无菌术课件概要1.pptVIP

Asepsis History Significance and Definition Asepsis of Surgical instrument and Dressing Preparation for Dr. and Pt. Key Points Pasteur (1862) Discovered bacterium Developed Pasteurization process Steam Sterilization Steam Sterilization (1974) Advanced Sterilizer Symptomatic anemia (providing oxygen-carrying capacity) Transfusion trigger (HCT30% ; HB10g/dl) 1 Unit increases 3% HCT or 1g/dl Shelf life =42 d (1-6 ℃) Thrombocytopenia ( 50,000) Platelet dysfunction Each unit increase 5,000 PLTs after 1 H Profoundly granulocytopenia (500) Serious infection not responsive to antibiotic therapy Coagulation factor deficiencies 1 ml increases 1% clotting factors Being used as soon as possible Albumin, hetastarch, crystalliods are equally effective volume expander but safer than FFP After use of 5 U of RBCs, matching 2 U of FFP --Volume Expander Dextran Most widely used Low/Middle M.W. (40,000-70,000) Massive transfusion could impair coagulation Occasional ALLERGIC reaction Hydroxyethyl Starch Formulation (HES) More stable Containing essential electrolytes No allergic reaction Massive transfusion complications: Volume Overload Congestive Heart Failure Tachycardia Tachypnea Cyanopathy Transfusion Reactions Volume Overload Heart Functional Failure Lung Functional Failure Reasons： Stop Transfusion Heart Functional Support Diuresis (Furosemide) Treatment： Massive Transfusion Complications: Contamination: Fever Shock DIC Bacterial Contamination Reasons： Transfusion Reactions Stop Transfusion Bacterial Exam and Culture Antibiotics Treatment： Double Check Operate carefully Prevention： Contamination: Hepatitis B, Hepatitis C HIV Cytomegalovirus (CMV) Syphilis Malaria Acquired diseases ： Transfusion Reactions No risk of infectious disease transmission No transfusion reactions No compatibility testing Reduced demand on blood bank stores An immediate source of autologous blood Autotransfusion： Red Blood Cells Packed RBC White Blood Cells