultation 听诊呼吸音减弱 Wheezing, crackles on auscultation 哮鸣音、湿啰音 Lethargy 嗜睡 Cyanosis 紫绀 Sometimes there is an obvious cause – choking, history of asthma, known pneumonia or heart disease 有时会有一个明显的病因—窒息、哮喘史、肺炎或心脏疾病 * Identifying Inadequate Perfusion辨认体液不足 Heart Rate 心率 Systemic Perfusion 体循环 Blood Pressure 血压 *