急诊护理个案讨论PPT课件

1 急診護理個案討論 新光醫院急診科張志華醫師 2005 09 15 2 常考 Hyperkalemia 3 Hyperkalemia SymptomsGeneralizedfatigueWeaknessParesthesiasParalysisPalpitations Nonspecific 4 Hyperkalemia EtiologyAcuteorchronicrenalfailureCrushinjuries rhabdomyolysis burnsFoods eg bananas oranges high proteindiets tomatoes saltsubstitutes Redistribution Acidosis insulindeficiency beta blocker acutedigoxinoverdose succinylcholine periodicparalysis PP Drugs slow K spirinolactonediuretics NSAIDs 考題 5 Hyperkalemia Mild 5 5 6 5mEq LpeakedTwavesModerate 6 5 7 5mEq LprolongedPRintervaldecreasedPwaveSTdepressionorelevationslightwideningoftheQRS 6 Hyperkalemia cont Severe 7 5 8 5mEq LwideQRSflatandwidePwavesVPCsLife threatening 8 5mEq LlossofPAVblocksVT VFsinusoidpatern 7 8 Hyperkalemia Specificmanagement SeeBIGPotassiumDrop CalciumBicarbonateInsulinandGlucoseKayexalateDialysis 考題 9 Hyperkalemia Generalmanagement ContinuousECGmonitoringDCK sparingdrugs ACEI spirinolactone DChigh Kfoods 10 Calcium StabilizecellmembraneCalciumgluconate10 10mlover2 5min2nddoseafter5minifnoresponseEffectoccursinminutesandlastsfor1hourFurthercalciumineffectiveunlesshypocalcemiaexistsDigoxinToxicity contraindication 11 Bicarbonate ShiftK tointracellular3ampJusomineIVover5minMayrepeatq10 15minOnsetin30min duration 1 2hoursAvoidbicarbonateif HypocalcemiaSeverelungedema 12 GlucoseandInsulin RedistributionRI10U D50GW50ccover5minConsiderAlbuterolNebasadjunctOnset50 60min duration severalhoursFollowF S 13 PotassiumRemoval Cation Exchangeresin Kayexalate 15 30gmPOq3 4hrsor50gmin200mlretentionenemafor30 60minq4hrDialysis Mayexperiencesignificanthyperkalemiaonrebound 14 Summary HyperkalemiaSymptoms Diagnosis EKG Etiology Treatment 15 余謹以至誠於上帝及會眾面前宣 終身純潔 忠貞職守盡力提高護理專業標準 勿為有損之事