Imaging in the ICU.ppt

1、Nov 2006,Kishore P. Critical Care Conference,Imaging in the ICU,Nov 2006,Kishore P. Critical Care Conference,Modalities,X-Ray CT scans MRI Ultrasound examinations Angiography Flouroscopy,Nov 2006,Kishore P. Critical Care Conference,X-Ray,Most common AP view Centering difficult Exposure equalization

2、difficult X-Rays other than chest difficult,?,Nov 2006,Kishore P. Critical Care Conference,Case 1,70 year old diabetic reverend admitted to the ICU for Urosepsis. Intubated for poor sensorium and labored breathing. On treatment gradually getting better. On day 5, being weaned from ventilation when h

3、e desaturates with no hemodynamic instability. On examination has decreased breath sounds on right side and crackles bilaterally,876308A,876308A,918121C,Nov 2006,Kishore P. Critical Care Conference,Collapse,Humidification Suction Chest physiotherapy Position PEEP Bronchoscopy,Nov 2006,Kishore P. Cri

4、tical Care Conference,Case 2,30 yr old man with AML on chemotherapy develops bilateral fungal pneumonia. He is intubated for persistent hypoxia in spite of CPAP. His lung infiltrates worsen on Amphotericin and antibiotics and he requires high peep, low tidal volumes and prone position ventilation to

5、 maintain saturations of 88-92%. He is also on high inotropes. On Day 15, he develops a sudden deterioration of oxygenation and hemodynamics.,864620C,864620C,864620C,864620C,864620C,898326C,20 yr old primi with scrub typhus,898326C,898326C,Nov 2006,Kishore P. Critical Care Conference,Pneumothorax,De

6、ep sulcus sign,Nov 2006,Kishore P. Critical Care Conference,Hemodynamic compromise Suspected tension,Hemodynamically stable,Needle aspiration and chest tube placement,FiO2 100% Reduce PEEP to 3,FiO2 100% Reduce PEEP to 3,Chest X-Ray,Clinically suspected pneumothorax,Chest X-Ray,Mechanical ventilatio

7、n Symptomatic,Self ventilating asymptomatic,Chest tube/pigtail,Conservative management,Nov 2006,Kishore P. Critical Care Conference,Case 3,Patient with Multiple Myeloma on mechanical ventilation for respiratory failure due to bilateral pneumonia. FiO2 100%, PEEP 15cm H2O, TV 360ml Rate 35/min.,A,B,A

8、,16 year old girl with ITP,autoimmune thyroiditis and medium vessel vasculitis on mechanical ventilation with high PEEP for ARDS due to viral pneumonia,A,B,Nov 2006,Kishore P. Critical Care Conference,Causes of pneumomediastinum in mechanical ventilation,High tidal volumes High PEEP “fighting” the v

9、entilator Auto PEEP,Nov 2006,Kishore P. Critical Care Conference,Case 4,35 yr old lady with SLE and lupus nephritis and mild CRF on steroids is intubated for severe hypoxia when she presents to the emergency department with breathlessness. Examination reveals bilateral crackles. She is started on co

10、ver for bacterial, fungal and PCP etiologies.,890403C,Nov 2006,Kishore P. Critical Care Conference,Ely, E. W. et al. Chest 2002;121:942-950,The VPW is measured by (1) dropping a perpendicular line from the point at which the left subclavian artery exits the aortic arch and (2) measuring across to th

11、e point at which the superior vena cava crosses the right mainstem bronchus,Vascular Pedicle Width,890403C,278680A,832720C-malaria,839892C,801557C-scrub,Nov 2006,Kishore P. Critical Care Conference,Patients with a VPW 70mm coupled with a cardiothoracic ratio 0.55 are more than three times likely to have a Pulmonary Artery Occlusion Pressure 18mm Hg compared to those without these findings.