【体外膜肺ECMO精品课件】 Case.pptVIP

* * * * * * * * * * * * * * * N-methyl-D-aspartate A-3-hydroxy-5-methly-4-isoxazole propionate * * Mechanism of Hypoxic-Ischemic Encephalopathy Excitatory amino acids, glutamate and aspartate, are released in response to hypoxia/ischemia Activation receptors, NMDA, AMPA, Kainate Ion channels open Influx of calcium into cells Cell death Lipid peroxidation of cell membranes Destruction of Na+/K+ ATPase Cerebral edema, neuron death Increased rate of apoptosis Related to influx of calcium into cell and nucleus Complications of hypoxic-Ischemic Encephalopathy Autonomic instability Hypertension Tachycardia Diaphoresis Agitation Muscle rigidity Aspiration Chemical Pneumonia pH less than 2.5 Volume greater than 0.3mL/Kg Inflammatory reaction by cytokines TNF-alpha, IL-8 Bacterial Pneumonia Anaerobic organisms Other organ involvement Occur 24-72 hours after initial insult Heart: decreased contractility, dilation, tricuspid regurgitation, “tako-tsubo stress induced cardiomyopathy Renal: acute tubular necrosis, oliguria, anuria Hepatic: increased LFT’s, hypoalbuminemia, coagulopathy, hyperbilirubinemia Rhabdomyolysis Management: CPR Bystander resuscitation necessary 30% pediatric cardiac arrest patients receive bystander CPR PUSH HARD, PUSH FAST Minimize interruptions Some bystander CPR, better than none Heimlich maneuver contraindicated because it can cause emesis, aspiration Rescue breaths at rates 20 breaths/min contraindicated because venous return can be obstructed Arrival to the hospital General Assessment: Appearance Work of Breathing Circulation Primary Assessment: Airway Breathing Circulation Disability Exposure Pediatric Advanced Life Support Provider Manual Management ET intubation: Cannot maintain PaO2 80 mm Hg on 100% O2 by face mask Inability to protect airway or handle secretions Respiratory failure - PaCO2 45 mm Hg Worsening ABG results Peep: shifts interstitial pulmonary water into the capillaries increases lung volume by preventing of alveolar co