09.01 危重疾病.pptVIP

Critical Care Medicine - Pei zhi Huang Zhong Shan Hospital Fu Dan University Objectives Assessment (APACH II , shock, RF,MODS) Monitoring (arterial blood-gas analysis, SpO2 , pulmonary artery catheter ) Neurologic dysfunction Severity-of-illness scoring systems APACHE (acute physiology and chronic health evaluation) = the most commonly scoring system in the ICU MPM (mortality probability model):calculate a direct probability of death SAPS (simplified acute physiology score): acute physiology + (AIDS, metastatic cancer, and hematologic malignancy) APACH II First 24 h : mild 10 , severe 20 Acute: 12 variables (0-4) Vital signs( T, P, R, BP ) Respiratory function(PH, oxygenation) Renal function(Cr, K+ , Na+ ) WBC+HCT Neurological function(15- GCS ) Age : (0-6) Chronic health(0- 5): after surgery or non, or emergency surgery Evaluation of shock Cardiovascular status Effect of circulatory inadequacy on other organs Hypotension MAP ?= CO ? × SVR preload(CVP) afterload(SVR) HR × cardiac function myocardial valvular pulse pressure ?(cold) conduction preicardial MAP ?= CO ? × SVR ? =pulse pressure ?(warm) Categories of Shock CO ?, blood Volume ? =hypovolemic CO ?, blood Volume ? =cardiogenic CO ?, SVR ? =high-output hypotension (e.g. , septic shock) Clinical classification of shock Hypovolemic(hemorrhagic, non-hemorrhagic) Cardiogenic (myocardium,valves