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Emergency lectures - Case for Mechanical ventilation
 

Emergency lectures - Case for Mechanical ventilation

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    Emergency lectures - Case for Mechanical ventilation 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
    • Chest X ray
    • Management
    • Evolution 04/09/2011 05/09/2011 06/09/2011 08/09/2011 09/09/2011 11/09/2011 16:00 5:30 12:49 17:21 11:25 23:12Mode A/C APRV APRV APRV APRV APRVTS set/total 14 10 10/33 10/26 10/24 10/30Vt set/Vt 480spontI time/PF 60FiO2 100 100 100 60 100PEEPhigh/PEEP /5 20/0 30/10 30/15 30/15 30/15lowT high/T low 5.4/0.6 5.4/0.6 5.4/0.6 5.4/0.6 5.4/0.6pH 7.335 7.41 7.47 7.517 7.473 7.49pCO2 49 51.3 44.1 38.6 42.7 40.8pO2 35.3 50.3 71.1 59.6 123.9 74.8SO2 63.1 84.7 94.8 92.3 98.5 95.1
    • Evolution of CXRDay 1 Day 2 Day 3
    • Evolution of CXRDay 4 Day 5 Day 6
    • The last 3 days• Febrile To = 40oC• Bloody sputum• Tachypnea > 40• Tachycardia > 120• SpO2 <70%
    • Chest X rayDay 7 Day 8 Day 9
    • P/F ratio LUNG RECRUITMENT LUNGRECRUITMENT
    • QA1. What is the lung lesion?2. Is clinical evolution corresponding to the lung lesion?3. What is the reason for the deterioration and death of patient?