tailieunhanh - Vital Signs and Resuscitation - part 9

Sau khi bảo vệ đường hô hấp, phổi auscultated cho âm thanh hơi thở song phương. Các bệnh nhân thở oxy 100% mặt nạ nonrebreather. Bệnh nhân hôn mê được đặt nội khí quản để bảo vệ đường hô hấp. Các bệnh nhân Nonbreathing được đóng bao với một túi mặt nạ-van (BVM) oxy 100% và được đặt nội khí quản. | 136 Vital Signs and Resuscitation 8 Fig. . Chest Tube Placement. 2. BREATHING After securing the airway the lungs are auscultated for bilateral breath sounds. Breathing patients receive 100 oxygen by nonrebreather mask. Comatose patients are intubated to protect the airway. Nonbreathing patients are bagged with a bag-valve-mask BVM at 100 oxygen and are intubated. Trauma If signs of tension pneumothorax or hemothorax are present or evolving chest pain dyspnea decreased breath sounds on affected side tracheal deviation jugular venous distention a 14g needle or angiocath is inserted in the 2nd interspace at the mid-clavicular line needle thoracentesis while preparing for chest tube thoracostomy tube placement before a chest x-ray is taken see Fig. . A 36F chest tube is inserted in the 5 th intercostal space at the midaxillary line over the top of the rib to avoid vessels and connected to an underwater seal apparatus Fig. . Paradoxic motion of the chest wall from moving rib segments flail chest may require intubation. An open wound of the chest wall open pneumothorax requires a sterile occlusive dressing taped on three sides providing a flutter-type valve effect followed by insertion of a chest tube. Respiratory Failure Respiratory failure is seen in asthma congestive heart failure COPD trauma . pulmonary contusion pneumo-hemothorax and occasionally Resuscitation 137 pneumonia. Signs of hypoxia are dyspnea tachypnea tachycardia restlessness gasping respirations and use of accessory ventilatory muscles. Lethargy and confusion are seen with hypercapnia see Chapter 6 Oxygen . ABGs show a PO2 50 mmHg and or a PCO2 50 mmHg implying impending respiratory failure although patients with COPD may normally carry a PCO2 of 60-70 mmHg. A rectal temperature is taken since the person is mouthbreathing. Treatment endotracheal intubation is usually required although some cases may respond to continuous positive airway pressure CPAP . Initial settings on a volume-cycled