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ID:17855546
大小:1.31 MB
页数:25页
时间:2018-09-07
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1、SpecialConsiderationsObjectivesUnderstandmanagementprinciplesofseveregastrointestinalhemorrhageDiscussdiagnosisandmanagementofpulmonaryembolismReviewrecognitionandmanagementofaorticdissectionListprinciplesofpoisoningmanagementIdentifymanagementprinciplesoftemperature-relatedinjuryA49-y
2、r-oldmaleisadmittedafterbloodyemesis.Hehasahistoryofheavyalcoholuse.Bloodpressure90/40mmHgHeartrate116beats/minHematocrit24%Heisconfusedanddiaphoretic.SevereGIHemorrhage–ManagementPrinciplesAssessadequacyofairwayIntravenousaccessPromptinitialresuscitationMonitoravailabilityofbloodpr
3、oductsMonitorforsecondaryconsequencesofhypotensionandanemiaRapiddiagnosticevaluation,surgicalconsultation,transferSevereUpperGIHemorrhageEndoscopyafterlavagetoestablishdiagnosisEndoscopictherapyVaricealbleedingEndoscopictherapyVasopressinOctreotideSevereLowerGIBleedingRectalexamination
4、ConsiderupperGIsourceEndoscopyAngiography+embolizationSurgerySPC6–®PediatricConsiderations–GIHemorrhageUpperGIbleedingrareCausesoflowerGIbleeding1mo–1yr:Meckel’sdiverticulum1–2yrs:intussusception2–12yrs:polyps,childabuse,inflammatoryboweldiseasePulmonaryEmbolismAnobesediabeticpatienti
5、satbedrestwithlowerextremitycellulitis.Shehadthesuddenonsetofdyspneaandpalpitations.SheisenroutetotheED.SPC8®RiskFactorsforPulmonaryEmbolismHeartfailureAdvancedageTraumaObesityEstrogens,pregnancyRiskFactorsforPulmonaryEmbolismMalignancySurgeryImmobility,paralysisPriorembolism,thrombos
6、isHypercoagulabledisordersPulmonaryEmbolism–DiagnosisNonspecificsigns/symptomsNonspecificchestradiographECGnonspecificHypoxemiacommonbutnormalPaO2possibleLevelofclinicalsuspicionimportantSPC11®DiagnosisofPulmonaryEmbolismSuspectPEAnticoagulate(unlesscontraindicationorhighriskforbleedi
7、ngcomplication)V/Qscan**WhenV/Qscanningunavailableorlogisticallydifficult,considerpulmonaryangiogram,spiralCTorechocardiographyDiagnosisofPulmonaryEmbolismV/QscanAnticoagulation**IVCfilter****WhenclinicalsuspicionforPEislow,despitehigh-probabilitylungscan,alegstudyand/orpulmon
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