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Acute benauwdheid

Dutch -ErasmusMC - 4.4.1 HC3

QuestionAnswer
Wat is duspnoe? - subjectief symptoom! - onaangename perceptie v/d ademhaling - door toename ademarbeid, niet toepasselijk voro de situatie
Dyspnoe <--> Tachypnoe tachypnoe is objectief, versnelde ademhaling
DD v Acute Dyspnoe -Longen -Thoraxwand/ pleura - Cardiovasculair - Hogere luchtwegen - Neuromusculair - CZS - Overig
DD v Acute Dyspnoe; longen -Astma -COPD -Bloeding -Malignitiet -Pneumonie -Interstitiele aandoening - Aspiratie -Atelectase -ARDS -Longcontusie
DD v Acute Dyspnoe; Thoraxwand/ pleura - Pneumothorax - Pleuravoch -Ribfracturen/ fladderthorax
DD v Acute Dyspnoe; cardiovasculair - longembolie - astma cardiale - pericardtamponade - coronair insufficientie - anemie
DD v Acute Dyspnoe; hogere luchtwegen - obstructie - oedeem -corpus alienum - secreet/ bloeding - abces - stembandverlamming - epiglottitis - trachea malacie/ tumor - compressie trachea - struma
DD v Acute Dyspnoe; neuromusculair - Guillain Barre - Dwarslaesie - Tetanus - Spierziekten - Elektrolytstoornissen
DD v Acute Dyspnoe; CZS - toxisch/ medicamenteus (o.a. sedativa) - CVA - Trauma
DD v Acute Dyspnoe; Overig - hyperventilatie - hyperthyreoidie - zwangerschap
Top 10 oorzaken v acute dyspnoe 1. pneumonie 2. exacerbatie astma/ COPD 3. hartfalen/ aritmieen (cave ischemie) 4. longembolie 5. pneumothorax 6. pleuravocht 7. thoracale pijn bij ribfracturen/ thoraxtrauma 8. atelactase 9. metabole acidose/ sepsis 10. anemie
Anamnese -voorgeschiedenis en medicatie -begin en verloop -karakter -inspanninsbeperking -intoxicaties -familie-anamnese -overige tracti
LO -pols, RR, SpO2 -ademhalingsfrequentie en patroon -beweeglijkheid thorax en abdomen -auscultatie en percussie -hart/ CVD -Abdomen -Extremiteiten
Aanvullend onderzoek -arteriele bloedgas analyse -overige lab -Rontgendiagnostie -ECG -Piekflow
Overig lab bu acute dyspnoe: -Hb -Elekrolyten -Nierfunctie -Glucose -Eventueel cardiale ezymen -D-dimeer (bij laag, kun je longembolie uitsluiten, bij positief niets bewezen) -Pro-BNP
Rontgendiagnostiek - X-thorax: shift v/h hart? - CT-thorax - Echo cor
Waar wijst 'n verlengd expirium op ? Obstrucite v kleine luchtwegen (astma, emfyseem)
Alarmsypmtomen v Astma - pols > 110/min - ademhalingsfrequentie > 25/ min --> laag CO2 --> respiratoire alkalose - "silent chest" bij zeer ernstige obstrucite met hyperinflatie v/d longen - stijgen pCO2
Beademingsindicaties v Astma - uitputting - bradycardie - hypotensie - niet in staat tot spreken
Alarmsymptomen voor COPD exacerbatie - minder alert - spreek geen volledige zinnen - temp >38.5 - Ademhalingsfreq >25/ min - Hartfreq. >110/ min - Hypercapnie - Saturatie <90% - PO2 <8.0 kPa
Behandeling acute exacerbatie COPD - O2 - herhaal bloedgas na 30 min - luchtwegverijders - glucocorticoiden -AB bij tekenen v bact. infectie
Let hypoxic drive uit normaal reageert je lichaam op CO2-receptoren.Nu reageert je lichaam op O2-prikkel en zijn de CO2-receptoren ongevoelig.
Indicaties voor invasieve mechanische ventilatie -adem-of hartstilstand -ademhalingsfrequentie >35/min -dreigende uitputting -pO2 <5.3kPa -pH <7.25 -verminderde mentale status -cardiovasculaire complicaties, sepsis, pneumonie -NIPPV falen
Alarmsymptomen bij 'n pneumothorax hypotensie en z.s.m. actie bij vermoeden v/e spanningspneumothorax
verdenking longembolie - tekenen v rechtsbelasting op 't ECG - hoog D-dimeer - volgens protocol CT-angio - Alarmsymptoom: hemodynamisch instabiliteit; strombolyse -Anders; laagmoleculair heparine en instellen op orale antistolling
Created by: SavageMD
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