Emergency Cases Management / Mx of circulatory collapse: 1. Correct hypoxaemia • Oxygen therapy • Consider ventilation if there is: {Intractable hypoxaemia, Hypercapnia: PaCO2 > 6.7, kPa (50 mmHg), Respiratory distress, Impaired conscious level} 2. Assess circulation • Heart rate • CVP • BP: direct arterial pressure • Peripheral perfusion 3. Optimise volume status • Fluid challenge(s) CVP < 6 mmHg: 250 mL 0.9% saline or colloid CVP > 6 mmHg or poor ventricular function suspected: 100 mL boluses and consider measuring cardiac output, e.g. PA catheter or oesophageal Doppler 4. Optimise haemoglobin concentration • 70–90 g/L; 100 g/L if ischaemic heart disease • Red cells as required • Septic patients can become profoundly anaemic with crystalloid/colloid resuscitation due to haemodilution and require blood transfusion 5. Achieve target BP • Use vasopressor/inotrope once hypovolaemia is corrected 6. Achieve adequate CO and D O2 • Inotropic agent if fluid alone inadequate 7. Other measures • Establish monitoring, including invasive measures, as resuscitation starts • Trends in haemodynamics, ABG, H+, base deficit and lactate guide further treatment
Posted on: Wed, 28 Aug 2013 07:14:10 +0000
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