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ถ้าเป็นผู้ป่วยจริงโทรมาหาผมที่บ้านดีไหมครับ  Posted by : Phoenix111 , Date : 2004-05-07 , Time : 09:42:00 , From IP : 172.29.3.206 |
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ถ้าเป็นผู้ป่วยจริงโทรมาหาผมที่บ้านดีไหมครับ Posted by : Phoenix111 , Date : 2004-05-07 , Time : 09:42:00 , From IP : 172.29.3.206 |
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I'm not Dr.Phoenix, but I would like to share my point of view. I have answered you question once in the name of insulin protocol. Unfortunately, my answer hasn't been posted in this webboard. Anyway, this poor man got the car accident and developed actue lung injury probably secondary from lung contusion. You didn't mention about lung contusion, but I guess this patient should have some lung contusion on the basis of hemothorax. If you take a look at his ABG, you will notice that this man got siginificant hypoxia and hs acute lung injury index of 197. This would suggests that this patient definitely has significant lung injury. I don't know how long he has been on ventilator. If he was on verntilator more than 3 days, you should think about the secondary infection and ventilator assocoated pneumonia. The other thing that I get from gases is he is acidotic with bicarbonate about 19. So, he would need some fluid filling and require fully investigation for secondary infection. You did not advise about his CXR. I reckon he need repeated CXR and sending sputum culture as well as empirical treatment for VAP. About he ventilator setting, I would suggest to up his PEEP to abuout 8-10 and down his TV to about 6-8 ml/kg as per ARDS net study for acute lung injury. What about his RR? I don't see any point to hyperventilate this patient. I would suggest to adjust RR to keep PCO2 at about 35-45 with pH above 7.25. The other thing I would suggest s this patient need pain control and some sedation. You can imagine that this patient had ICD put in to his chest. How pain and how difficult of breathing he has been. So, I would suggest pain control, morphine low dose infusion may be a good things for him. Anyway, if you can't manage this patients very well, please retrieve him to PSU hospital for further care. This patient needs intensive review and ICU care. I hope I have answered your question. Feel free to ask,I 'm very happy to help. Cheers mate!!! Posted by : Kangaroo on board , E-mail : (Intensivist @Adelaide) , Date : 2004-05-07 , Time : 10:00:47 , From IP : ppp47.ar3.adl1.airne |
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I forgot one thing. I'm not sure why you set the peak flow up to 70. I think normal peak flow at 40-60LPM is enough. Posted by : Kangaroo on board , E-mail : (Intensivist@Adelaide) , Date : 2004-05-07 , Time : 14:58:24 , From IP : ls12.internode.on.ne |
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I forgot one thing. I'm not sure why you set the peak flow up to 70. I think normal peak flow at 40-60LPM is enough. Posted by : Kangaroo on board , E-mail : (Intensivist@Adelaide) , Date : 2004-05-07 , Time : 14:58:24 , From IP : ls12.internode.on.ne |
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I forgot one thing. I'm not sure why you set the peak flow up to 70. I think normal peak flow at 40-60LPM is enough. Posted by : Kangaroo on board , E-mail : (Intensivist@Adelaide) , Date : 2004-05-07 , Time : 14:58:30 , From IP : ls12.internode.on.ne |
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Posted by : d , Date : 2004-05-07 , Time : 17:52:26 , From IP : 172.29.3.102 |
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CAse Hemothorax( โดนวัวชนล้มลง) ICD 3 cc /hr หลัง off ื no dyspnea แต่ CxR lung ยังไม่ expand เต็มที่ ทำไงดีครับ Posted by : Intern , Date : 2004-05-08 , Time : 11:59:11 , From IP : 203.150.209.231 |
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