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Approach to the Patient with Dyspnea PowerPoint Presentation

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Description : Check out this medical presentation on Diastolic Heart Failure, which is titled "Approach to the Patient with Dyspnea", to know about the approach to the patient with dyspnea.

Tags : Diastolic Heart Failure, Approach, Patient, Dyspnea

Published on : Jul 01, 2021 | Views : 2988 | Downloads : 11

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APPROACH TO THE PATIENT WITH DYSPNEA Dr. Rajendra Prasad
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Breathless patient Oxygen (15 L) via NRB mask with 15l/Min o2 CBC, CBG, ECG,ABG,UREA, CREAT,CXR, USG THORAX HAEMODYNAMICALLY UNSTABLE HEMODYNAMICALLY STABLE
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CIRCULATION IV ACCESS MONITOR CENTRAL VEIN ACCESS MEDICATION IVF : CVP GUIDED VT/SVT CARDIOVERSION TYPE II H.B, COMPLETE H.B PREPARE FOR TCP CONSIDER ATROPINE ADRENALINE DOPAMINE ↑ CVP NORMAL CVP PUL.EDEMA PTE PaO2/FiO2 < 300 < 200 ALI ARDS IF UNAVAILABLE
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PUL.EDEMA MANAGEMENT
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TREATING ASTHMA
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ANGIOEDEMA
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Unexplained tachypnoea, tachycardia, Hypoxia –Suspect PTE
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PULMONARY EMBOLISM FLEISCHNER’S SIGN local widening of pulmonary artery due to distension from clot. WESTERMARK’S SIGN darker area of reduced perfusion HAMPTON’S HUMP segmental pleurally based wedge shaped opacity representing a pulmonary infarct.
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BREAK THE BLOCK Enoxaparin 1mg/kg twice daily Warfarin started at 5mg/day . can go upto 7.5 or 10mg/day 100mg of tPA as continuous peripheral iv infusion for 2 hrs : 15mg bolus and 85 mg infusion x 2hrs
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ACUTE SALICYLATE INTOXICATION Ingestion of less than 150 mg/kg may produce "mild" toxicity, with nausea, vomiting, and GI irritation
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ACUTE SALICYLATE INTOXICATION Ingestion of 150 to 300 mg/kg may produce "mild to moderate" toxicity, with vomiting, hyperpnea, diaphoresis, tinnitus, and acid-base disturbances. Acute ingestion of more than 300 mg/kg may produce "severe" toxicity.
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LETS ANNIHILATE SALICYLATE!!!
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AMNIOTIC FLUID EMBOLISM
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AMNIOTIC FLUID EMBOLISM Phase I, pulmonary artery vasospasm with pulmonary hypertension and elevated right ventricular pressure cause hypoxia. Hypoxia causes myocardial capillary damage and pulmonary capillary damage, left heart failure, and acute respiratory distress syndrome Phase II. This is a hemorrhagic phase characterized by massive hemorrhage with uterine atony and DIC; however, fatal consumptive coagulopathy may be the initial presentation. If platelets are less than 20,000/µL, or if bleeding occurs and platelets are 20,000-50,000/µL, transfuse platelets at 1-3 U/10 kg/d
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LONG BONE FRACTURE
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FAT EMBOLISM Gurd's Major Criteria: - Axillary or subconjuctival petechia - occurs transiently (4-6 hours) in 50-60 % of the cases; - hypoxemia (PaO sub 2, <60 mmHg; FiO sub 2, <= 0.4) - central nervous system (CNS) depression disproportionate to hypoxemia, and pulmonary edema; - Gurd's Minor Criteria: - Tachycardia (more than 110 beats per minute) - pyrexia (temperature higher than 38.5 degrees) - emboli present in retina on funduscopic examination - fat present in urine - sudden unexplainable drop in hematocrit or platelet values - increasing sed rate; - fat globules present in sputum; - Misc: - Occurs w/in 72 hours of skeletal trauma; - shortness of breath; - altered mental status; - occasional long tract signs and posturing; - urinary incontinence
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SURE IT IS FES? Subconjuctival petechiae Hypoxemia CNS depression
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CRF PERICARDIAL EFFUSION PUL. EDEMA PLEURAL & PERICARDIAL RUB
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GBS Progressive weakness Areflexia CSF profile (acellular, increase in protein level) Evidence of demyelination
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BRIEF PHYSICAL EXAM TENSION PNEUMOTHORAX ↓ BREATH SOUNDS + HYPERRESONANCE CLOSED PNEUMOTHORAX PARADOXICAL CHEST WALL MOTION / ↓ BREATH SOUNDS FLAIL CHEST SUSPECTED CHEST TRAUMA ↓ /ABSENT BREATH SOUNDS U/L + HYPERRESONANCE
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