BG Suy ho hap 2018

Fetal hemoglobin binds to oxygen more strongly than adult hemoglobin, enabling the transfer of oxygen from mother to fetus prenatally.. Oxygen exchange within the tissue is thus affected

mpulses are transmitted from the brain via the vagus and spinal nerves to the larynx, trachea, bronchi, bronchioles, and acini; the glossopharyngeal to the pharynx; the hypoglossal (CN XII) to the tongue; and the spinal accessory (CN XI) to accessory muscles Cervical nerves (C2 to C4), the phrenic nerve (C3 to C5), and the intercostal nerves (T1 to T12), innervate accessory muscles, the respiratory diaphragm, and intercostal muscles, respectively

An infant’s thoracic cage is more compliant than that of the adult or older child, allowing a greater tendency toward alveolar

collapse The intercostal muscles are poorly developed and unable to achieve the “bucket-handle” motion characteristic of adult breathing, and the diaphragm is shorter and relatively flat with fewer type I muscle fibers, making it less effective and more easily fatigued The infant’s airways are smaller in caliber than those in older children and adults, resulting in greater resistance to

inspiratory and expiratory airflow and greater susceptibility to occlusion by mucus plugging and mucosal edema Compared with adults, the alveoli of children are also smaller and have less collateral ventilation, again resulting in a greater tendency to collapse and develop atelectasis Finally, young infants may have an especially reactive pulmonary vascular bed, impaired immune

system, or residual effects from prematurity, all of which increase the risk of respiratory failure

Fetal hemoglobin binds to oxygen more strongly than adult hemoglobin, enabling the transfer of oxygen from mother to fetus prenatally Oxygen exchange within the tissue is thus affected by the strength of the binding between hemoglobin and oxygen Human infants continue to generate significant amounts of fetal hemoglobin for up to 6 months postnatally (Thein et al., 2009), which impacts (diminishes) oxygen exchange between the vasculature and tissue throughout the body, including in the brain.1

Như vậy:

Nguy kịch hô hấp bao gồm các duấ hiệu như phấp phồng cánh mũi, co lõm ngực, thở nhanh và ám chỉ về mặt lâm sàng Trong khi suy hô hấp ám chỉ sự cung cấp oxy không đủ hay không thể thải CÒ2 cho nhu cầu cơ thể

Nguy kịch hô hấp có thể có ở BN không có bệnh hô hấp (shock tim, Shock nhiem trùng) và suy hô hấp có thể xảy ra ở Bn mà không có biểu hiện nguy kịch hô hấp

An important fact to bear in mind is that even though the definition of hypoxemic respiratory failure rests on measurement of PaO2, the major threat of arterial hypoxemia is inadequate tissue oxygenation, reflected in tissue oxygen delivery Tissue oxygen delivery is determined by the product of cardiac output and blood oxygen content (see Chapter 15, Blood-Gas Transport); the latter, in turn, depends on hemoglobin concentration and oxygen saturation Therefore, factors that lower cardiac output or

hemoglobin concentration, or inhibit dissociation of oxygen from hemoglobin at the tissue level, may promote tissue hypoxia without technically producing respiratory failure

Thường gây suy hô hấp loại II

Hypoventilation (↓V)

- V /Q? (< 0.8)

- Also called “Functional shunt” or

“Venous admixture”

- V /Q ? (> 0.8)

- Also called “Dead space-like ventilation”

Khả năng khuếch tán của CO2 gấp 20 lần oxy thường gây suy hô hấp loại I thường gây suy hô hấp loại I

Why acidosis leads to hyperkalemia? Across cells: H+-K+ interchange; Kidney: H+-Na+ exchange increase, K+-Na+ exchange decrease

In acidosis, 1) HCO3- goes out from the cell, and Cl- goes in; 2) NH4Cl secretion is increased (therefore lower Cl)

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Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, resulting in a falsely high reading.

Pulse oximetry can yield falsely low saturations in critically ill patients who have vasoconstriction, poor perfusion, hypothermia,

or arrhythmia Methemoglobin absorbs light equally at both wavelengths (940 and 660), with pulse oximetry displaying a O2 Sat of 85%

Viral Pneumonia Frontal view of the chest demonstrates hyperinflation with marked increase in bronchovascular markings emanating from hilum and areas of atelectasis at both bases

Ngửa đầu nâng cằm: một bàn tay ấn trán bệnh nhân xuống, đầu ngón trỏ và ngón giữa của bàn tay thứ hai sẽ nâng cằm bệnh nhân, đồng thời nâng lưỡi bệnh nhân từ phía họng sau Kỹ thuật này giúp thông đường thở tạm thời

3.2 Động tác nâng hàm (nhấc hàm): khi nghi ngờ chấn thương cột sống cổ dùng thủ thuật ấn hàm mà không ngửa đầu để tránh di lệch cột sống cổ Bệnh nhân nằm ngửa, cấp cứu viên giữ chặt góc hàm bằng ngón trỏ và các ngón dài đồng thời kéo hàm về phía trước giúp thông đường thở mà không làm ngửa cổ bệnh nhân