Pnumonia

Overview is a shock associated with severe pneumonia, more virulent by the strong yang or Gram negative bacteria infection caused rapid progress in serious condition. Chang various serious complications, such as not prompt treatment can be life-threatening. Hypotension and a medical examination was in a trance or indifferent, paleness, Jueling limbs, lips or fingertip cyanosis, small pulse rate, cold sweat, lowering blood pressure and circulatory failure week outer signs; pulmonary pneumonia corresponding signs. Auxiliary inspection (1) X-ray, pulmonary inflammatory infiltrates (should avoid moving to bedside film). (2) etiology inspections : this should be done expeditiously sputum smear and culture, a clear pathogens. (3) white blood cell counts and neutrophil increased, it will be nuclear bits. (3) The level of PaO2, pH, Standard bicarbonate (SB) actual bicarbonate (AB) can lower serum lactic acid was increased metabolic acidosis; Severe could have urine and liver and kidney function. Apart from the clinical respiratory symptoms, accompanied by hypotension, peripheral circulatory failure, altered consciousness, urinary symptoms. For a general treatment : recumbent, oxygen, to ensure warming. 2, antibacterial therapy : to be early, broad and effective as a guiding principle. Undetermined pathogens, may choose to send piperacillin (oxygen piperazine penicillin), Ting for the door (for Kaxilinjia clavulanate potassium); cefuroxime, cefotaxime, cefoperazone, ciprofloxacin, Ofloxacin such treatment (see bacterial pneumonia). Training was pathogens and antimicrobial susceptibility test results after adjustment antibacterial drugs. 3, anti-shock treatment : no renal dysfunction, according to the heart rate, blood pressure, and urine rapid infusion 800-1000ml blood pressure to rise. urine "30 ml / h slower infusion rate, the 24-hour infusion of up to 3000-4000ml. Liquid crystal choice fluid (normal saline, 5% glucose drip, balanced salt), which If necessary, add the proper colloidal solution such as albumin, such as whole blood. Commonly used for low molecular weight acid L-sugar up to 24 hours over 100 ml. Blood volume in the supplementary application, as appropriate, on the basis of vasoactive drugs, dopamine, dobutamine, Aramine or scopolamine, and so on. 4, correct acidosis : - alkali capacity by 1 mmol = 0.3 × (normal-HCO3-measured - HCO3) x weight (kg) Calculation (1 mmol = ‧ 4% sodium bicarbonate). Importing calculation of 1 / 3, in accordance with the illness and blood gas values added. Also available 11.2% of sodium lactate and 3.63% of Trihydroxymethyl ammonia methane correct acidosis. 5, adrenal cortical hormones : Hydrocortisone of loose 200 ~ 600 mg / d or dexamethasone 10-30mg / d, Graded by adding liquid infusion for 3 ~ 5 days. Meanwhile plus ranitidine 150 mg, 1 ~ 2 times / d, to prevent stress ulcers. 6, preventing complications : heart failure early or signs of acute pulmonary edema, West to give Portland 2.4 mg of 5% glucose solution 20 ~ 40ml, slow injection. may also increase with furosemide 20-40mg. Acute respiratory distress syndrome, disseminated intravascular coagulation, renal failure, arrhythmia treatment accordingly. Differential diagnosis with other cause of the shock phase identification.