s**********r
发帖数: 178 | 1 我的理解，组织摄氧靠的是O2 content，跟PaO2,SaO2,以及Hb的浓度都有关系。 虽然
CO中毒的动脉氧分压不变，但因为CO跟Hb的亲和力比氧气强很多倍，所以导致SaO2下降
，继而O2 content也下降，所以组织缺氧。 贫血是因为Hb的浓度下降，所以O2
content下降。 |
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L****n
发帖数: 12932 | 2 来自主题: Medicalpractice版 - 做人要低调 well, well, thanks so much for your pray. He turn out fine. Here is the
whole story.
this is a 73 yo 280lb good old mid-westerner living a happy life until one
week ago, he had a stroke and was admit to neuro floor. only significant
history was a lap chole turn open 2 yrs ago. Since he is not able to feed
himself now, GI put a peg tube in yesterday morning. by noon he was found
aspirated the gastric feed in his room. was rushed to the ICU. later in the
afternoon, they found free air in his abd... 阅读全帖 |
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L****n
发帖数: 12932 | 3 来自主题: Medicalpractice版 - 做人要低调 well, well, thanks so much for your pray. He turn out fine. Here is the
whole story.
this is a 73 yo 280lb good old mid-westerner living a happy life until one
week ago, he had a stroke and was admit to neuro floor. only significant
history was a lap chole turn open 2 yrs ago. Since he is not able to feed
himself now, GI put a peg tube in yesterday morning. by noon he was found
aspirated the gastric feed in his room. was rushed to the ICU. later in the
afternoon, they found free air in his abd... 阅读全帖 |
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c********e
发帖数: 496 | 4 the target of current treatment of COPD is to maintain SaO2 and PaO2 at a
safe level for the patient, put it in other words, there is no cure for it.
The damage of the pulmonary parenchyma is irreversible in COPD. |
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b********d
发帖数: 72 | 6 【 以下文字转载自 MiddleSchool 讨论区 】
【 原文由 whatever 所发表 】
sao2 qing
pi gan
(cui zi, also in Si Chuan??)
xiu2 xian
ba ha
ri ta
... |
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u***e
发帖数: 611 | 7 不佩服风mm不行，又学了不少。
没有人想到PE吗？半夜里把attending叫起来后，她第一个反应是病人又来了一次PE。
病人在做CT前就被上了heparin drip，转到了ICU。PT INR回来后是1.2. SaO2很好，没
有chest pain, SOB.
至于fluid，a-fib八成是和这个有关，病人的确如风mm分析的以前的echo有右心扩大，
LV的EF是正常的，我和senior谈了他还是认为要bolus病人。肺没有crackle，CXR没有
congestion. 脚也不肿，不太像是fluid overload. 现在病人还在run着fluid..... 我
不知道well compensated的右心衰是不是需要fluid restriction.
BMP回来后钾只有2.1，低钾会导致afib吗，不太确定。
BUN 55,Creatinine 1.2, 看上去像dehydration. 这个肾功能你们会让病人去做
contrast CT吗？
下回分解。 |
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c***y
发帖数: 811 | 8 1，O2在血液主要两种方式存在：解离+结合
2, O2分压只取决于解离形式的O2( dissoled),而结合部分的O2不影响O2分压
3，在肺换气时，血中游离O2浓度受血气分配系数影响，CO与O2竞争性与Hb结合，减少
SaO2，使血中总O2含量减少，导致缺氧；但是CO不影响游离O2在血中的溶解度，所以，
不影响动脉血氧分压
4，“书上说CO中毒,氧的分压不变”应该是指PaO2，而不是PvO2。在CO中毒时，因为总
的运送到组织的O2量减少，事实上PvO2应该是低于正常的
5，如果我的理解有误，请指正，谢谢。 |
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l*****t
发帖数: 190 | 9 大家新年好！想请教几个问题，谢谢！
19 yo DKA comatose，bp 86/65，PR: 110, RR 17, SaO2 98% on 2L O2. next step?
A. Intubation B. IV fluid and Insulin
答案是B。不是说comatose的都插管吗？非常迷惑的说。
问题二：
五岁小儿otitis media while on prophylactic single dose amoxicilin at bed
time (原来有几次otitic media）. next ?
A.10 day oral amoxicillin B.consider tympaostomy tube placement.
Answer: A.
听说failure abx prophlaxis 是放tympaostomy tube的一个标准。不明白的说。
请不吝赐教！
谢谢了！ |
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a*******d
发帖数: 5 | 10 question #1
RR 17, SaO2 98% --> oxygenation is good, no indication for intubation
#1 rule for DKA --> bolus, bolus and bolus
question #2
tympaostomy tube placement only after acute event resolved. In reality, this
patient should be treated with augmentin instead of amoxicillin as
recurrent OM is an indication for augmentin. |
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r*****2
发帖数: 309 | 11 Regarding DKA, sometimes even if SaO2 is alright, but if blood gas indicates
retaining CO2, this patient still should be intubated. I don't think these
questions are good one, caused too much confusion. |
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t******n
发帖数: 102 | 12 每個地方不同.我只說說我之前的long term.我以前幹的地方一個月可能才一次call
911.當然每個病人狀況不同.不能都這麼說.但是為什麼都要等到病人狀況緊急的時候才
反應？例如：如果你知道病人呼吸痰很多.呼吸不正常.又有發燒的症狀.這個時候想到
有可能是肺炎.如果病人狀況不穩.就提早送到醫院.這時還用不到call 911.但是等到
SaO2=88% via 10L O2. 不call 911也不行了吧！ |
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t******n
发帖数: 102 | 13 每個地方不同.我只說說我之前的long term.我以前幹的地方一個月可能才一次call
911.當然每個病人狀況不同.不能都這麼說.但是為什麼都要等到病人狀況緊急的時候才
反應？例如：如果你知道病人呼吸痰很多.呼吸不正常.又有發燒的症狀.這個時候想到
有可能是肺炎.如果病人狀況不穩.就提早送到醫院.這時還用不到call 911.但是等到
SaO2=88% via 10L O2. 不call 911也不行了吧！ |
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p***e
发帖数: 12 | 14 A 49-year-old construction worker is admitted to the emergency department
after a severe laceration of his
left thigh. He lost about 4 units of blood prior to effective closure of the
wound. He received several hundred
milliliters of normal saline during the procedure. Postsurgical clinical
data are as follows: vital signs lying
down, HR 115, BP 98/60, RR 28; sitting, HR 140, BP 92/62, RR 28; Hct 22,
hemoglobin 8, PaO2 90, SaO2 98%
breathing room air. N.R. continues to have significant oozing fr |
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w****n
发帖数: 237 | 15 囧。。。不会吧~~FiO2要100%？ 可能是失血~Hgb太少~即使全部saturated~还是不够
tissue用~所以要很多O2？
还有就是SaO2有+/- 3%的幅度~所以即使测量的是98%~可能只有95%
= =瞎猜的~~~(*^__^*) 嘻嘻…… |
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c***y
发帖数: 811 | 16 来自主题: Medicalpractice版 - 做人要低调 真惊险.
the
one
significant
feed
found
in the
came to
SaO2 |
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c***y
发帖数: 811 | 17 来自主题: Medicalpractice版 - 做人要低调 真惊险.
the
one
significant
feed
found
in the
came to
SaO2 |
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s**********t
发帖数: 217 | 18 i guess u have lower lobe pna..
it belongs zone 3 0f the lung. with pna, consolidation, it produces more
shunt. thats why ur sao2 was low.
如果还不好，要查一下军团菌。如果你考前一周还不好，可以考虑短期激素治疗。
在 cutiee (joy) 的大作中提到: 】 |
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