Respiratory system 9 emergency treatment, comprehensive and practical! (I)

A severe asthma, asthma acute attack, the general application of antiasthmatic drugs including intravenous aminophylline small dose glucocor


A severe asthma, asthma acute attack, the general application of antiasthmatic drugs including intravenous aminophylline small dose glucocorticoid treatment can relieve at 24 h, is a severe attack of bronchial asthma. The clinical manifestations of 1 patients not supine, irritability, sweating, speech is not consistent; 2 respiration is greater than 30 times per minute, respiratory motion decreased, three concave syndrome, Qi vein; blood gas analysis 3 PaO2< 60 paco2=" " > 45 mmHg, pH 4; X-ray showed pulmonary gas filling over 5; wheezedisappeared from obvious to. The principle of treatment relieves the panting, dredge the airway, and immediately gives oxygen to improve the difficulty of breathing and correct the acid-base imbalance. Emergency plan 1, sitting posture and the environment and be back support, peaceful environment and good ventilation, attention to relieve the patient's anxiety and tension. 2, to ensure smooth airway and correct hypoxia. (1) the sputum clearance and assist sputum suction. Before and after sputum aspiration should pay attention to high flow oxygen inhalation; (2) 4-6 L/min, and proper humidification; (3) if necessary, manual or mechanical ventilation. 3, and expanded support to improve ventilation function, reduce the difficulty in breathing. (1) sublingual 5-10 or Mg (d) of 0.1% of epinephrine was injected with either 0.5 mg or 3-4. (2) 0.25 or 0.5% mg xiaoerzhichuanling salbutamol 1 mg diluted aerosol inhalation. (3) 0.25 g plus 25% Glucose Injection aminophylline 100 ml intravenous drip, the total should not exceed 1.5 G. 4. The key to successful treatment is early and adequate use of corticosteroids. Hydrocortisone or dexamethasone 20 100-400 mg 500 ml mg is added to the liquid infusion, each 6-8 1 h, 3 d after the symptoms can switch to oral maintenance. The principle of medication in a week or so. 5, correct dehydration and saline alkali imbalance (1) isotonic 2000-3000 ml/d, keep the urine volume of > 1000 ml/d; () 5%NaHCO3 100-200 ml intravenous drip; (3) should pay attention to timely urine potassium. 6, the anti infection should be large doses and combined application, attention to the selection of sensitive antibiotics based on drug sensitivity test. The other 1, to stop breathing when necessary to take emergency preparedness, tracheal intubation or tracheostomy to try to save the patient's life. Reflect 2, close observation of disease and medication: including dyspnea, wheeze, heart rate, blood pressure, blood gas analysis and ECG changes and timely give emergency treatment. 3, guard against complications such as pneumothorax and mediastinal emphysema. 4, to ensure the effect of oxygen therapy, do a good job observation and nursing of artificial respiration. 5, to stabilize the patient's emotions, the treatment of rapid and orderly. 6, active treatment, removal of predisposing factors. Two. Acute respiratory distress syndrome (ARDS) is characterized by acute progressive dyspnea and hypoxemia, which is common in shock, severe trauma and infection. The 1 clinical manifestations, dyspnea, cyanosis and irritable anxious sweating; 2, hypoxemia; 3, a small amount of lung rales; 4, a large number of X-ray sheet infiltrates. The emergency plans 1, procumbent or Fowler position (according to the illness and the patient will), keep quiet, relieve anxiety and fear. 2, correct hypoxemia, take the following measures: (1) immediately give oxygen and clear the respiratory tract secretion self-criticism, keep the respiratory humidification. The oxygen flow rate of 6-8 L/min; (2) when necessary should be performed immediately tracheotomy or tracheal intubation mechanical ventilation; (3) immediately to the positive end expiratory pressure, to high concentrations of oxygen to PaO2> 60 mmHg, oxygen saturation was above 90%; (4) using quantitative 10-15 ml/ kg air respirator, ridicule, ventilation volume 20 L/min. 3, immediately open up vein passage and maintain sufficient effective circulating volume, timely pumping blood biochemical and blood gas analysis. 4, to eliminate pulmonary edema and prevent pulmonary alveoli, improve microcirculation. (1) phentolamine 5-10 mg added 10% Glucose Injection 500 ml intravenously, 2 D; (2) DIC can be treated with heparin. 5, active treatment. 6, adrenal cortical hormone application should be as early as possible, large dose, short course of treatment. Hydrocortisone or dexamethasone 1000-2000 mg/d, 20-30 mg intravenous injection, 3 D, can also be used methylprednisolone therapy. Used 2 D, began to reduce the amount of 1 weeks, such as no effect as soon as possible to disable. 7, if the need for rehydration, rehydration should follow the following two principles: (1) be sure to maintain a negative balance of the liquid (-500-1000 ml), can be used as appropriate albumin and diuretics. (2) the reasonable input of crystal and colloid solution, the early stage should be crystal oriented, to prevent aggravating pulmonary edema. 8, vigilance with or without organ failure and respiratory heartbeat stop, do the necessary rescue preparation. Other treatment 1, close observation of the disease, especially pay attention to the detection of respiratory distress, hair forceps, hypoxemia and acid imbalance, and timely symptomatic rescue. 2, pay attention to artificial airway patency and humidification, timely removal of secretions, to ensure the effect of oxygen. 3, according to the condition of the timely adjustment of ventilator parameters, to ensure the treatment effect. 4, do a good job of patients and their families to explain the comfort, get together and pay attention to the patient warm. 5, actively prepare good rescue supplies in time for treatment. Three, acute respiratory tract obstruction due to foreign body aspiration or chest trauma after a large number of airway secretions, airway mucosal edema and smooth muscle spasm caused by pulmonary atelectasis and systemic hypoxia. 1, the clinical manifestations of inspiratory dyspnea; 2, inspiratory phase wheezing, or decreased breath sounds; 3, cyanosis, cold extremities; 4, X-ray visible atelectasis, foreign body or patchy shadow. The emergency plan 1, take a side or prone position, the tongue is moved forward, the blockage by means of gravity leads, keep fresh air in the ward. 2, immediately clear the mouth, nose, throat secretions and vomit, remove the dentures, if necessary, can be used to pull the hand, suction aspirator, emergency when the taste of artificial sputum suction. Respiratory obstruction should be identified as soon as possible. 3, raise the mandibular angle and move up, the tongue forward out of the airway, wrapped with gauze or tongue forceps will pull the tongue. 4, such as the Department of nasal or nasal bleeding, nasal cavity gauze packing method. 5, foreign bodies should be given immediately after removal of oxygen, 4-6 L/min. 6, such as severe airway obstruction and associated with maxillofacial trauma or throat and pharyngeal foreign body in widely occur near death state, should be performed immediately and at the same time for tracheotomy thyrocricoid puncture. 7, spontaneous breathing did not recover, should be treated with endotracheal intubation, or bedside bronchoscopy and the removal of the foreign body, prompting atelectasis lobe reopening, improve ventilation. 8, even if the extraction of sputum and secretion. 9, diuresis, can choose the following drugs: (1) 20-40 mg with furosemide infusion liquid. (2) Mannitol Injection Glucose Injection ml 250 or 40% ml 100 quick drop. 10, the use of dexamethasone 5-10 mg to add intravenous drip, while giving enough antibiotics. Other treatment 1, close observation of vital signs, hypoxia and consciousness state, to ensure timely supply of oxygen. 2, such as patients with asphyxia caused by cardiac arrest, should be carried out immediately rescue heart, lung, brain resuscitation. 3, as soon as possible to remove respiratory obstruction is the key to successful rescue. To stimulate the cough, back heel beating method on abdominal compression, prompting foreign loose or discharged. 4, keep the patient calm, irritability, attention to the appropriate constraints to prevent falling bed. 5, if you need to move and transport the patient, should be ready for the establishment of artificial airway and continue to oxygen. Four, severe pulmonary heart disease cause lung, chest or pulmonary artery chronic chronic lesions caused by increased pulmonary circulation resistance, pulmonary hypertension, and then make the right heart failure disease. Mainly for the breath extremely difficult, lips clamp, not lying, sputum, weak heart, abdominal distention, lower limb swelling, severe coma, high mortality rate. 1 clinical manifestations of dyspnea and cyanosis; 2 mental and neurological symptoms of mental disorder, mania, coma, convulsions and other symptoms; 3 blood and circulatory system: heart rate, cardiac output increased, high blood pressure, arrhythmia, circulatory failure; 4 hematemesis, hematochezia, oliguria, anuria; other: headache, 5 sweating, muscle twitching, conjunctival congestion and edema. 6 blood gas: PaO< paco2=" " > 45 mmHg; 60. The emergency plans, 1 position and environment semirecumbentposition, keep quiet and room temperature, maintain good ventilation. 2, immediately open the vein to facilitate the use of rescue medication. 3, active control of infection sensitive antibiotics selected and combined medication. 4, improve respiratory function and hypoxia. (1) immediately to oxygen, with continuous low flow is appropriate, usually 1-2 L/min; (2) to maintain airway patency and airway humidification, good sputum discharge; (3) if necessary, tracheal intubation or mechanical ventilation; (4) the application of respiratory stimulant, according to the condition of action selection, often used for Nicole Rizal m 0.375-0.75 g slow intravenous injection, or 3-3.75 g with 500 ml liquid intravenous drip slowly, note the close observation of the disease timely adjust the dropping speed; (5) on pulmonary encephalopathy and timely to symptomatic treatment. 5, the control of heart failure (1) should be carried out immediately in the basis of infection control and correct respiratory failure; (2) the use of diuretics, its principle is small, intermittent, combined with medication, such as furosemide 20-40 mg intramuscular injection or intravenous injection, Rone (spironolactone) 20-40 mg intramuscular injection, pay attention to prevent the electrolyte disorder (; 3) application of cardiotonics: the principle of fast, low dose, anti poisoning. Such as digoxin Lanatoside C0.2-0.4 0.1-0.2 mg, Mg slow intravenous injection etc.. 6, correcting acid-base imbalance and electrolyte disturbance (1) blood gas show call acid alkali, PH< 7.2, can be used 5%NaHCO3 50-100 ml intravenous drip; (2) acid poisoning prone to hyperkalemia, can drink with calcium or 5% Glucose Injection 500ml 8-12 U plus insulin infusion; (3) simple to acidosis, oxygen therapy and basic drugs; (4) respiratory alkalosis, high concentrations of oxygen to 6-8 L/min parallel positive end expiratory pressure; (5) low potassium hypochloremic alkalisis should replenish potassium, sodium, chloride, and timely application of potassium sparing diuretics. 7, application of glucocorticoid hydrocortisone or dexamethasone 100-200 mg 5-10 mg with liquid infusion. The other 1, attention to prevention and treatment of complications, such as upper alimentary tract hemorrhage, cerebral edema, shock and the occurrence of ARDS need timely rescue; 2, close observation, especially consciousness, spirit, hypoxia, heart rate (Law) and urine volume changes, and symptomatic treatment; 3, positive treatment; 4 when necessary, the auxiliary immunotherapy and nutrition and energy

Source: sound of Medicine

Cerebral Vascular Disease,Acne,Heart Disease,Deaf,Headache,Std,Condyloma Acuminatum,Fibroid,Pneumonia,Brain Trauma,。 Rehabilitation Blog 

Rehabilitation Blog @ 2018