TAEM10:Respiratory distress

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<ul><li> 1. Respiratory distress Dr.Rapeeporn Rojsaengroeng Emergency DepartmentRamathibodi Hospital</li></ul> <p> 2. (respiration) </p> <ul><li> metabolism </li></ul> <p> 3. </p> <p> 4. 5. Respiratory failure 6. </p> <p> 7. 8. 9. 10. Case 60 RR=36/min Lung- wheeze ,O2sat(RA) =80% 11. Hypoxic-Hypercapnic respiratory failure </p> <ul><li>ABG- pH=7.2, PaO2=45,PaCO2=90 </li></ul> <ul><li>Hypoxic RF -open airway, O2, ventilator </li></ul> <ul><li>Hypercapnic RF - ventilator</li></ul> <p> 12. COPD 13. </p> <ul><li> irreversible airflow obstruction </li></ul> <p> 14. 15. 16. 17. 18. 19. Drug</p> <ul><li>Beta2 agonist </li></ul> <ul><li>Anticholinergic drug </li></ul> <ul><li>Steroid </li></ul> <ul><li>Tiotropium</li></ul> <p> 20. 21. 22. 23. 24. 25. 26. </p> <ul><li> long term oxygen therapy </li></ul> <ul><li>Indications of LTOT </li></ul> <ul><li>-PaO2 20 / </li></ul> <ul><li>respiratory rate &gt;30 / </li></ul> <ul><li>low blood pressure</li></ul> <ul><li>(systolic600 ./ 200 ./ </li></ul> <p> 65. 66. 67. </p> <ul><li> massive hemoptysis ICU </li></ul> <ul><li> active massive hemoptysis ET tube 8 double lumen endotracheal tube</li></ul> <p> 68. 69. 70. pneumothorax </p> <ul><li>Spontaneous pneumothorax </li></ul> <ul><li>- primary secondary </li></ul> <ul><li>traumaticpneumothorax </li></ul> <p> 71. primary spontaneous pneumothorax </p> <ul><li> ,marfans syndrome mitral valve prolapse </li></ul> <ul><li>subpleural bulla lung apex </li></ul> <p> 72. secondary spontaneous pneumothorax </p> <ul><li>COPD , </li></ul> <p> 73. </p> <p> 74. </p> <ul><li> pneumothorax CXR - AP </li></ul> <ul><li><ul><li>-expiratory CXR </li></ul></li></ul> <ul><li><ul><li>-lateral decubitus( ) </li></ul></li></ul> <p> 75. 2 76. 77. 78. 79. primary spontaneous pneumothorax </p> <ul><li>20% 6 CXR </li></ul> <p> 80. ICD </p> <ul><li>2.5 / ICD ( 7F-14F)</li></ul> <ul><li>Primary spont pneumothorax 1/3(16-50%) 2 ICD </li></ul> <p> 81. Secondary spont pneumothorax </p> <ul><li> 39-47% ICD( 20-28F) pleurodesis </li></ul> <ul><li> ICD 4-7 </li></ul> <p> 82. 83. Pleural fluid </p> <ul><li>Transudate Exudates</li></ul> <ul><li>Transudative pleural effusion hydrostatic pressure oncotic pressure </li></ul> <ul><li>Exudative effusion </li></ul> <p> 84. 85. Lights criteria </p> <ul><li>98% &gt;1 exudate </li></ul> <ul><li>Protein-pl/ protein-se &gt;0.5 </li></ul> <ul><li>LDH-pl/ LDH-se &gt;0.6 </li></ul> <ul><li>LDH-pl &gt; 2/3 upper limit of normal LDH-se </li></ul> <p> 86. </p> <ul><li>Amylase pleural effusion esophageal rupture ( 10%) </li></ul> <ul><li> adenosine deaminase &gt;45 IU/L- TB pleura </li></ul> <ul><li> cytology pleural effusion 40- 87% </li></ul> <ul><li> Hct pleural fluid &gt;50% hemothorax </li></ul> <p> 87. 88. </p> <ul><li> &gt;1500 Postexpansion pulm. Edema </li></ul> <ul><li> loculated effusion streptokinase urokinase </li></ul> <ul><li>Pleural fluid pH</li></ul>