R E-DO
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- なごみ ねぎたや
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1 2005
2 R E-DO
3 ICU C
4 HDF IABP (PCPS) PCPS PCPS...58 PCPS
5 PCPS...60 ECLA V-V ECLA...62 PCPS...62 ECLA...63 ECLA DPC CCS NYHA
6 7:30 8:00 8:30 ICU ICU ICU ICU ICU ICU 9:00 Ope 2 ) Ope 1 Ope 1 Ope C4 10:00 C4 C4 C4 C4 C4 16:30 18:00 C4 C4 ICU ICU ICU C4 10:00 C4 X-p 6
7 C
8 LMT NYHA 3 AS (VT,Vf C4 VAIO-JX CABG CABG + [Valve or TAA] CABG Valve ( AVR MVR MVP Bentall ) Valve + CABG Valve + TAA ASD TAA (+ other) TAA 8
9 CABG ( ) free LMT 75% free LMT 90% 1 NYHA free NYHA free NYHA (100 NYHA Ns BB ( ) SP 9
10 B DM 1400 kcal or 1200 kcal P70 (or P60) C4 Vital ( ) Vital 1 Vital 3 BS ( ) BS ( ) 10
11 ICU 1. HIV : HBV HCV STS HIV TSH FT 3 FT 4 2. ANP BNP 3. : R L : 4. LMT NYHA 3 AS 5. 11
12 MRSA MRSA MRSA
13 1. HbA 1 C 75gOGTT 2. room air MRI MRA CT MRI MRA CT Dr CABG AS MR (Aneurysm Dyskinesis)
14 (PHS: ) CABG ATP RI (PHS: ) 14
15 C4 VAIO JX [ coronary disease ] [ valvular disease and others ] print out VAIO ICU 2 ID ICU ICU CABG + Dor + MVP 15
16 81mg severe ASO 6 risk factor MRA MRI 16
17 CT Ope Ht 30% 800cc 2T H.S. 400cc 500cc drip 20mmHg LMT ( 90 % ) CCS NYHA AS 15mm Ht 35% 80 BS 140mg/dl 17
18 16 MDCT (PHS: ) Cr 1.5mg/dl CCr 30ml/min HDF 18
19 18 00? 19
20 1g ml SIRS 1g 1g 1g 2g 3g ICU CABG Off-Pump On-Pump Beating Off-Pump conversion Conventional CABG Valve Closed Circuit Closed Circuit Open Circuit Open Circuit CABG + Valve or Others(Dor etc) Open Circuit ME 1300ml Ht < 40 % Alb 4.0 mg/dl 500ml 25% albmin 2vial Ht < 35 % MAP 4u + 25% albmin 2vial 20
21 Re-do Pump PCPS 8mm DC pacing HDF ( Cr 1.5mg/dl CCr 30ml/min ) CRF on HD HDF
22 3-5 ME On Pump Beating Bypass Vf ASD closure A KCL Mg 500 ml 10 ml 8 meq ( 4 ml ) 7 ml CABG - - DV S-VHS ME 22
23 EPSON Balance Sheet (ME ) 2kg % 1vial 5% 1vial FFP 2 Ht< 23% Ht % MAP 4 /mm 3 /mm 3 23
24 ICU SVO 2 ICU ICU - Excel File ICU ml/kg/hr 24
25 2 1 H.S. Ht > 35% (8) 1T (20) 2T 2 A(25) 2T 2 50kg 50kg 3mg 2mg PT INR CABG On Pump Off Pump Radial A. GEA 1T 2T (25)3T 3 (100) 2 50kg SVG 50kg 3mg 2mg PT INR Off Pump CABG HD APTT APTT
26 1A im Cooling 38.5 Dr call 1A im 6 CABG Valve 500ml/day 1000ml/day 26
27 200ml/day 70ml / 8hr Swan-Ganz Cath. CV line A line 27
28 C4 1, 2, 3, 4, 6, 8, 10, 12 (ICU ) P A A P PT INR ( PTINR 1.5 ) APTT Off Pump CABG [ ] 28
29 C4 C4 PTINR POD3 POD POD7 POD 3-10 POD g / 100ml div 0.5g / 100ml div 2 /day 2 /day 29
30 CABG PHS: (PHS: ) C4 CT CD-ROM Xp EKG HOPE/EMAIN-EX 30
31 PTINR Pro 5.5 ( for Windows) MO 31
32 BS mg/dl (RI: 1cc= 1u) BS (mg/dl) - 70 RI ( ml/hr ) RI Off 20% Tz 2A div (5 min ) Dr Call RI Off hr hr hr Dr Call 32
33 consult ~ 150 ~200 ~250 ~300 ~ ~ mg/dl 50kg ( ) 50kg mg/dl 20% 2A iv Dr call 500mg/dl 500ml / 2hr Dr call 33
34 CABG ECG( ECG(12 Bentall David Full Root Root Replacement ECG( ) ECG(12 ) ASD Valve & Others ECG( ECG(12 ) 34
35 ECG ECG Dr call 1 ECG 30mmHg 20mmHg 120/min 40/min ST 0.1mV ST 0.2mV 80msec PAC PVC sinus rhythm Af VT ) 35
36 mg 3mg 2mg 1mg 0mg 0mg 0mg 4mg 2mg 1mg 0mg 0mg 0mg 0mg 3mg 2mg 1mg 0mg 0mg 0mg 0mg 2mg 1mg 0.5mg 0mg 0mg 0mg 0mg [ ] + LMT 90% (LAD & Cx etc) 1 36
37 2cc (2000 U) 200 / kg / day APTT cc + 40cc APTT ( ) APTT (kg) (ml / hr) APTT (ml / hr ) Off Off APTT Off APTT (ml / hr ) Off 3.6-1cc iv 20 37
38 [ ] LAD 50mm severe 5cm 9 21 APTT ( ) APTT ( kg ) ( ml ) ( ml ) APTT (0.2ml) (0.1ml) ( 0 ml) (0.1 ml) (0.2 ml) Off (0.3 ml) 38
39 (0.6ml) / ( ) ml / APTT Power On [SELF TEST] [INSERT CARTRIDGE] [SELECT SAMPLE TYPE] [ PATIENT ] [ CARTRIGE HEATING ] ml [APPLY SAMPLE] 0.1ml i-stat [ ENT ] [ ENT ] [PRINT] 39
40 C4 i-stat 40
41 HD ( ) HD ( ) HD HD ( ) ( Ope ) ICU HD ( or ICU) HD HD HD ENT ( ) ( ) ( ) Fax (50mg) 4vial HDF 41
42 ICU CV Swan-Ganz 20ml/hr line 5ml/hr ICU K + GI BUN 80 CHDF HD C4 ICU HD ICU HD 42
43 HDF HDF CHDF C.I. 2.5 L/min/ HDF HD CHDF Cr 1.5mg/dl CCr 30ml/min HDF
44 cc Cr HDF HD 44
45 HDF 25mg/hr 200ml/min ml/hr ml/hr CVP(RAP) K + Ht C.I. 3-5 mmhg meq/l 30 35% > 2.5L/min/m 2 CVP C.I. 45
46 Off Pump CABG HDF 4L 40-70ml/min HDF inflow HDF inflow HDF L MAP4u 25% 2vial MAP Ht <30% MAP Ht 30% % 1vial 5% 1vial FFP 2 EPSON Balance Sheet HD TP 6.0mg/dl Alb 3.5mg/dl 46
47 25% 2vial FFP 10 ACT FiO 2 40% PO 2 < 80mmHg PEEP PCWP MR C.I >3.0 L/min/m 2 PCWP 10mmHg PEEP 10cmH 2 O K + free 47
48 sinus rythm rate bpm 1) sinus rythm (PAC Af PVC VT ) K+ heart rate overdrive pacing(a-pacing) PAC Af PVC VT 2% 2) rate A-pacing digoxin digoxin rate V( ) IABP Af AF rate control 48
49 RAP CVP or PCWP RAP( ) Volume up RAP Volume up Volume up capillaly leak syndrome RAP Ht (DOA NAD) ( ) (DOA DOB NAD BOS ) PDE ( etc) Ca( ) IABP PCPS ICU SIMV 49
50 2ml/kg/hr 1ml/kg/hr C.I. 2.5 ml/kg/ 20 /min PCO 2 60mmHg FiO 2 0% PO 2 100mmHg ( CABG ) /mmHg RAP 7-10mmHg ST-T (PMI) Volume up ( MVR or MVP ) /mmHg RAP 5-7mmHg RAP PAP 50
51 (AVR) AS AVR / mmhg RAP 3-7mmHg bpm 15mm IABP 4.2 K+ 4.7mEq/l PVC VT AR AVR /mmHg bpm RAP 7-10mmHg ASD /mmHg RAP 3-5mmHg ST 51
52 SIRS (ADH) IL-8 SIRS 70,000/mm3 Ht 30-35% MAP ACT FFP 4u CVP(cmH 2 O) PEEP CABG 1 mmhg = 13.54( )mmh 2 O cmh 2 O CVP(RA) 8mmHg 10.8 cmh 2 O cmh 2 O PEEP PEEP C.I. PEEP 2ml/kg/hr ( 52
53 C.I. Ht (33-35 ) ICU C.I. (37 ) % 5% 53
54 C.I. CVP HD CHDF ECUM IABP (PCPS) IABP C.I.<2.2 PCPS PEEP BiPAP BiPAP 54
55 PCPS(V-A Bypass) PCPS SIRS ALI(Acute Lung Injury) 100% SaO 2 90% 2 24 FiO 2 80% PEEP 10cmH 2 O SaO 2 90% TRALI( ) ECLA ECLA 24 BIS BIS
56 3 total 40 kcal/kg/day DIC FDP D- ACT APTT FOY FOY 56
57 PCPS PCPS FiO % PEEP 5-10 cmh O 5-10 ml/kg 4-8 /min CVP PCPS LVAD 60 kg 60 kg 13.5 F 15 F 16.5 F 19.5F 21 F 23 F Medtronic 60 kg 60 kg 15 F 17 F 21 F 23 F 57
58 PCPS PCPS cut down PCPS IVC Medtronic PCPS (19 or 21F) 20-30cm ASO 5F PCPS C.I. Swan-Ganz Cath. PCPS C.I. 2.5 ml/kg/ IABP 58
59 A-line SpO 2 PCPS Volume CVP 5-10mmHg FFP L/min flow Medtronic PCPS 15-25cm ( ) 59
60 O 2 ACT ( s ) PCPS PCPS V-V ECLA FiO 2 100% PCPS C.I. Swan-Ganz Cath. PCPS C.I. 1:2 SpO 2 PCPS PCPS CVP(RA) IABP C.I. Swan-Ganz Cath. PCPS C.I. 2.5 ml/kg/ PCPS PCPS ACT s 60
61 ECLA (extracorporeal lung assist; ECLA) (extracorporeal membrane oxygenation; ECMO) PCPS FiO 2 60% PEEP ECLA Ht 35-40% MAP Medtronic PCPS 4cm PCPS mm Medtronic 60 kg 60 kg 19 F 19 F or 15 F 17 F 21 F 23 F or 15 F 17 F 61
62 V-V ECLA Swan-Gantz Cath. SvO 2 in vivo calibration PCPS V-V ECLA 1. PCPS PCPS 20cm 2. Medtronic PCPS 20cm 16.5F PCPS 1-2 cm PCPS PCPS(V-A Bypass) V-V ECLA PCPS PCPS(V-A Bypass) V-V ECLA 62
63 PCPS 20cm V-V ECLA Medtronic PCPS 20-25cm PCPS 30cm ECLA Swan-Ganz Cath. SvO 2 ECLA ECLA SV E O 2 Swan-Gantz Cath. SV P O 2 ECLA SV P O 2 - SV E O 2 SaO 2 - SV P O 2 SaO % ECLA PCPS 3L/min ECLA ECLA ECLA 63
64 PN DIC 5ml/hr (20%) 200 ml 200ml 40g (400 kcal) 1 1kg 2g 1A 1A (20)1A 1A 64
65 (20)1A 70 ml/hr ( 1320 kcal /day / 142 ) 2 1A 1A (20)1A 1A 2 (20)1A 75 ml/hr ( 1640 kcal /day / 149 ) 1 1A 1A 1A Fischer Na 10% NaCl ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A 45ml/hr ( 700 kcal /day / 143 ) 65
66 3 700 ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A 45ml/hr (1000 kcal /day / 204 ) ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A ml 400 ml (20)1A 90ml/hr (2000 kcal /day / 204 ) K+ free 200 CHDF 1 RF 500ml 300ml 1A 1A 1A 1A 32 ml/hr ( 1000 kcal /day / 333 ) 66
67 bacterial translocation ST ED ICU 8-12F ED (80-100cm) ST (14-18F) ST 500 ml/day ED 60ml ST 1cc = 1kcal (300mOsm/kgH 2 O) 60ml ED 67
68 5% 10 ml/hr 20 ml/hr 40g / 300cc ( 1cc = 0.5 kcal ) 20 ml/hr 40 ml/hr 80g / 300cc ( 1cc = 1 60 ml/hr 1500kcal/day kcal ) 40 ml/hr ST ED 16 F2 ED ED ST 1-2 ST 68
69 ; Percutaneous Endoscopic Gastrostomy ED tube 69
70 DPC DPC DPC DPC 70
71 1. ( ICU ) 2. (DPC) DPC MRSA 71
72 TSH ft 3 ft g OGTT 3 HbA1 C
73 ICU ICU 2 H 2 blocker CABG On Off Pump Pump 73
74 PGE1 MAP 74
75 FOY DIC PTINR MRSA MRSA MRSA 75
76 TTS 76
77 CCS 1 NYHA 77
78 ECG SaO 2 free 1 Ccr free 1 Ccr free 1 Ccr ECG SaO 2 free 1 Ccr free 1 Ccr free 1 Ccr
79 MAP FFP PLT re Ope
80 Copyright(c) 2005 CVS-KPUM all rights reserved. 80
SpO2 FIO2 Hypoxic Pulmonary Vasoconstriction HPV 30 FIO2 FIO2 PaCO mL/kg I/E CPAP P
11 a. 2012 1 15 26 http://www1.koalanet.ne.jp/anesth_memorandum/sub19.html SpO2 FIO2 Hypoxic Pulmonary Vasoconstriction HPV 30 FIO2 FIO2 PaCO2 20 30 8 10mL/kg I/E CPAP PEEP 27 b. CO2 ( ) SpO2 COPD PETCO2
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