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ICU drowning nursing rounds

Updated: 2019-09-12

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Nursing rounds of ICU drowning_fundamental medicine_medicine_professional materials. Nursing care of a drowning patient ICU Duchang Feijing Hospital ICU Du Changfei Shenyang ICU Contents CONTENTS 2 1 2 3 Introduction to the disease and related nursing care diagnosis and methods Shenyang ICU

Nursing care of a drowning patient ICU Duchang Feijing Hospital ICU Du Changfei Shenyang ICU Contents CONTENTS 2 1 2 3 Illness introduction and related nursing diagnosis and methods ICU Shenyang ICU illness introduction? Patient: Qin Fei, 19 years old, admitted to hospital : 2015-08-1218: 50 3 Dai Congxue: After being found drowning, I knew that the obstruction was more than an hour. The current medical history: The patient was in the deep water area at the time of the battle at 17:30 on August 12th. The lifeguard complained that the patient was sinking into the water within about 1 minute. After being rescued ashore, the patient was assessed as fainted , Heartbeat, pulse, respiratory containment, lips cyanosis, cardiopulmonary resuscitation immediately, after about 7-8 minutes, the patient's heartbeat, pulse, breathing resumed, still fainting, vomiting hemorrhagic fluid and pink foam-like sputum, no content; 120 was sent to the emergency department of our hospital. After being intubated urgently, it was planned to "drown, after CPR" and sent to the ICU for further emergency treatment. • Previous history: negating hypertension, diabetes, coronary heart disease, negating blood transfusion history, negating drug and food allergy history, etc. Introduction of ICU condition in the intensive care unit? Physical examination: At admission: T: 36.5P: 135 times / minute R: 17 times / minute Bp: 4 92 / 57mmHgSPO2: 90%. Fainted, GCS score of 5 points, since the body position, physical examination is not common, the skin is slightly bruising. Lips are bruised. The pupil diameter of both sides is large and equal, the diameter is 3.0mm, and the reflection of light is dull. Both lungs have thick breath sounds, and both lungs are full of wet rales. ? Assistant check: blood gas analysis showed: PH7.01, PCO256mmHg, PO259mmHg, Lac12.7mmol / L, BE-B-17.9mmol / L. Coagulation: PT: 18.7sec, APTT: 50sec, FIB: 1.549g / L. Admission diagnosis: 1. drowning 2. post-CPR 3. ischemic hypoxic encephalopathy; ARDS, aspiration pneumonia; acute gastric mucosal lesions; DIC Shenyang ICU condition introduction introduction treatment points 5 1. mechanical ventilation treatment: maintenance High PEEP (12cmH2O), ventilation, and proper energy conversion. 2. Brain awake, reduce brain edema: put ice pillow on the head, reduce brain oxygen consumption; give edaravone root radical oxygen, cerebroside carnosine nutrient brain cells. 3. Anti-infective treatment: The patient understands the pulmonary edema and the aspiration pneumonia persists after drowning. Supushen + tinidazole are given anti-infective treatment, and diuresis is used to reduce pulmonary edema. 4. CRRT treatment: The patient was merged with ARDS, acute gastric mucosal lesions, myoglobin and albuminuria, in order to facilitate the removal of inflammatory mediators, liquid handling and renal net function, CRRT treatment was performed. Definition of drowning in ICU related to ICU 6 Drowning is also called drowning, which means that the human body is covered with water, the respiratory tract is blocked by water, mud, weeds, or reflex spasm of the throat, trachea, bronchus, causing acute hypoxia, infarction, Breathing, heartbeat containment. Pathological and psychological changes related to ICU in the intensive care unit 7 Hypoxia? Drowning pulmonary edema? Disorders of acid-base and water-electrolyte balance: Metabolic, respiratory or mixed acidosis caused by hypoxia and CO2 retention. Low temperature analysis sign: Deep body temperature below 35 degrees Celsius is low temperature. ? Diving reflex? ICU in ICU 8 ICU related science patho-psychological changes 9 Hypoxia? Drowning pulmonary edema? Disorders of acid-base and water-electrolyte balance: due to hypoxia and CO2 retention Causes metabolic, respiratory or mixed acidosis. Low temperature analysis sign: Deep body temperature below 35 degrees Celsius is low temperature. ? Dive reflex? Peri-rescue ICU 10 ICU 10 ICU 11 ICU Related Knowledge What is PEEP? 12 PEEP (positive end-expiratory pressure) is the positive end-expiratory pressure, which is a positive pressure generated by the mechanical ventilator during the inhalation of the gas phase, and the gas enters the lungs. When the end-expiratory airway is in use, the airway pressure is still higher than atmospheric pressure, and Prevent alveolar atrophy and collapse. The major symptoms of ARDS, noncardiogenic pulmonary edema, and pulmonary hemorrhage are under treatment. Principles of PEEP in the ICU of Shen Shen Clinic 13: 1. The inspiratory pressure of positive end-expiratory pressure → end-expiratory small airway → facilitates the discharge of CO2. 2. End-expiratory alveolar contraction → functional residual capacity (FRC) ↑ → conducive to oxygenation in general and quiet form, the end-expiratory gas volume in the lungs is in the intensive care unit ICU. Preventive use of PEEP to maintain alveolar expansion and contraction and add functional residual capacity; 2.5? 20cmH2O combined for raising the oxygen concentration to 60% and still unable to make the PaO2 linking above 60mmHg 3. > 20cmH2O combined for the treatment of hard hypoxemia Disease, which has a greater impact on reincarnation, pay attention to the use of time. 14 ICU related studies in the ICU of Shen Shen Hospital: The effect of PEEP on respiratory reincarnation function 1. Use of PEEP can prevent alveolar collapse, and functional residual gas (FRC) is added to the area of the gas exchange area. 15 2. The use of PEEP can improve the sex of the lungs. PEEP treatment in patients with ARDS can increase the sex of the lungs and improve ventilation and oxygenation. Changes in net lung capacity under unit pressure sensitivities in ICUs of Shen Shen Clinic 16 Knowledge of oxygen concentration PO2 PCO2 Oxygenation finger PO2 (80- 35PCO2 (35 PEEP time FiO2 80-100mmHg) 45mmHg 3 0 0 (cmH2O 45mmHg) 500mmhg ) 8.12 8.13 8.14 8.16 8.17 60% 50% 45% 45% 45% 59 72 155 136 118 56 50 43 37 32 12 12 10 8 5 Eradicate tracheal intubation and change nasal plug oxygen supply 3L / min ICU IPPV auxiliary unit Bang ventilation, "Effectiveness of using high-end positive expiratory pressure on ventilator to treat pulmonary edema after drowning" 17 According to the PEEP value used by the ventilator, it was divided into two groups of treatment groups: the highest PEEP value was 10 to 22 cmH2O. The control group was 7 cases: the highest PEEP value is 5 ~ 10cmH2O. ICU 18 in the intensive care unit. Adding tidal volume, improving ventilation and foreign body deposits and accumulating alveolar profiles. Active substance drowning. Respiratory membrane ventilation. Adding pulmonary edema. Mechanical ventilation pressure is increased, reducing pulmonary edema and improving ventilation. PEEP makes atrophic alveoli. De novo ventilation prevents V / Q disorders and hypoxemia to improve V / Q ICU 19 2015-8-12 2015-8-14 ICU 20 2015-08-20 ICU nursing Diagnosis and Nursing Methods P

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