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PART XIII

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  1. PART XIII Other Important Topics

  2. Chapter 42 Near Drowning PC FWS RBC Figure 42-1. Near wet drowning. Cross-sectional, microscopic view of the alveolar-capillary unit. Illustration shows fluid moving from a pulmonary capillary to an alveolus. PC, Pulmonary capillary; FWS, frothy white secretions; RBC, red blood cell; TI, type I alveolar cell; IE, interstitial edema.

  3. Anatomic Alterations of the Lungs • Largyngospasm and bronchial constriction • Interstitial edema, including engorgement of the perivascular and peribronchial spaces, alveolar walls, and interstitial spaces • Decreased pulmonary surfactant • Increased surface tension of the alveolar fluid • Alveolar shrinkage and atelectasis • Frothy, white secretions throughout the tracheobronchial tree

  4. Etiology • 6000 to 8000 people drown each year in the United States • Children under the age of 5 account for 40% • 20% occur in persons between 5 and 20 years of age • About 8000 victims of near drownings are hospitalized annually

  5. Box 42-1.

  6. Table 42-1.

  7. Table 42-1., cont.

  8. Overview of the Cardiopulmonary Clinical Manifestations Associated with NEAR WET DROWNING The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Atelectasis (see Figure 9-7), Alveolar Consolidation (see Figure 9-8), and Increased Alveolar-Capillary Membrane Thickness (see Figure 9-9), and Bronchospasm (see Figure 9-10)—the major anatomic alterations of the lungs associated with near wet drowning (see Figure 42-1).

  9. Figure 9-7. Atelectasis Clinical Scenario.

  10. Figure 9-8. Alveolar Consolidation Clinical Scenario.

  11. Figure 9-9. Increased Alveolar-Capillary Membrane Thickness Clinical Scenario.

  12. Figure 9-10. Bronchospasm Clinical Scenario (e.g., asthma).

  13. Clinical Data Obtained at the Patient’s Bedside Vital Signs • Increased respiratory rate • Increased heart rate, cardiac output, blood pressure

  14. Clinical Data Obtained at the Patient’s Bedside • Cyanosis • Cough and sputum production • Frothy, pink, stable bubbles • Chest Assessment Findings • Crackles and rhonchi

  15. Clinical Data Obtained from Laboratory Tests and Special Procedures

  16. Pulmonary Function Study: Expiratory Maneuver Findings FVC FEVT FEF25%-75% FEF200-1200  N or  N or N PEFRMVV FEF50% FEV1% N N or N N or 

  17. Pulmonary Function Study: Lung Volume and Capacity Findings VT RV FRC TLC N or    VC IC ERV RV/TLC%    N

  18. Arterial Blood Gases Early and Advanced Stages of Near Drowning • Acute Ventilatory Failure with Hypoxemia pH* PaCO2 HCO3-* PaO2 (lactic acid) * When tissue hypoxia is severe enough to produce lactic acid, the pH and HCO3- values will be lower than expected for a particular PaCO2 level.

  19. Oxygenation Indices QS/QT DO2 VO2 C(a-v)O2  Normal Normal O2ER SvO2 

  20. Radiologic Findings Chest radiograph • Fluffy infiltrates • Pneumothorax and pneumomediastinum

  21. Figure 42-2. This radiograph of a young man, taken just after an episode of near drowning,shows a pulmonary edema pattern. (From Armstrong P et al: Imaging of diseases of the chest, ed 2, St Louis, 1995, Mosby.)

  22. General Management of Near Wet Drowning • The first responder • Management during transport • Management at the hospital

  23. Classroom DiscussionCase Study: Near Drowning