Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

ショック

13,216 views

Published on

ショックへのアプローチの基本です。
http://kensyui.com/shock.html

  • DOWNLOAD THI5 BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

ショック

  1. 1. ショックとは??  循環系異常により組織の酸素需要に酸素 供給が満たない病態のこと 血圧低下を起こす前から、組織への有効な酸素供給ができない状態は起こる!
  2. 2. ショックの5徴 5P  肉体的・精神的虚脱(prostration)  冷汗(perspiration)  不十分な呼吸(pulmonary insufficiency)  脈拍減弱(pulselessness)  皮膚・顔面蒼白(pallor)
  3. 3. ショックの5徴 具合い良そう(ぐあいよそう) ぐ=ぐったり  肉体的・精神的虚脱(prostration) あ=汗  冷汗(perspiration) い=息苦しい  不十分な呼吸(pulmonary insufficiency) よ=弱い脈拍  脈拍減弱(pulselessness) そう=蒼白  皮膚・顔面蒼白(pallor)
  4. 4. ショックへの分類 -アプローチのために重要な4つの分類-
  5. 5. 病態によるショックの分類  Hypovolemic (循環血液量減少性) 出血、脱水、広範囲熱傷  Distributive (血液分布異常性) 敗血症性ショック、アナフィラキシー、 神経原性ショック  Cardiogenic(心原性) 急性心筋梗塞、重症不整脈、心筋炎  Obstructive(閉塞性) 肺塞栓症、緊張性気胸、心タンポナーデ
  6. 6. 初期対応 1)ABC、バイタルのチェック 2)モニター 3)酸素投与(リザーバー10~15L) 4)輸液 5)原因検索・対処
  7. 7. ABC、バイタルのチェック Airway(気道)、Breathing(呼吸)、Circulation(循環)     血圧 収縮期血圧<90mmHg (個人差あり) ⇒「普段より低い血圧」は要注意 体温 発熱、低体温⇒敗血症ショック? 呼吸数 呼吸数>20回/分でショックを疑う ショック指数=心拍数/収縮期血圧(健常者は0.5) (shock index=SI)
  8. 8. 身体診察  頸静脈 低血圧+頸静脈怒張 ⇒心タンポナーデ、緊張性気胸、肺塞栓、右室梗塞  胸部 ⇒ラ音:心原性 喘鳴:アナフィラキシー 呼吸左右差・胸郭の上がりの左右差:気胸   皮膚 じんま疹 アナフィラキシーの徴候 発汗、末梢の冷感 下肢 浮腫の左右差(DVT⇒肺塞栓症)
  9. 9. ショック触診  頸動脈が触れない ⇒収縮期血圧60mmHg以下  大腿、浅側頭動脈が触れる ⇒収縮期血圧70mmHg以上  橈骨動脈が触れる ⇒収縮期血圧80mmHg以上 ※脈は左右で評価しよう!
  10. 10. 検査    血算 生化学 血液ガス分析 代謝性アシドーシス、乳酸値(Lac)の上昇をみる Hb、Kなども迅速に測定できるため有効!    胸部レントゲン 心電図 超音波検査 右室負荷所見・IVC径・(外傷では)腹腔内出血の有無も
  11. 11. Shock 遷延すると 大量のサイトカインで死亡 炎症と凝固反応
  12. 12. すべてのショックの終末現象 cardiogenic infection 出血 その他 LOCAL Systemic SHOCK サイトカイン 炎症+凝固 血管拡張 血管透過性亢進 臓器不全 死亡 Irrevesible point

×