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1、Copyright2011,AmericanCollegeofEmergencyPhysicians.Allrightsreserved.NopartofthischaptermaybecopiedordistributedwithoutexpresswrittenpermissionfromACEP.CHAPTER3TheCrashingVentilatedPatientJairoI.Santanilla,MDInthIschapterEvaluationofhemodynamicallyunstableventilatedpatientsindistressManagemen
2、tofhemodynamicallyunstableventilatedpatientsSpecialscenarios:pediatricpatientsandpatientswithatracheostomyIntroductiontilatedpatientis,bydefinition,criticallyill.However,heorshecanfallanywhereonthespectrumfrombeingventilatedCriticallyillpatientspresenttotheemergencydepartmentforairwayprotecti
3、on,withnormalvitalsigns,bloodpressure,everyday.Someofthemrequiredintubationintheprehospi-andoxygensaturation,tobeingventilatedandincardiacar-talsetting;othersareintubatedonarrivalorduringemergencyrest.Determiningwherethepatientisonthisspectrum,in-departmentevaluation.Aftertheirairwayshavebeen
4、securedcludingassessingforhypotensionandhypoxia,willdictatehowandtheirconditionsstabilized,patientscanremaininthemuchtimethepractitionerhastoimplementrescuestrategies.emergencydepartmentbecauseofalackofcriticalcarebeds.InInaddition,itisimportanttoanticipatethepatient’sclinicalsomehospitals,ad
5、edicatedintensivistwilltakechargeofthesecourse.Theapproachtoapatientwhoisintubatedforhypoxiapatients,butinothersthistypeofcoverageisnotavailableatallstemmingfrompneumoniaandwhosebloodpressureandoxy-ornotaroundtheclock.Thus,acutecomplicationsordeteriora-genationgraduallytrenddownoverhoursorday
6、sisdifferenttionsmustbehandledbyemergencyphysicians.fromtheapproachtoapatientwhoisdecliningoveraspanofThischapterprovidesaframeworkformanagingthecrash-minutes(Figure3-1).ingmechanicallyventilatedpatient.TheinformationprovidedAsageneralrule,thefollowingevaluationshouldbeper-willassistthepracti
7、tionerindeterminingifthepatient’scon-formedwithin1houronpatientswithnewunexplainedhypo-ditionisrelatedtotheunderlyingpathologythatnecessitatedtension(systolicbloodpressure[SBP]<90mmHg),newunex-mechanicalventilationorifitisbeingcausedbymechani
