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CASE STUDY 2

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by

adam davies

on 14 May 2011

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Transcript of CASE STUDY 2

CASE STUDY TWO SIGNS, SYMPTOMS + PROBLEMS SOBAR LOW O2 SATS AND PaO2 ESP AS ON 40% FiO2 HAZY LEFT LOWER OPACITY WITH MEDIASTINUM SHIFT TO LEFT TO THE EFFECTED SIDE- MEANS VOLUME LOSS COLLAPSE SLUMPED IN BED DROWSY COLD HANDS/CENTRAL CYANOSIS USING ACCESSORY MUSCLES RR QUITE HIGH, HR LITTLE HIGH, TEMP BORDERING HIGH POOR EXPANSION OF CHEST LEFT SIDE PAIN ON COUGHING DESPITE PCA DULL PN LEFT BASE AND MIDDLE NO BREATH SOUNDS LEFT BASE, CRACKLES LEFT MIDDLE 25-USUALLY 12
103- USUALLY 70-90 ATELECTASIS LEFT LOWER LOBE PRIORITY * PAIN- ALLOW HIM TO EXPAND HIS CHEST AND PARTICIPATE IN TREATMENT * TREATMENT OF ATELECTASIS AND PNEUMONIA * HYPOXAEMIA- TYPE 1 RESP FAILURE RISK FACTORS FOR PPC SMOKER UPPER ABDOMINAL SURGERY- INCIDENCE OF ATELECTASIS POST UAS IS 70% - CLINICALLY SIGNIFICANT (5-20%) EFFECTS OF ANAESTHESIA REDUCED CILLIA ACTION DEHYDRATION REDUCED COUGH REDUCED FRC ABG'S -TYPE 1 RESPIRATORY FAILURE
-LOW PaO2-DESPITE FI02 40%
-PCO2 BORDERING ON HIGH- ACCESSORY MUSCLES MAY GET TIRED
-NEEDS MORE FiO2 PUSHING ABDOMINAL CONTENTS AGAINST DIAPHRAGM, SQUASHING LUNGS- REDUCING VOLUME -REDUCED SURFACE AREA/GASEOUS EXCHANGE
-REDUCED V/Q RATIO LOW O2, HAPPENS WHEN SATS 85% OR LESS CHEST OR WOUND INFECTION CONSOLIDATION/COLLAPSE/LUNG ABSCESS RESTRICTIVE- REDUCED COMPLIANCE *LOSS OF VOLUME- LEFT BASE COLLAPSE(COULD ALSO BE PLEURAL PNEUMOTHORAX) LOW O2 LEVELS THROUGHOUT BODY TREATMENTS ACBT-HOLD AND SNIFF- FOCUS ON TEE *IMPROVE V/Q RATIO
*IMPROVE COLATERAL VENTILATION
*REMOVE SECRETIONS
*3-5 CYCLES- HOURLY MOBILISE INCREASE TV AND REVERSE ATELECTASIS POSITIONING RIGHT LUNG DOWN SIDE LYING-IMPROVE V IN DEPENDENT LUNG IPPB CPAP INSPIRATORY SPIROMETER ...OR SITTING UP- AB CONTENTS NOT PUSHING ON BASES *DECREASE WORK OF BREATHING *INFLATE LUNGS WITH ADDED POSITIVE PRESSURE *INCREASE INSPIRED VOLUME *IMPROVED GASEOUS EXCHANGE *REVERSES ATELECTASIS THINGS TO KNOW *IMMODIUM-LAXATIVE
*PREDNISOLONE-CORTICOSTEROID, CONTROL INFLAMMATION
*CODEINE-PAIN KILLER
*CROHNS DISEASE-INFLAMMATORY BOWELS DISEASE (USUALLY AFFECTS INTESTINES)
*LAPAROTOMY-INCISION TO AB WALL TO GAIN ACCESS TO AB CAVITY EXPECTORATED THICK GREEN PLUG WCC HIGH-USUALLY 4.5-10 OFTEN SEEN AFTER SURGERY DUE TO RETAINED SECRETIONS IN LEFT LOWER LOBE BRONCHUS CRACKLES INDICATE FLUID. OPACITY-CONSOLIDATION OR COLLAPSE PNEUMONIA- SPUTUM PLUGS CAN OFTEN LEAD TO COLLAPSE HELP MOBILISE SECRETIONS RECOMMEND ANTIOBIOTICS AND REQUEST SPUTUM C&S TREAT THE PNEUMONIA PEP AND FLUTTER/ACAPELLA REMOVE SECRETIONS MAY GET TIRED AND NOT BLOW OFF CO2-BREATHING CONTROL POS OF EASE MORE O2 * REMOVAL OF SECRETIONS-TO GET RID OF COLONISED SPUTUM AND REMOVE BLOACKAGES (ALLOWING FOR REVERSE OF ALELECTASIS INCREASE IN HB NOT BOUND TO O2
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