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SPECIAL RESUSCITATION SITUATIONS ?????????

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SPECIAL RESUSCITATION SITUATIONS * * note the – PowerPoint PPT presentation

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Title: SPECIAL RESUSCITATION SITUATIONS ?????????


1
SPECIAL RESUSCITATION SITUATIONS ?????????
????????
2
40??? Sudden collapse
???????
3
40??? 12?????
4
40??? ????????? (K7.0meq/L)
5
????????
  • ?????????????
  • ???????????????
  • ????????

6
???
  • ?? gt 5.0 mEq/L
  • pH ? 0.1 U ? serum K ? 0.3 mEq/L

7
?????
  • Drugs (K-sparing diuretics, ACEI, NSAIDs, K
    supplements)
  • ESRD
  • Muscle breakdown (rhabdomyolysis)
  • Metabolic acidosis
  • Pseudohyperkalemia
  • Hemolysis
  • Tumor lysis syndrome
  • Diet (rarely sole cause)
  • Hypoaldosteronism (Addison disease,
    hyporeninemia)
  • Type 4 renal tubular acidosis
  • Other hyperkalemic periodic paralysis

8
???
  • ??????(??????????) ,????
  • ?????
  • T???
  • P???
  • PR??
  • QRS???
  • S???
  • idioventricular rhythm
  • sine waves
  • VF?????

9
Hyperkalemia
  • Etiology renal failure, transcellular shifts,
    cell death, drugs, pseudohyperkalemia
  • Manifestations cardiac, neuromuscular

10
???????
11
Hyperkalemia
  • Treatment
  • Stop potassium !
  • Get an ECG
  • Hyperkalemia with ECG changes is a medical
    emergency

12
Hyperkalemia
  • Treatment
  • First phase is emergency treatment to counteract
    the effects of hyperkalemia
  • IV Calcium
  • Temporizing treatment to drive the potassium into
    the cells
  • glucose plus insulin
  • Beta2 agonist
  • NaHCO3
  • Therapy directed at actual removal of potassium
    from the body
  • sodium polystyrene sulfonate (Kayexalate)
  • dialysis
  • Determine and correct the underlying cause

13
???
  • ?? lt 3.5 mEq/L
  • ??
  • ????
  • ????(????????)
  • ?????????

14
???
  • ??
  • ????????
  • ????
  • ?????????
  • ????
  • ????

15
???
  • ?????
  • U?
  • T???
  • ST??
  • ????(??digoxin???)
  • PEA or Asystole

16
???????
  • ???? (Arrhythmia)
  • Atrial or ventricular tachyarrhythmia
  • Decreased amplitude of P wave
  • U wave.
  • Conjoined T-U wave "camel's hump"

17
??
  • ????????
  • ????? K lt2.5 ? IV K
  • ???10-20 mEq/h ECG
  • ????(VF/VT)
  • 2 mEq/min ? 10 mEq /5-10 min
  • ???1mEq???150-400 mEq

18
???
  • ?? gt 145 mEq/L
  • ??
  • ??????????????????????????

19
??
  • ?????????
  • ?????????
  • ??? ?? x 0.5 x (?? - 140) /140 ? ?? x 0.4 x
    (?? - 140) /140 ?
  • 70????,??160,??? ? L
  • ?? ? 0.5-1.0 mEq/h (lt 12 / 24 hrs)
  • Daily supply Water deficit x 10 / (?? - 140)
  • Rate Daily supply/24 ongoing demand

20
???
  • ?? lt 135 mEq/L
  • ????? lt120 ????
  • ???????????????????????

21
??
  • ????
  • SIADH ?? ( 50 - 66 )
  • Na deficit (desired Na - current Na) x
    0.5 x body wt (kg) ( 0.5 for men, 0.4 for
    women.)
  • 3 saline 513 mEq Na/L
  • ? Na 0.5 -1/hr (max. 10-12/24h)
  • ???? ? pontine myelinolysis

22
?
  • Na, K, Ca??????
  • ????????????
  • ??????? ???????

23
???
  • ?? gt 2.2 mEq/L
  • ????? ???
  • ????
  • ????
  • ?????????

24
???
  • ???? ???????????????????
  • ?????????
  • ??????????????????????

25
???
  • ?????
  • PR? QT ??
  • QRS ??
  • P?????
  • T???
  • Complete AV block?Asystole

26
??
  • ????
  • CaCl2 ( 5 to 10 mEq IV )
  • ??????????
  • ????
  • ????
  • ?????????
  • IV N /S furosemide
  • ????

27
???
  • ?? lt 1.3 mEq/L
  • ???????
  • ???????????
  • PTH?????
  • (eg, pentamidine, diuretics, alcohol)
  • ???????

28
??? - ??
  • GI loss bowel resection, pancreatitis, diarrhea
  • Renal disease
  • Starvation
  • Drugs diuretics, pentamidine, gentamicin,
    digoxin
  • Alcohol
  • Hypothermia
  • Hypercalcemia
  • Diabetic ketoacidosis
  • Hyperthyroidism/hypothyroidism
  • Phosphate deficiency
  • Burns
  • Sepsis
  • Lactation

29
??? - ??
  • ??????????
  • ????
  • ????????????????????
  • ???????

30
??? - ?????
  • QT??
  • ??T???
  • Heart blocks
  • VF

31
??
  • Severe or symptomatic hypoMg
  • 1 to 2 g IV MgSO4 over 15
  • Torsades de pointes
  • 2 g of MgSO4 over 1 - 2
  • Seizures
  • 2 g IV MgSO4 over 10
  • Calcium gluconate (1 g)
  • ???? hypoCa
  • ?????????

32
?
  • 1/2 Ca in the ECF bound to alb
  • Alkalosis Ca-alb binding ? ? Ca2? Acidosis ?
    Ca2?
  • serum alb ? 1 g/dL ? total serum Ca ? 0.8 mg/dL
    (Ca Serum Ca 0.8 (4 - Albumin))
  • In hypoalb., Ca2 may be normal
  • Ca antagonizes K and Mg at the cell mem.
  • Ca regulated by PTH and vit. D

33
???
  • serum Ca gt 10.5 mEq/L or
  • Ca2 gt 4.8 mg/dL
  • Primary hyperparathyroidism and malignancy
    account for gt90 cases.

34
??? -??
  • Total serum Ca ?12 to 15 mg/dL
  • Neuro. S/S
  • depression, weakness, fatigue, ,confusion (at
    lower levels)
  • hallucination, disorientation, hypotonicity, coma
    (at higher levels)
  • Renal concentration of urine

35
??? -??
  • CV S/S variable
  • lt 15 to 20 myocardial contractility ?
  • gt 15 to 20 myocardial depression
  • Automaticity and ventricular systole is shortened
  • Arrhythmias ( refractory period ? )
  • Digitalis toxicity is worsened
  • Hypertension
  • Many patients with hyperCa develop hypoK

36
??? -??
  • GI S/S
  • dysphagia
  • constipation
  • peptic ulcers
  • pancreatitis
  • Renal S/S ability to concentrate urine ?
  • dehydration
  • diuresis (loss of Na, K, Mg, and P? vicious
    circle of Ca reabsorption)

37
??? -?????
  • QT??
  • PR and QRS ??
  • QRS voltage ??
  • T-wave?????
  • Notching of QRS
  • AV block

38
??
  • Symptomatic or gt15 mg/dL
  • NS at 300 to 500 mL/h
  • --????200 to 300 mL/h
  • After adequate rehydration NS at 100 to 200 mL/h
  • Closely monitor K Mg
  • Heart F. or Renal I. hemodialysis
  • Extreme conditions chelating agents
  • PO4 50 mmol/8-12 h or
  • EDTA 10 to 50 mg/kg/4 h

39
??(II)
  • Lasix (1 mg/kg IV)
  • controversial
  • heart failure required
  • ? reuptake of Ca from bone
  • Reduce bone resorption
  • calcitonin
  • Glucocorticoids (prednisolone 2040 mg/day)

40
???
  • serum Ca lt 8.5 mEq/L or Ca2 lt 4.2 mg/dL
  • Causes
  • toxic shock syndrome
  • abnormalities in Mg
  • tumor lysis syndrome
  • rapid cell turnover
  • hyperK, hyperP, and hypoCa

41
??? - ??
  • Occur when Ca2 lt 2.5 mg/dL
  • Paraesthesia
  • Muscle cramps, carpopedal spasm
  • Stridor
  • Tetany
  • Seizures
  • Hyperreflexia
  • Chvostek and Trousseau signs
  • Cardiac contractility?, heart failure

42
??
  • ??,???
  • 10 Ca gluconate IV 10
  • IV drip 0.5 to 2.0 mg/kg/hr in D5W
  • ???? Q4-6H
  • ???? 7-9 mg/dL
  • ?? Mg, K, and pH

43
(No Transcript)
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