tailieunhanh - Oxford Handbook of Critical Care - part 9

Tiêm chủng trước đây chống lại hepati tis B, bệnh lao Ống nghe cần được làm sạch giữa các bệnh nhân Rõ ràng đăng ký niêm yết biện pháp phòng ngừa được thực hiện trên cánh cửa tủ Khách thăm | A cherry red appearance of the skin and mucosae are classical but not common. PaO2 will be normal unless there is respiratory depression and pulse oximetry is misleading. The half life of carboxyhaemoglobin is 4h when breathing room air and 50min when breathing 100 oxygen. Management Carboxyhaemoglobin levels should be measured by a co-oximeter and treatment started immediately with oxygen at the maximum concentration that can be delivered FIO2 if ventilated and if self-ventilating . If carboxyhaemoglobin levels 25 or carbon monoxide poisoning is associated with mental disturbance the optimal treatment is hyperbaric oxygen at 3 atmospheres for 30min repeated 6-hrly if levels remain 25 . Death is likely with carboxyhaemoglobin levels 60 . High concentration oxygen treatment should continue until carboxyhaemoglobin levels 10 . Cyanide Severe cyanide poisoning has an extremely rapid onset and occurs in some cases of smoke inhalation. Survival may be associated with anoxic brain damage. Diagnosis must be made clinically since a blood cyanide level takes 3h to perform. Clinical features Clinical features include anxiety agitation hyperventilation headache loss of consciousness dyspnoea weakness dizziness and vomiting. The skin remains pink and hypotension may be severe. An unexplained metabolic acidosis is suggestive. Management High concentration oxygen should be given but is only truly effective when given at hyperbaric pressures. In mild cases rapid natural detoxification reduces cyanide levels by 50 within 1h allowing supportive therapy only. Sodium thiosulphate 150mg kg intravenously followed by 30-60mg kg h converts cyanide to thiocyanate and should be used if there is unconsciousness. It is however slow-acting. Nitrites produce methaemoglobinaemia and may potentially worsen cyanide toxicity. Dicobalt edetate 300mg IV is the specific antidote to cyanide but is severely toxic vomiting urticaria tachycardia hypotension dyspnoea chest pain in the absence