Emergency lectures - Case for Mechanical ventilation Presentation Transcript
Mechanical ventilationfor a chest trauma patientDo Ngoc Son MD., PhD.,Emergency Department of Bach Mai Hospital
Case study• A male of 16 years old.• He was sent from a provincial hospital with a diagnosis of multiple trauma, lung atelectasis and respiratory failure.• History: he had a traffic accident (motorbike vs. motorbike) → a provincial hospital in comatose state however he gained of consciousness after that. He was diagnosed multiple trauma (mandible fracture, chest injury). He was intubated and sent to us.
On admission• Alert and responsive to commend• HR: 130; BP 100/60; RR > 40 with respiratory muscle contraction• SpO2 62% (FiO2 100%, PEEP 7)• Bloody bubble came from ET tube• FAST: no fluid accumulation in the pleural and peritoneal cavity• 2nd survey: mandible fracture, posterior fracture of 4th -5th ribs on the right side, lung contusion, no brain injury, no spinal cord injury and no abdominal injury
Laboratory CBC Chem ABGsRBC 3.95 Ure 7 pH 7.335HGB 117 Glucose 7.55 pCO2 49HCT 0.35 Creatinin 105 pO2 35.3MCV 89.1 Protein 53 SO2 63.1MCH 29.6 Albumin 31.2 Hct 39MCHC 332 CK 3586 Hb 127PLT 178 CK-MB 68.7 Na 156.1RDW-CV 13.6MPV 9.5 CRP 6.704 K 4.2WBC 17.12 SGOT 182.1 Ca 1.09NEU% 78.4 SGPT 93.8 Glu 8.2EO% 0 Na 144 Lac 6.7BASO% 0 K 4.46MONO% 10.7 Cl 110.6LYM% 10.9