EAB cazuri clinice
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Transcript of EAB cazuri clinice
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EAB cazuri clinice
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Cazul I Istoric
Pacient in varsta de 25 ani, sex masculin APP nesemnificative Prezinta de 2 zile : febra, tuse productiva, respiratie dificila
Examen clinic
Febra (t=39.3°C), Respirator: -polipnee (FR=28 resp/min);
-utilizarea muschilor respiratori accesori; ampliatii toracice reduse
-auscultator raluri bronsice la nivelul lobului stang pulmonar
-SpO2=89%(in aer atmosferic); Hemodinamic: TA=118/70 mmHg
AV=104 /min
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ANALIZA GAZELOR SANGVINE ARTERIALE
PH=7.50Pco2=28,1mmHgPo2=57.8 mmHgBicarbonat=23.9m
mol/lBE= -0.5mmol/lSPO2=88.7%Lactat=1.2K=3.7 mmol/mNa=138 mmol/lCl=99 mmol/lHb=15g/dlGlucoza=97mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Are pacientul indicatie de oxigenoterapie ?
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RASPUNSURI
1 Disfunctie respiratorie usoara
2 Alcaloza respiratorie necompensata
-hiperventilatia este raspunsul compensator hipoxemiei si dispneei , rezultand astfel alcaloza respiratorie
3 Atitudinea corecta este administrarea de O2suplimentar pentru corectarea hipoxemiei si administrarea de antibiotice pt tratarea infectiei.
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CAZUL 2
Istoric: Pacienta in varsta de 34 ani; sex feminin APP: obezitate morbida ( BMI=49)
diabet zaharat tip II este internata pentru reducerea greutatii corporale chirurgical
Examen clinic:Fara semne si simptome respiratorii
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ANALIZA GAZELOR SANGVINE ARTERIALE
PH=7.35
H*=45nmol/l
Pco2=54,8mmHg
Po2=72,2 mmHg
Bicarbonat=29mmol/l
BE= +3,8mmol/l
SPO2=96%
Lactat=1
K=4.7 mmol/m
Na=134 mmol/l
Cl=102 mmol/l
Hb=13g/dl
Glucoza=162mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Care este cel mai probabil diagnostic ?
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1. Insuficienta respiratorie cronica moderata.
2. Acidoza respiratorie compensata ?
3. Insuficienta respiratorie cronica moderata cauzata de obezitatea morbida.
RASPUNSURI
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CAZUL 3 Istoric:
Pacienta in varsta de 24 ani; sex feminin APP: nefumatoare
fara antecedente de TVP si afectiuni pulmonare Pacienta prezinta dispnee la 1 zi dupa un zbor cu avionul
Examen clinic: Pacienta anxioasa, deprimata, RESPIRATOR:
polipnee (FR = 22 resp/min), SpO2=95%
expansiunea cutiei toracice normala
nu prezinta semne clinice de TVP
Rx. pulmonar in limite normale radiologic HEMODINAMIC:
TA = 126/74 mmHg
AV = 88 /min ritmic
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ANALIZA GAZELOR SANGVINE ARTERIALE
PH=7.51H*=31,2nmol/lPco2=29,3mmHgPo2=77 mmHgBicarbonat=25,0mmol/lBE= +0,7mmol/lSPO2=93,7%Lactat=1K=4.3 mmol/mNa=141 mmol/lCl=101 mmol/lHb=13g/dlGlucoza=82mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Care este cel mai probabil diagnostic ?
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1. Disfunctie respiratorie tip usoara
2. Alcaloza respiratorie necompensata
3. Embolie pulmonara
RASPUNSURI
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CAZUL 4 Istoric:
Pacient in varsta de 78 ani; sex masculin, APP: patologie biliara Stare comatoasa la cateva ore dupa colecistectomie pe cale deschisa NB: pac. a primit 3 doze a 10 mg morfina subcutan suplimentar morfinei
administrata prin PCA.
Examen clinic:Stare comatoasa, pupile miotice simetric bilateralRESPIRATOR:
- respiratie superficiala
- bradipnee (FR = 5 resp/min). HEMODINAMIC:
- TA = 98/64 mmHg
- AV = 90 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 4
PH=7.18H*=65,4nmol/lPco2=62mmHgPo2=87 mmHgBicarbonat=22mmol/lBE= -1,5mmol/lSPO2=99,8%Lactat=1K=4.4 mmol/mNa=137 mmol/lCl=103 mmol/lHb=11g/dlGlucoza=72mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Care este cel mai probabil diagnostic ?
4. Care este cel mai indicat tratament ?
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1. Disfunctie respiratorie severa
2. Acidoza respiratorie necompensata
3. Toxicitate determinata de doza crescuta de opioid.
4. Antagonisti ai opioizilor (naloxona), pt. antagonizarea disfunctiei respiratorii.
RASPUNSURI - caz 4
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CAZUL 5 Istoric:
Pacient in varsta de 75 ani; sex masculin, APP: BPOC In urma cu 3 zile tuse productiva cu expectoratie voluminoasa, respiratie
dificila Internat pentru: respiratii superficiale, senzatie de sufocare
Examen clinic:Pacient epuizat, afebrilRESPIRATOR:
- "sete de aer", respiratie suieratoare
- polipnee, FR = 26 resp/min, SpO2 = 81%HEMODINAMIC:
- TA = 150/80 mmHg
- AV = 120 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 5
PH=7.40H* = 39,5 nmol/lPco2 = 36 mmHgPo2 = 44 mmHgBicarbonat = 23 mmol/lBE = -1,2mmol/lSPO2 = 80%Lactat = 1K = 4,1 mmol/mNa = 137 mmol/lCl = 99 mmol/lHb =16,5 g/dlGlucoza = 68 mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Are indicatie de administrarea oxigenului suplimentar ?
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1. Disfunctie respiratorie moderata
2. Status acidobazic normal
3. Da
RASPUNSURI - caz 5
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CAZUL 6 Istoric:
Acelasi pacient ca la cazul precedent A fost tratat cu: bronhodilatatoare, prednison oral, antibiotic
oxigenoterapie la FiO2 = 28%. Clinic: fara imbunatatire, SpO2 = 84%.
Examen clinic:Pacient epuizat, usor confuz, somnolentRESPIRATOR:
- FR = 16 resp/min, SpO2 = 83% (la FiO2 = 28%)HEMODINAMIC:
- TA = 120/80 mmHg
- AV = 120 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 6
PH = 7.29H* = 51 nmol/lPco2 = 52 mmHgPo2 = 48 mmHgBicarbonat = 24 mmol/lBE = -0,9 mmol/lSPO2 = 84%Lactat = 1K = 4,0 mmol/mNa = 137 mmol/lCl = 99 mmol/lHb =16,5 g/dlGlucoza = 75 mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Ar trebui intrerupta O2-terapia ?
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1. Disfunctie respiratorie severa
2. Acidoza respiratorie necompensata
3. Nu
RASPUNSURI - caz 6
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CAZUL 7 Istoric:
Pacienta in varsta de 77 ani, sex feminin Internata pe STI - Neurologie pentru:
Deficit motor hemicorp drept Tulburare de vedere, bradilalie
Alimentata pe SNG --> in urma cu 24h, episod de voma urmat de respiratie dificila la cateva ore dupa incident.
Examen clinic:Pacienta agitata, febrila, epuizataRESPIRATOR:
- polipnee, FR = 28 resp/min, SpO2 = 92%
- murmur vezicular prezent bilateral, diminuat bazal bilateral, raluri crepitante bazal bilateral
HEMODINAMIC:
- TA = 112/65 mmHg
- AV = 92 bpmNEUROLOGIC - stationar
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 7
PH = 7.41H* = 38,8 nmol/lPco2 = 33,2 mmHgPo2 = 65 mmHgBicarbonat = 21,2mmol/lBE = -2,8 mmol/lSPO2 = 92,7%Lactat = 1,6K = 4,0 mmol/mNa = 144 mmol/lCl = 103 mmol/lHb =13 g/dlGlucoza = 118 mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Care este diagnosticul cel mai probabil ?
4. Care este starea generala a pacientului
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1. Disfunctie respiratorie usoara
2. Alcaloza respiratorie usoara compensata.
3. Pneumonie de aspiratie
4. Stare generala grava
RASPUNSURI - caz 7
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CAZUL 8 Istoric:
Pacient in varsta de 68 ani, sex masculin APP: BPOC,
dispnee de efort (tolara mersul a 500m) Internat pentru: respiratie dificil
dispnee de repaus (la imbracare),
Examen clinic:Constient, cooperant, usor epuizatRESPIRATOR:
- polipnee, FR = 24 resp/min, SpO2 = 72%
- respiratie suieratoare
- foloseste musculatora respiratorie accesorieHEMODINAMIC
- TA = 138/82 mmHg
- AV = 96 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 8
PH = 7.36H* = 43,2 nmol/lPco2 = 54,1 mmHgPo2 = 40 mmHgBicarbonat = 30,6 mmol/lBE = +4,9 mmol/lSPO2 = 75,2 %Lactat = 1,2K = 3,7 mmol/mNa = 144 mmol/lCl = 102 mmol/lHb =16 g/dlGlucoza = 78 mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Care parametrul s-a modificat semnificativ in ultimele 24h ?
4. De care parametrii (2) se va tine cont la administrarea O2-terapiei?
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1. Disfunctie respiratorie cronica
2. Acidoza respiratorie compensata.
3. PO2
4. PCO2 si HCO3
RASPUNSURI - caz 8
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CAZUL 9 Istoric:
Pacientul precedent A urmat tratament cu: bronhodilatatoare (aerosoli), prednison oral, O2-
terapie (FiO2 = 60% pe masca faciala) Status respirator imbunatatit considerabil iar la 1 ora pacientul devine
somnolent, necooperant, pseudocomatos.
Examen clinic:Ametit, greu cooperant, RESPIRATOR: respiratii ample, fara dispnee
FR = 14 resp/min, SpO2 = 96%
HEMODINAMIC
- TA = 132/80 mmHg
- AV = 88 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 9
PH = 7.29H* = 50,8 nmol/lPco2 = 65,3 mmHgPo2 = 84 mmHgBicarbonat = 30,3 mmol/lBE = +4,7 mmol/lSPO2 = 96,2 %Lactat = 1,2K = 3,6 mmol/mNa = 144 mmol/lCl = 102 mmol/lHb =16 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator ?
2. Descrieti statusul acidobazic ?
3. Specificati cauza deteriorarii starii generale.
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1. Disfunctie respiratorie cronica acutizata
2. Acidoza respiratorie partial compensata.
3. O2-terapie excesiva
RASPUNSURI - caz 9
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CAZUL 10 Istoric:
Pacienta in varsta de 21 ani, sex femini APP: Astm Bronsic --> cu exacerbari necesitand spitalizare Internata pentru: dispnee, wheezing de aproximativ 6 ore
Examen clinic: Clinic: fara ameliorare la administrare de salbutamol. RESPIRATOR: dispnee, expir prelungit
utilizeaza musculatura respiratorie accesorie
polipnee cu FR = 30 resp/min, SpO2 = 96%
murmur vezicular, raluri sibilante bilateral
VEMS = 160 litrii/sec (normal = 400 litrii/sec) HEMODINAMIC
- TA = 120/80 mmHg
- AV = 115 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 10
PH = 7.38H* = 42 nmol/lPco2 = 43 mmHgPo2 = 76 mmHgBicarbonat = 24 mmol/lBE = -1,3 mmol/lSaO2 = 96 %Lactat = 1K = 4,0 mmol/mNa = 140 mmol/lCl = 99 mmol/lHb =13 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care din parametrii EAB sunt modificati semnificativ ?
4. Care este severitatea crizei de astm ?
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1. Disfunctie respiratorie usoara
2. EAB normal
3. Criza de astm bronsic cu potential letal.
RASPUNSURI - caz 10
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CAZUL 11 Istoric:
Pacienta in varsta de 23 ani, sex feminin APP: nesemnificative Internata pentru: durere la nivelul gleznei (in urma unei excursii)
- in timpul anamnezei: foarte agitata, plange
- la 1 h dupa anamneza afirma: parestezii la nivelul cav. buc. si bratelor, durere presternala, lipsa de aer.
Examen clinic: Clinic: pacienta speriata, foarte agitata. RESPIRATOR: polipnee, FR = 36 resp/min, SpO2 = 100%
VEMS = normal
Rx. pulmonar = normal HEMODINAMIC
- TA = 130/80 mmHg
- AV = 96 bpm
- ECG = normalRx. glezna: Normal
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 11
PH = 7.53H* = 29 nmol/lPco2 = 24 mmHgPo2 = 108 mmHgBicarbonat = 24 mmol/lBE = -1,8 mmol/lSaO2 = 99 %Lactat = 1K = 3,5 mmol/mNa = 140 mmol/lCl = 99 mmol/liCa = 0,9 mmol/lHb =12 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Ce alte modificati observati pe EAB?
4. Care este cel mai probabil diagnostic ?
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1. Hiperventilatie.
2. Alcaloza respiratorie necompensata
3. iCa usor scazut.
4. Atac de panica.
RASPUNSURI - caz 11
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CAZUL 12
Istoric: Pacient in varsta de 40 ani, sex masculin APP: nesemnificative Victima unui incendiu, prins in spatiu inchis 20 min
Examen clinic: Clinic: ametit, acoperit de funingine, miros de fum, greata, fara leziuni interne
RESPIRATOR: echilibrat, SpO2 = 99% cu O2 pe masca 15 l/min
HEMODINAMIC: stabil
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 12
PH = 7.36H* = 44 nmol/lPco2 = 34 mmHgPo2 = 353 mmHgBicarbonat = 18 mmol/lBE = -5,5 mmol/lSaO2 = 100 %Lactat = 2K = 3,6 mmol/mNa = 145 mmol/lCl = 103 mmol/lHb =14 g/dlGlucoza = 72 mg/dlMonoxid de Carbon (CO) = 40%
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este cel mai probabil diagnostic ?
4. Care dintre parametrii EAB sunt neadecvati ?
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1. Hipoxemie severa.
2. Acidoza metabolica compensata
3. Intoxicatie cu CO
4. SaO2.
RASPUNSURI - caz 12
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CAZUL 13
Istoric: Pacienta in varsta de 79 ani, sex feminin APP: rectoragii de aprox. 6 luni, Internata pt. interv. chir. pt. o tumora colonica (descoperita la
colonoscopie).
Examen clinic: Clinic: epuizata, respiratii superficiale,
- fara modificare cantitativa a rectoragiilor RESPIRATOR: dispnee, polipnee, FR = 24/min, SpO2 = 100%
HEMODINAMIC:
- TA = 100/80 mmHg
- AV = 100 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 13
PH = 7.49H* = 32,3 nmol/lPco2 = 25 mmHgPo2 = 89 mmHgBicarbonat = 22 mmol/lBE = -2 mmol/lSaO2 = 99,8 %Lactat = 1K = 3,8 mmol/mNa = 138 mmol/lCl = 96 mmol/lHb =6,8 g/dlGlucoza = 70 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este cauza manifestarilor respiratorii ?
4. Care este solutia ameliorarii hipoxiei?
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1. Hiperventilatie (hipoxemie secundara anemiei)
2. Alcaloza respiratorie necompensata
3. Anemia
4. Transfuzie sangvina pt refacerea Hb
RASPUNSURI - caz 13
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CAZUL 14
Istoric: Pacienta in varsta de 78 ani, sex feminin APP: FiA (trat. digoxin si aspenter), Internata pt. durere abdominala difuza severa aparuta spontan
- anterior durere colicativa abdominala fara iradiere particulara.
Examen clinic: Clinic: teg. si extremitatii normal colorate, calde,
RESPIRATOR: echilibrata HEMODINAMIC: stabila ABDOMINAL: mobil cu respiratia, dureros la palpare profunda, fara formatiuni
tumorale palpabile
- Rx.abdo: fara modificari Pe parcursul examinarii --> deteriorarea starii generale --> transfer STI
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 14
10 L O2 pe mascaPH = 7.28H* = 52,5 nmol/lPco2 = 33 mmHgPo2 = 215 mmHgBicarbonat = 16,2 mmol/lBE = -10,4 mmol/lSaO2 = 99,8 %Lactat = 3,2K = 4,6 mmol/mNa = 135 mmol/lCl = 96 mmol/lHb =12 g/dlGlucoza = 68,4 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este cel mai probabil diagnostic ?
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1. Hiperventilatie
2. Acidoza metabolica partial necompensata
3. Ischemie mezenterica
RASPUNSURI - caz 14
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CAZUL 15
Istoric: Pacienta in varsta de 35 ani, sex feminin APP: DZ tip I Internata pt. stare generala grava, greata, varsaturi de cateva zile, lipsa
aportului alimentar, lipsa administrarii insulinoterapiei.
Examen clinic: Clinic: ametita, extremitati reci, palide (periferie inchisa)
RESPIRATOR: polipnee, FR = 26 resp/min, fara dispnee
HEMODINAMIC:
- TA = 100/60 mmHg
- AV = 130 bpm
Glicemie > 450 mg/dl
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 15
10 L O2 pe mascaPH = 7.05H* = 88,9 nmol/lPco2 = 11 mmHgPo2 = 187 mmHgBicarbonat = 6 mmol/lBE = -25 mmol/lSaO2 = 99,8 %Lactat = 1K = 4,6 mmol/mNa = 141 mmol/lCl = 96 mmol/lHb =12 g/dlGlucoza = 630 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Calculati An gap.
4. Care este diagnosticul cel mai probabil?
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1. Hiperventilatie
2. Acidoza metabolica severa partial compensata
3. An gap = 43,6 (normal = 10-12)
4. Cetoacidoza diabetica
RASPUNSURI - caz 15
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CAZUL 16
Istoric: Pacienta in varsta de 37 ani, sex masculin APP: necunoscute Internat inconstient gasit cu o sticla de vodka si o sticla de methanol
Examen clinic:
Clinic: GCS = 9, aparent fara deficite motorii sau semne de focar.
RESPIRATOR: polipnee
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 16
aer atmosfericPH = 7.20H* = 63,3 nmol/lPco2 = 25 mmHgPo2 = 96 mmHgBicarbonat = 9,5 mmol/lBE = -16,2 mmol/lSaO2 = 97,8 %Lactat = 1,3K = 4,5 mmol/mNa = 136 mmol/lCl = 99 mmol/lHb =13,5 g/dlGlucoza = 70 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Calculati An gap.
4. Statusul acidobazic este superpozabil cu ingestia de methanol ?
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1. Hiperventilatie (secundara)
2. Acidoza metabolica severa partial compensata
3. An gap = 32 (normal = 10-12)
4. Da
RASPUNSURI - caz 16
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CAZUL 17
Istoric: Pacienta in varsta de 52 ani, sex masculin APP: litiaza renala recurenta Internat pt. litiaza renala si fatigabilitate
Examen clinic:
Clinic: echilibrat respirator si hemodinamic Rx. abdominal pe gol = litiaza renala dreapta
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 17
aer atmosfericPH = 7.37H* = 43 nmol/lPco2 = 31,5 mmHgPo2 = 99 mmHgBicarbonat = 18 mmol/lBE = -7 mmol/lSaO2 = 99 %Lactat = 1K = 3,0 mmol/mNa = 137 mmol/lCl = 109 mmol/lHb =13 g/dlGlucoza = 72 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Calculati An gap.
4. Care este diagnosticul cel mai probabil ?
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1. Hiperventilatie usoara (secundara)
2. Acidoza metabolica compensata
3. An gap = 13 (normal)
4. Acidoza tubulara renala
RASPUNSURI - caz 17
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CAZUL 18
Istoric: Pacienta in varsta de 18 ani, sex feminin APP: necunoscute Internat pt. greata, tinitus, post ingestia unei substante necunoscute in
urma cu 5h
Examen clinic:
somnolenta, confuza, subfebrila 37,6 RESPIRATOR: polipnee, FR = 26 resp/min, SpO2 = 99%
dispnee absenta HEMODINAMIC:
- TA = 132/100 mmHg
- AV = 100 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 18
aer atmosfericPH = 7.41H* = 38,8 nmol/lPco2 = 22,6 mmHgPo2 = 97,5 mmHgBicarbonat = 17,6 mmol/lBE = -8,3 mmol/lSaO2 = 99 %Lactat = 1,4K = 3,6 mmol/mNa = 140 mmol/lCl = 99 mmol/lHb =13 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Calculati An gap.
4. Care este diagnosticul cel mai probabil ?
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1. Hiperventilatie
2. Acidoza metabolica compensata sau Acidoza metabolica concomitent cu alcaloza respiratorie
3. An gap = 27
4. Aspirina
RASPUNSURI - caz 18
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CAZUL 19
Istoric: Pacient in varsta de 24 ani, sex masculin APP: nesemnificative
scadere ponderala si fatigabilitate in ultimile luni Internat pt. fatigabilitate, dezorientat temporospatial, ameteli si crampe
musculare
Examen clinic:
confuz, afebril, extremitati palide, reci RESPIRATOR: polipnee, FR = 25 resp/min, SpO2 = 99% HEMODINAMIC:
- TA = 75/55 mmHg
- AV = 120 bpm NEUROLOGIC: fara semne neurologice de focar, fara adenopatii ABDOMINAL: normal
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 19
aer atmosfericPH = 7.32H* = 48 nmol/lPco2 = 24,8 mmHgPo2 = 97 mmHgBicarbonat = 13,4 mmol/lBE = -13,9 mmol/lSaO2 = 99 %Lactat = 3K = 5,6 mmol/mNa = 125 mmol/lCl = 101 mmol/lHb =13 g/dlGlucoza = 45 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Specificati ce alte modificari exista pe EAB.
4. Precizati tratamentul specific ?
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1. Hiperventilatie (secundara)
2. Acidoza metabolica severa partial compensata
3. Hiponatremie, hiperpotasemie, hipoglicemie, lactat crescut
4. Corticosteriozi i.v.
RASPUNSURI - caz 19
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CAZUL 20
Istoric: Pacient in varsta de 87 ani, sex masculin APP: BCI, dementa, IRC gasit in stop cardio-respirator, s-a urmat protocolul de resuscitare timp
de 12 min
Examen clinic:
GCS = 3, tegumente palide, cadaverice RESPIRATOR: ventilat cu O2 pe masca 15L/min HEMODINAMIC:
- ECG ritm agonic, fara puls central palpabil
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 20
15 L O2 pe mascaPH = 6,8H* = 160 nmol/lPco2 = 36 mmHgPo2 = 240 mmHgBicarbonat = 3,8 mmol/lBE = -20 mmol/lSaO2 = 100 %Lactat = 9K = 4,5 mmol/mNa = 136 mmol/lCl = 96 mmol/lHb =14 g/dlGlucoza = 72 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este prognosticul pacientului ?
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1. Oxigenare buna asigurata de ventilatia pe masca.
2. Acidoza metabolica severa necompensata
3. Prognostic rezervat
RASPUNSURI - caz 20
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CAZUL 21
Istoric: Pacient in varsta de 59 ani, sex masculin APP: consumator cronic de etanol Internat pentru: dureri abdominale severe in erajul superior de
aproximativ 3 zile
Examen clinic:
pacient agitat RESPIRATOR: dispnee usoara, polipnee,
Rx. pulmonar: infiltrate pulmonare bilateral HEMODINAMIC:
- TA = 75/60 mmHg
- AV = 120 bpm PARACLINIC: Amilaza 1890 ui/ml, PCR = 274 mg/l
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 2115 L O2 pe masca cu rezervor
PH = 7,33H* = 47 nmol/lPco2 = 24 mmHgPo2 = 81 mmHgBicarbonat = 14,9 mmol/lBE = -11,8 mmol/lSaO2 = 99 %Lactat = 3,1K = 3,6 mmol/mNa = 141 mmol/lCl = 96 mmol/lHb =12 g/dlGlucoza = 288 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este FiO2 aproximativ ?
4. Care este diagnosticul cel mai probabil ?
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1. Disfunctie respiratorie severa
2. Acidoza metabolica severa partial compensata
3. FiO2 = 0,6-0,8
4. Pancreatita Acuta
RASPUNSURI - caz 21
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CAZUL 22
Istoric: Pacienta in varsta de 35 ani, sex feminin Internata pentru: varsaturi multiple de aproximativ 3 zile
Examen clinic:
afebrila, tegumente si mucoase deshidratate RESPIRATOR: bradipnee, FR = 10 resp/min, SpO2 = 96% HEMODINAMIC:
- TA = 160/100 mmHg
- AV = 100 bpm ABDOMINAL: in limite normale
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 22aer atmosferic
PH = 7,44H* = 36 nmol/lPco2 = 48 mmHgPo2 = 83 mmHgBicarbonat = 32 mmol/lBE = +4 mmol/lSaO2 = 96 %Lactat = 1K = 3,0 mmol/mNa = 133 mmol/lCl = 91 mmol/lHb = 11 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Ce dezechilibre electrolitice sunt prezente?
4. Care este tratamentrul pt. corectarea dezechilibrelor acido-bazice ?
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1. Disfunctie respiratorie cronice (raspuns compensator)
2. Alcaloza metabolica compensata
3. Hipopotasemie, hiponatremie, hipocloremie
4. Reechilibrare hidroelectrolitica (perfuzii)
RASPUNSURI - caz 22
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CAZUL 23
Istoric: Copil de 8 saptamani APP: APGAR = 10
fara complicatii postpartum Internata pentru: scadere ponderala, varsaturi multiple de aproximativ 2
sapt.
Examen clinic:
agitat, teg. si mucoase uscate ABDOMINAL: formatiune tumorala la palpare in epigastru
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 23aer atmosferic
PH = 7,54H* = 29 nmol/lPco2 = 45,8 mmHgPo2 = 80 mmHgBicarbonat = 37,5 mmol/lBE = +14 mmol/lSaO2 = 99 %Lactat = 1K = 2,5 mmol/mNa = 135 mmol/lCl = 86 mmol/lHb = 18 g/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Avand in vedere valoarea PH si HCO3 cum vi se pare valoarea PaCO2 ?
4. Care este diagnosticul probabil?
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1. Disfunctie respiratorie cronice (raspuns compensator)
2. Alcaloza metabolica partial compensata
3. Mai mic decat ne-am fi asteptat
4. Stenoza pilorica
RASPUNSURI - caz 23
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CAZUL 24
Istoric: Pacienta in varsta de 36 ani - gravida APP: nesemnificative Internata pentru: respiratie dificila
Examen clinic:
RESPIRATOR: dispnee, usoara polipnee, FR = 20 resp/min, SpO2 = 99 % HEMODINAMIC:
- TA = 112/100 mmHg
- AV = 110 bpm
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 24aer atmosferic
PH = 7,45H* = 35 nmol/lPco2 = 35 mmHgPo2 = 35 mmHgBicarbonat = 24 mmol/lBE = +2 mmol/lSaO2 = 74 %Lactat = 1K = 3,6 mmol/mNa = 138 mmol/lCl = 104 mmol/lHb = 13 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Care este explicatia pt. PaO2 asa de mic ?
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1. Aparent disfunctie respiratorie severa
2. Status acido-bazic normal
3. Proba venoasa
RASPUNSURI - caz 24
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CAZUL 25
Istoric: Pacienta in varsta de 55 ani - sex feminin APP: nesemnificative Internata pe sectia de ortopedie pt. proteza de genunchi
la 4 zile postoperator prezinta respiratie dificila, dispnee usoara, durere precordiala si la nivelul bratului stang
Examen clinic:
RESPIRATOR: dispnee usoara, polipnee, FR = 20 resp/min, SpO2 = 99 %
fara semne clinice de TVP
Rx. pulmonar in limite normale HEMODINAMIC:
- TA = 160/100 mmHg
- AV = 98 bpm
- ECG = tahicardie sinusala
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ANALIZA GAZELOR SANGVINE ARTERIALE - caz 25aer atmosferic
PH = 7,43H* = 36 nmol/lPco2 = 37 mmHgPo2 = 91 mmHgBicarbonat = 25,8 mmol/lBE = -1,8 mmol/lSaO2 = 99 %Lactat = 1K = 3,8 mmol/mNa = 136 mmol/lCl = 99 mmol/lHb = 10 g/dlGlucoza = 90 mg/dl
INTREBARI
1. Descrieti statusul respirator.
2. Descrieti statusul acidobazic.
3. Calculati diferenta alveolo-capilara ?
4. Necesita alte investigatii suplimentare ?
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1. Fara disfunctie respiratorie
2. Status acido-bazic normal
3. A-a = 15mmHg (normal)
4. Da (pt. excluderea TEP)
RASPUNSURI - caz 25