作者/講者: 游人樺醫師
指導者: 李宜蓉醫師
校稿: Dr. Ian YC Chen
上次校閱: 2018/03/31
Case Scenario:
This is a 38-year-old woman with a past medical history of twice spontaneous abortions, which was suspected to be a result of antiphospholipid syndrome (or the like), for which she once took aspirin and hydroxychloroquine. She is a non-smoker and does not drink alcohol.
She comes in to the ED (on 2018.01.06), complaining shortness of breath, which is progressive and getting worse after exertion.
Tortuosity of thoracic aorta with borderline cardiomegaly.
* Infiltration over both lower lung, bronchitis is considered.
* Normal appearance of thoracic cage.
* Post pig tail drainage superimposed left thoracic cage ( post pericadiocentasis) , clinical correlation.
* Blunting of bil. C-P angle, pleural thickness is suspicious.
P(A-a)O2 大約為8-10mmHg. n PaO2: 104.2 – (0.27 x age) n PAO2: (大氣壓-水蒸氣壓) x FiO2 – (PaCO2 x 1.25)
pH = 7.334n paO2 = 29.1 n PaCO2 = 47.7 n 大氣壓: 760 mmHg n PAO2= (760-47) x 0.21- (47.7×1.25)= 149.73-59.625=90.105 n P(A-a)O2=90.105-29.1=60
P(A-a)O2 大約為8-10mmHg. n PaO2: 104.2 – (0.27 x age) n PAO2: (大氣壓-水蒸氣壓) x FiO2 – (PaCO2 x 1.25)
pH = 7.334n paO2 = 29.1 n PaCO2 = 47.7 n 大氣壓: 760 mmHg n PAO2= (760-47) x 0.21- (47.7×1.25)= 149.73-59.625=90.105 n P(A-a)O2=90.105-29.1=60
Hypoventilation
Nerve injuries and neuropathies such as Guillain Barre or critical illness neuropathy may affect motor neurons supplying respiratory muscles.
Neuromuscular blockers or disease of the neuromuscular junction (eg myasthenia gravis) may impair transmission of nerve impulses to respiratory muscles
The problem may be in the muscle itself. Respiratory muscle fatigue, disuse atrophy and malnutrition are important causes of respiratory muscle failure in the ICU.
Alternatively the problem may be a problem of increased resistance to airflow. For example due to obstruction of the upper airway or bronchospasm.
The problem may be decreased compliance of the lung itself, the pleura or the chest wall.
40% ocular → 1/3 involve generalized (prognosis: generalized poorer than just in ocular)
Generalized → add steroid
Thyoma op → consider DC drug
