风湿病急危重症课件.ppt

* The patient is hypoxaemic * Despite near maximal oxygen therapy by facemask * His tachypnoea also indicates that his respiratory failure is severe * And his agitation and metabolic acidosis indicate tissue hypoxia * Furthermore he is only on the first day of antibiotic therapy for community acquired pneumonia and he is therefore unlikely to respond rapidly to treatment of his underlying condition. The risk benefit ratio therefore favours ventilation. * 对于清醒病人，向其解释你将要对他做什么非常重要，能减轻病人的焦虑 如果你缺少插管经验，可能在插管过程中需要有经验的人的帮助，那么就应预先让他做好准备以便需要时能立即到场。气管插管遇到困难时，任何的帮助都将是有用的。 下面这点怎么强调都不过分：当你觉得需要帮助时，不要有任何犹豫。 * 必须准备好基本装备并确定其工作状态良好。装备不完善可以导致不良事件发生，而某些装备缺乏或工作状态不良可能导致灾难性的的不良事件 可以列举一些例子 氧源 吸引器 监护仪 插管器械 药物（包括建立静脉通路用品） * 气道管理可分为基础气道管理的高级气道管理 开放气道的基本手法 将头部后仰是简单有效的减轻气道梗阻的方法。以一只手用力下压前额使得寰枕关节后伸，从而使头部后仰。 用另一只手的手指放在下颌的骨质部分，将下颏往前提，从而将下颏完全抬起。 注意 舌头被提起从而离开后咽部〔原句中第一个“posterior pharynx ”似乎是多余的〕 * 当其它开放气道的方法失败时可用仰头举颌开口法（开放气道三步手法） 将患者头后伸，双手分别握住其下颌支向前上方推，用两拇指将患者的下嘴唇打开。 对于颈椎损伤的患者开放其气道时应十分小心－详细方法见关于创伤的讲座 * * * * * * * 总结。患者出现以下问题时，应引起临床医师的警觉，特别是急性起病或程度严重时。合并这些问题越多，患者病情可能越严重 * Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, For the International Sepsis Definitions Conference. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250-1256 * Delay in administration of antibiotics or administration of inappropriate antibiotics results in worse outcome * 以上措施应该尽快完成，目标是在1小时内应用抗生素，同时应对患者进行液体复苏、做出诊断并采集病原学标本。 * Anemia of chronic diseases is seen in some rheumatologic diseases, especially in rheumatoid arthritis and systemic lupus erythematosus [64] [65] [66] . The hemoglobin in these patients rarely drops below 8 g/L, however. A lower hemoglobin level is usually associated with iron-deficiency anemia resulting form chronic gastrointestinal blood loss. Anemia of chronic disease can be distinguished from anemia of chronic blood loss by reduced serum iron-binding capacity and serum iron, although the ratio o