![åη
? ֢Ȅe
C
? sBP+ Mʮ֤ʏպ
C ѪR(Ǵ)
? sBPε+ Mʮ֤ʏպ
? ̈́e
1. ѭhѪҺpHypovolemic shock
2. ѪҺֲDistributive shock
3. ԭCardiogenic shock
4. ]Obstructive shock
5. ؚѪAnemic shock](https://image.slidesharecdn.com/20143-1-141127073802-conversion-gate01/85/-10-320.jpg)
![åJRե``
RďպѭhѪҺpѪҺֲԭ]
ݵ(A) _ͨԚݵ_ͨƤꡢS֤Ǥ/S֤Ǥʤ
(B)
ŬŬ
()
ѭh(C)
sѪRԥå? ѪRԥå
}R״rǮʤ
ĩҤ}?
Ƥwn?ů/n?
CRT W״rǮʤW
p
Uѧ(D) R٥ڤ״̼? ڤ
\(E) ״rˤäƮʤ
PALSץХ`ޥ˥奢һĉ](https://image.slidesharecdn.com/20143-1-141127073802-conversion-gate01/85/-13-320.jpg)
More Related Content
What's hot (20)
Viewers also liked (20)
Similar to СΥå tՓ (20)
СΥå tՓ
- 1. СɳТ 24 July. 2014 2014Сo㏊ 3-1. åtՓ Ver. 1.1
- 2. ޤϏ ? ǰؤΥʥե饭`㏊ åˤĤƺghޤ! ? ҙƤޤ? C åζx C Mؤعo C C C
- 3. åζx ? MؤؤȖBιoʮ֤ǡ xҪʤ𤳤ΣC ״r? å ѪR¤ǤϤʤ! ? åˤ벻ʮ֤ʽM־A ȡĠ˲ĤϺ ٤ķΙCܲȫؤMС ֹͣȤʤ
- 4. Mؤعo ? Mؤʮ֤عo C MؤѪʮ֤Ǥ뤳 C ѪҺФغʮ֤Ǥ뤳 ? ǰؓ ? Ľs ? ؓ 1ij ij غ عo C Сij¤ɤϡ1ij ε¤Ǥ뤳Ȥत
- 5. Ȥ ? ijϣؤĤͤѪ ҺǤ ? ¤ΣĤˤäҎޤ C ǰؓɣsǰҤ˴ڤѪҺ C ĽssΏ C ؓɣҤsrܤֿ
- 6. C ? 1ij¤ϡMؤ oS֤뤿Ckˤʤ C l} C ѪֿܵΉ ? Ƥw䤿k ? CRT (capillary Refilling Time)L ? ĩҤ}}RΜp C ĽsΉ C }oΉ
- 7. åΏպC ? C Ġ: l} ? Ѫֿܵ C Ƥw: Сnסk C ѭh: ëѪٳ䜺rgW C }: ĩ}}Rp(dBP) ? ĠѪֿܵϕN C I?c: I¡쥦
- 8. åΏպ5P ? Pallor C n ? Pulmonary insufficiency C ȫ ? Pulselessness C }Ĵ֪ ? Perspiration C 亹 ? Prostration C
- 9. \åΏպ SHOCK ? S: Skin C 䤿nסk ? H: HR C l} ? O: Outer bleeding C ѪПoδ_J ? C: CRT C capillary refill time (ëѪٳ䜺rg) ? K: Ketsuatsu (ѪR)
- 10. åη ? ֢Ȅe C ? sBP+ Mʮ֤ʏպ C ѪR(Ǵ) ? sBPε+ Mʮ֤ʏպ ? ̈́e 1. ѭhѪҺpHypovolemic shock 2. ѪҺֲDistributive shock 3. ԭCardiogenic shock 4. ]Obstructive shock 5. ؚѪAnemic shock
- 11. ѪRζx hsѪR(mmHg) ڮb (028) <60 郹 112£ <70 С 110r ѪR5ѩ` <70 + (h2) С >10r<90
- 12. ѪRԥåؤMչֹ! ? å ѪR ? ԥå״Bǽ뤷ʤС ѪRԥåMչ? C ԥå?ѪRԥårg C ѪRԥå?ֹͣ
- 13. åJRե`` RďպѭhѪҺpѪҺֲԭ] ݵ(A) _ͨԚݵ_ͨƤꡢS֤Ǥ/S֤Ǥʤ (B) ŬŬ () ѭh(C) sѪRԥå? ѪRԥå }R״rǮʤ ĩҤ}? Ƥwn?ů/n? CRT W״rǮʤW p Uѧ(D) R٥ڤ״̼? ڤ \(E) ״rˤäƮʤ PALSץХ`ޥ˥奢һĉ
- 14. åι ? Ŀ C åѸ٤JR??x C Mؤعo؏ͤMȴ xҪΥХƤ뤳!! ? λ C ѪҺغm C ijѪҺֲθ C Ҫ C xϺ
- 15. Ͷ뷽 ? ɤΤ褦Ͷ뷨ޤ? C ƥ ? ǥ˥` ? gեޥ(ݝ: 60%) C ƥ ? ٺʽꥶ`Щ`ޥ ? ٺʽꥶ`Щ`ޥ ? åϺrˤϸ ʹä!
- 16. ƥ ٺʽꥶ`Щ`ޥٺʽꥶ`Щ`ޥ
- 17. ƥ ٺʽꥶ`Щ`ޥ ? gեޥ˥ `Щ`Хå ? ؝:50-60% ?(10-12 L/min) Ҫ ? ꥶ`Щ`ޤ װ ? ꥶ`Щ`Хå ʤ{ ٺʽꥶ`Щ`ޥ ? ޥȡޥ? ꥶ`Щ`Хåg ݷһͤװ ? ݤϥޥų ? ؝:95%? (10-15 L/min) Ҫ ? פ˵͓Q ?ؤȤʤ
- 18. Ѫܤδ_ ? ݔҺKaͶΤѪܴ_ Ҫˤʤޤ C ޤ ? ĩҾ}ؤΥ˥`쒷ԇߤ C yʈ ? ĩҴ_˕rgȡʤ ? lᘤäƹl·_
- 19. l·δ_ ? Ʒ C Υl(Ժ) C ?ݔҺ饤 ? ̲λ C ÄǽλڂȤÄǴ(ƽ)һxk C ÄǽY1-3cmhλĿȤơȤ ·ƴ̤ ? ȹhλ??ǰcǼʤɤ̲λ ä¤
- 20. Υl ? ǥץ`ɤǒ뤹 { ? ׃?СΈϡƤ Ƥ|؞ͨ ǤۤȤ1cm ? ᡢ` åפ⤷ åȤir˹ li Ԥע⤹! Υlĕ
- 21. 1. ֫Xܞ?ϥX 2. ̲λ(ʹ) 3. lᘤˤƴ C ̲λYȤ֤ؤʤ! 4. _J C ᘤ֧ʤ C ˤꎈRȹlҺ C ʳcˮֿʤעǤ܇줬[ʤ 5. ̶lᘤֱӥƩ`פǹ̶
- 22. ݔҺK ? åˤݔҺҪ C ѭhѪҺȽMλ؏ ? ֪äƤȣ C ɤݔҺuä? C ɤγ̶ȤͶ? C ɤγ̶Ȥٶ?
- 23. Һڷֲ ھtˮ(total body water: TBW) ICF g|ҺѪ{ ECF ? ھtˮ(total body water: TBW) ?С: 60% ׃: 65% : 75% \ Һ(intracellular fluid: ICF) : 40% ?ȫhlj餺 \ Һ(extracellular fluid: ECF): 20(-35)% \ Ѫ{(Ѫ): 5% \ g|Һ: 15(-30)%
- 24. ݔҺ ? ԭt C ݔҺѪڤꡢg|ؤƄӤơ ˼ҺؤƄӤ C åǴФʤΤѭhѪҺ 뤳! C ҺLȤɤޤݔҺuxk Һg|Ѫ { ECF
- 25. ݔҺu1LͶ뤷 ݔҺu MɤUҺ (8) Һ(4) ȏҺˮg|(3) Ѫ(1) ʳcˮ (Na: 154 mEq/L) 1000 mL 0 mL 0 mL 750 mL 250 mL T1? (Na: 90 mEq/L) 590 mL 410 mL 275 mL 545 mL 180 mL T3? (Na: 35 mEq/L) 360 mL 640 mL 425 mL 430 mL 145 mL 5%Һ (Na: 0 mEq/L) 0 mL 1000 mL 665 mL 250 mL 85 mL
- 26. ݔҺu ? N C ȏ|Һ(Һ) ? ʳcˮ(Na+: 154, Cl-: 154mEq/L) ? Һ(饯ƥå?) C (Na+: 130, K+: 4, Ca2+: 3, Cl-: 109, L-Lactate-: 28 mEq/L) ? Һ(`F??`F?) C (Na+: 130, K+: 4, Ca2+: 3, Cl-: 109, Acetate-: 28 mEq/L) ? ̿Һ(ӥ`ܥ?) C (Na+: 135, K+: 4, Ca2+: 3, Mg2+: 1, Cl-: 113, HCO3 -: 25, Citrate3-: 5 mEq/L) ? (lactate) vs (acetate) vs ̿(HCO3 -) ??
- 27. vs vs ̿ ? x뤳Ȥˤäơ KĤˤ̿߳ޤ C ˴x ? Ġ?IĠ ? ȫν?x礤 ? ̿x줺ˤΤޤnȤƃP C ˤʹä?Ϥʤ C år ? ϸߤʤäƤ롣 ? ԺǤǤϤʤ( `?)ʹ
- 28. ݔҺͶͶrg ? ǤݔҺKr1Ͷ? 5 mL/Kg 10 mL/Kg 20 mL/Kg 30 mL/Kg 50 mL/Kg ? 𤨤Ϣ١ڡۤǤ C ͶϥåԭˤäƮʤޤ
- 29. åԭe ݔҺͶ?Ͷٶ åηݔҺͶͶٶ ѭhѪҺpԥå ѪҺֲԥå 20 mL/kg (ҪrR귵) 5-10֤ ԭԥå(ж) 5-10 mL/kg (ҪrR귵) 10-20֤ ԥå餦DKA 10-20 mL/kg (ҪrR귵) 1rg ж (륷a, ¥ɥʥڶaʤ) 5-10 mL/kg (ҪrR귵) 10-20֤ PALSץХ`ޥ˥奢һĉ
- 30. ݔҺK΄u ? ѭhѪҺpԥåˌ C 20 mL/kgʳcˮͶ뤷ޤ C ɤΤ褦Ҋע⤷ίж ޤ? C ίĤжϤҊ C CRTθơѪRϕNε¡ Μp١ΉӡR״Bθ
- 31. ˥ ? ίжΤᡢ¤Ŀl ⤷Ͼ@AĤ˥˥` C SpO2 C C C ѪR}R C R״B C C CRT C Х륵Ҫ!!
- 32. årΗʖ ? åβ֢ȡĠCϺ xϺʤɤuĿĤʩ C ѪҺʖ ? Ѫ㡢늽|(Na, K, Cl, Ca) ? Ѫ(ؤѪǂy) ? ѪҺ(årˤτ}Ѫu) C ԭʖ ? BʖˣƩ`ƥˤBѪҺB ? ѸٗʖˣҪˏꤸƸN륹ԭʖ C ʖ ? ȥʖ?CTʖ?ʖetc
- 33. ѪǤˤĤ ? ѪǤ֢СJ C 륳`äߤAi٤ʤʤ СϵѪǤθߥꥹ C x<45mg/dL, 郹С<60mg/dL C ѪǤwӤ×AĤϺ⤿餹 ? C lؤѪǜy C ѪǕrGlu 0.5-1g/kg (= 20%Glu 2.5mL/kg, 10%Glu 5mL/kg) 20%Glu (=200g/L = 200mg/mL) 2.5mL/kg =500mg/kg =0.5g/kg
- 34. ݔҺKrǺuʹ ? åˌݔҺK˥֥ɥǺ u`Ͷ뤷ƤϤʤʤ! ? 1. Υ֥ɥؓ 2. Ѫ 3. ѪRϕN 4. R 5. ѭhѪҺp ?åː
- 35. RӋʽ ? Ѫ{R(: 285-295 mOsm/kgH2O) =2(Na+) + Glu(mg/dL)/18 + BUN(mg/dL)/2.8 {+ Mannitol (mM) + Alcohol (mM)} ? } C ʳcˮ? Na:1542 = 308 mOsm/kgH2O C T1? ? Na:902 + Glu:2600/18 = 324 C 5%Һ? Glu:5000/18 = 278 ʳcˮ: Na: 154mEq/L, 5%Һ: Glu: 5% (=50g/L = 50000mg/10dL = 5000mg/dL) T1?: Na: 90mEq/L, K: 20mEq/L, Cl: 70mEq/L, Glu: 2.6% ____non-effective osmoles ? Ĥɤͨ^뤿R߳ʤ
- 36. ؤݔҺͶδΤ??? ? ͶʮݔҺɡ ? ʤϤ갲뤿 ? aͶ뤷ޤ C ɤΤ褦ʷNaʹäޤ?
- 37. åίäѪa Na ԉa? ɥʥ ? ɥѥߥ ? ɥ֥ߥ ? Ľs ? ? SVRˤޤޤ ۥۥƥ`躦a (ԉѪܒa) ? ߥΥ ? ʥΥ ? SVRε ? ڄ}Ѫθ ? Ľs Ѫܒa? ˥ȥꥻ ? ˥ȥץ륷 ? SVRȾ}oε Ѫ܅sa(NRa) ? ɥʥ ? Υ륢ɥʥ ? ɥѥߥ ? Хץ쥷 ? SVRϕN ? Ľs (Хץ쥷) SVRѪֿܵPALSץХ`ޥ˥奢
- 38. åγڹΤޤȤ ? ݵδ_Ͷ롢 C ҪraQ ? Ѫܴ_ C ĩҾ}jĿʤѤäѤȹl· ? ݔҺK C ϵȏ|Һ20mL/kg, 5-20֤Ͷ C ѭhƤޤͶR귵 C ԭԤτeǤ衢 ? mФʥ˥ C Х뤬! CRT ? Rʖ C Ѫǂע⤷ ? aﯟ C Bˏꤸʹ֤褦
- 39. Сȼҽ Off the Jobȥ`˥` ? BLS Basic Life Support ? PALS Pediatric Advanced Life Support ? PFCCS Pediatric Fundamental Critical Care Support ? PEARS Pediatric Emergency Assessment, Recognition, and Stabilization