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Oxford Handbook of Critical Care - part 6

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Thuốc trừ sâu organophosphate là nguyên nhân chính gây ngộ độc tự tử ở các nước đang phát triển và được sử dụng như thần kinh các đại lý trong các vụ tấn công khủng bố (ví dụ như Sarin, Tabun, VX, GF). Phương thức hoạt động của họ là thông qua độc tính chol inergic. | Causes Collapsed lobe segment bronchial obstruction e.g. sputum retention foreign body blood clot vomitus misplaced endotracheal tube Macroatelectasis air space compression by heavy oedematous lung tissue external compression e.g. pleural effusion haemothorax sputum retention Microatelectasis inadequate depth of respiration nitrogen washout by 100 oxygen with subsequent absorption of oxygen occurring at a rate greater than replenishment. Sputum retention Excess mucous sputum normally stimulates coughing. If ciliary clearance is reduced e.g. smoking sedatives or mucous volume is excessive e.g. asthma bronchiectasis cystic fibrosis chronic bronchitis sputum retention may occur. Sputum retention may also be the result of inadequate coughing e.g. chronic obstructive lung disease pain neuromuscular disease or increased mucous viscosity e.g. hypovolaemia inadequate humidification of inspired gas . Preventive measures Sputum hydration maintenance of systemic hydration and humidification of inspired gases e.g. nebulized saline bronchodilators heated water bath heat moisture exchanging filter . Cough requires inspiration to near total lung capacity glottic closure contraction of abdominal muscles and rapid opening of the glottis. Dynamic compression of the airways and high velocity expiration expels secretions. The process is limited if total lung capacity is reduced abdominal muscles are weak pain limits contraction or small airways collapse on expiration. It is usual to flex the abdomen on coughing and this should be simulated in supine patients by drawing the knees up. This also limits pain in patients with an upper abdominal wound. Physiotherapy postural drainage percussion and vibration hyperinflation intermittent positive pressure breathing incentive spirometry or manual hyperinflation. Maintenance of lung volumes increased VT CPAP PEEP positioning to reduce compression of lung tissue by oedema. Management Specific management depends on the cause and should be .