2. Treating ventricular fibrillation by early defibrillation: the single-phase defibrillator is set to 360J, and the dual-phase defibrillator is set to 200J, or according to the manufacturer's instructions. You must know which defibrillator to use. For the first failure of ventricular fibrillation, vasopressin or epinephrine is given every 2 minutes, or cardiopulmonary resuscitation is performed for 5 cycles, and then defibrillation is performed again.
3. Using pulse oximeter, the absorption mode of methemoglobin (for different wavelengths of light) can be characterized by 85% pulse oxygen saturation, so the increased level of methemoglobin can make SPO2 _ 2 reach 85%, regardless of the actual oxygen saturation (sao2 _ 2).
4. The mixed venous oxygen saturation (SVO2) provides a sign of systemic perfusion. When the mixed oxygen saturation is lower than 60%, it means that the perfusion is insufficient, which is probably caused by congestive heart failure.
5. There is little evidence to support the use of advanced monitoring tools, such as pulmonary artery catheterization. Without proper professional knowledge and judgment, it is futile and even harmful to use these devices.
6. Pulse oximeter is suitable for monitoring, but ABG is the best choice for diagnosis and first aid. If the results of oximetry are inconsistent with the clinic, arterial blood gas analysis should be made in combination with oximetry. Using alveolar gas equation to help understand the mechanism of hypoxemia-this effort is worthwhile!
7. Use maintenance intravenous infusion to supplement the detectable and undetectable fluid loss. The fluid loss of adult patients is 30-35 ml/kg. Crystal solution is still the first choice to continue capacity recovery.
8. respiratory quotient (RQ) refers to the ratio of carbon dioxide produced by patients to oxygen consumed. Respiratory quotient helps to guide the nutrition treatment plan.
9. For COPD patients, noninvasive ventilation is helpful to reduce the need for tracheal intubation and improve the survival rate. For patients who need emergency tracheal intubation, do not use noninvasive ventilation.
10. When establishing mechanical ventilation, minimize tidal volume and airway pressure, and even allow respiratory acidosis.
1 1. Daily sedation and analgesia should be reduced or interrupted, so that patients can stay awake, breathe spontaneously and protect the airway, thus getting rid of mechanical ventilation.
12. In most patients, tracheal intubation may not be needed to keep the airway open. Five main indications of tracheal intubation: upper airway obstruction, insufficient oxygenation, insufficient ventilation, increased respiratory work and airway protection.
13. Repeated aspiration by patients with abdominal distension, frequent belching or tracheotomy suggests that tracheoesophageal fistula may occur.
14. Up to 85% of patients with penetrating chest injuries only need thoracic catheter drainage. The blood discharged from the thoracic duct can be reinjected without further treatment.
15. Fiberoptic bronchoscopy is often used to diagnose VAP in intensive care unit and guide antibiotic selection. Chest physiotherapy has the same effect as bronchoscope in treating atelectasis, although bronchoscope plays an important role in retaining viscous airway secretions and foreign bodies.
16. the most common reason for the temporary failure of intravenous pacemakers is that the lead loses contact with the heart; Pacing is resumed and the electrode is advanced until it contacts the myocardium again to "capture" or pace the heart.
17. circulatory AIDS are only used for transitional treatment. These devices are used in the transitional period of resuscitation, vascular reconstruction and transplantation.
18. Severe CAP can be identified by the following abnormal signs: confusion, urea, respiratory rhythm and blood pressure changes.
19. Normal PCO2 in acute asthma warns that respiratory failure is coming.
20. Minimizing the ventilation per minute, even reaching the allowable hypercapnia, is the best strategy to reduce dynamic hyperventilation, secondary hemodynamic hazards and barotrauma in patients with acute severe asthma with mechanical ventilation.
2 1. Non-invasive ventilation reduces the dependence on tracheal intubation and the occurrence of respiratory failure in patients with AECOPD. For AECOPD patients with continuous mechanical ventilation, the application of antibiotics can reduce the morbidity and mortality.
22. Pulmonary heart disease refers to right ventricular hypertrophy caused by pulmonary blood vessels or lung parenchyma. Ltot is the main treatment.
23. The goal of hypoxic respiratory therapy is to achieve PO2 of about 50mmHg. Once the patient is in a physiological stable state and can maintain sufficient oxygenation and carbon dioxide concentration under oxygen supply, he should try to leave the ventilator every day and stop mechanical ventilation in a planned way.
24.ARDS cannot be prevented. The only treatment to reduce the mortality of ARDS is low tidal volume ventilation.
25.ICU critically ill patients have the risk of frequent aspiration and the consequences of aspiration. The consequences of inhalation depend on the amount and nature of inhalation and the patient's response to stimulation.
26. It is more common for massive hemoptysis to die from asphyxia and acute respiratory failure than from bleeding. The first-aid method of massive hemoptysis is to protect healthy lung tissue by placing posture. If the bleeding is local, put the bleeding lung tissue in a lower position. If there is a lot of bleeding, keep your head down and your feet up.
27. Because there is no specific clinical, X-ray and laboratory diagnosis basis for pulmonary embolism, the possibility of pulmonary embolism should be considered in any critically ill patient with deteriorating cardiopulmonary condition.
28. The equivalent symptoms of angina pectoris refer to atypical symptoms of myocardial ischemia, including nausea, dizziness and dyspnea, which are induced or relieved as angina pectoris.
29. The short-term goal of the treatment of acute myocardial infarction is to restore blood perfusion, which can be achieved by percutaneous coronary intervention or drug thrombolysis.
30. With regard to acute tachycardia, firstly, blood pressure is measured by invasive or non-invasive means to confirm that the patient has sufficient systemic perfusion. If the patient's blood pressure is insufficient, perform synchronous cardioversion therapy.
3 1. In the treatment of acute aortic dissection aneurysm, before sodium nitroprusside is used to prevent aortic dissection from expanding, sufficient β -blockers must be used to prevent the increase of reflex cardiac output.
32. Surgical intervention should be considered when or before pulmonary hypertension occurs in patients with mitral stenosis, because the mortality rate of patients diagnosed with pulmonary hypertension is obviously increased.
33. Critically ill patients with severe aortic stenosis and severe left ventricular dysfunction can benefit from careful treatment with sodium nitroprusside.
34. The most common ECG manifestation of acute pericarditis is the elevation of st segment ascending branch in all leads except AVR and V 1.
35. Severe sepsis syndrome (SSS) is defined as sepsis complicated with organ dysfunction related to sepsis. Early diagnosis and treatment intervention can improve the prognosis of such patients.
36.60-80% of endocarditis patients are caused by streptococcal infection. Staphylococcus aureus is usually the most common pathogen of infective endocarditis among intravenous drug users.
37. Adjuvant dexamethasone can reduce the mortality rate of adult bacterial meningitis from 15% to 7%, among which pneumococcal meningitis has the best effect, but the application of steroid compounds should not be delayed in etiological diagnosis.
38. How to suspect disseminated fungal infection? Don't wait for the culture results to come out before treatment. All critically ill patients should consider the possibility of fungal infection as soon as possible, because treatment failure will lead to high mortality.
39. About 65,438+0% people carry MRSA. The proportion is higher in areas with poor sanitation and dense population, and community-acquired MRSA infection is also quite common.
40. When selecting central venous catheterization, subclavian vein is the first choice, because it will lead to lower risk of catheter-related infection and bacteremia. Central venous catheter inserted through peripheral route has the same risk of catheter-related infection as standard central venous catheter inserted through subclavian vein or internal jugular vein.