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Vital Signs and Resuscitation - part 5

Phương trình chuyển sang bên trái kết quả là nồng độ axit tăng. Tỷ lệ tăng hô hấp trong một nỗ lực để thổi CO2 tích lũy. Điều trị: tăng thông khí với thuốc giãn phế quản. Đôi khi đặt nội khí quản và thông khí hỗ trợ cần thiết | 64 Vital Signs and Resuscitation Fig. 4.7. Metabolic Acidosis. 4 H HCO co2 o Fig. 4.8. Metabolic Alkalosis. stomach and in those using diuretics loss of H from the kidney . Treatment correcting the condition Fig. 4.8 . Respiratory acidosis is seen in severe asthma chronic obstructive pulmonary disease COPD and in conditions in which ventilation is poor such as congestive heart failure and pneumonia. The person is unable to blow off CO2 which accumulates. The equation shifts to the left resulting in rising acidity. The respiratory rate increases in an effort to blow off accumulated CO2. Treatment increasing ventilation with bronchodilators. Occasionally intubation and assisted ventilation are required Fig. 4.9 . Respiratory alkalosis occurs as a compensatory reaction to metabolic acidosis and in anxiety reactions hyperventilation syndrome see next section . Treatment for hyperventilation is a quiet setting to restore CO2 and in the case of metabolic acidosis i.e. ketoacidosis the underlying condition is treated Fig. 4.10 . H HCO3 -----CO2 BLOCKED Fig. 4.9. Respiratory Acidosis. Fig. 4.10. Respiratory Alkalosis. Vital Sign 3 Respiration 65 Often two acid-base conditions occur together. In diabetic ketoacidosis as mentioned the metabolic acidosis triggers a compensatory respiratory alkalosis. In this case the HCO3- is low but so is the CO2. The pH will be close to normal. The person with COPD in respiratory acidosis may also have developed an additional metabolic acidosis. In this case instead of the HCO3- being close to normal it will fall. In general if the pH is close to normal and the CO2 and or HCO3- are abnormal one may assume a mixed condition. Atypical Breathing Fast Breathing Tachypnea Tachypnea is usually significant at rates above 20. A low oxygen a high CO2 or a low pH or combinations may cause tachypnea seen in asthma pneumonia CHF exacerbations of COPD and DKA. Other conditions causing tachypnea are emotional reactions i.e. hyperventilation pulmonary .