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Caso

Learn how to handle shock in an elderly woman with pneumonia, monitoring vital signs and optimizing tissue perfusion. Explore treatment protocols and common issues encountered in such cases.

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Caso

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  1. Caso • Mulher, 80 anos, demência senil, pneumonia e insuficiência respiratória. PA 80/30 mmHg, FC 120 bpm, PTP lentificada, diurese de 150 ml em 12h, Glasgow 6.

  2. PROBLEMAS? • MONITORIZAR?

  3. Mulher, 80 anos. PNEUMONIA evolui c/ choque. • PAM 40 mmHg • PAPO 0 mmHg • IC 1 L/min/m2 • IRVS 2800 dyna.seg.cm-5/m2 • SvO2 50% • O QUE FAÇO? Cristiano Hecksher

  4. Mulher, 80 anos. PNEUMONIA evolui c/ choque. • PAM 50 mmHg • PAPO 18 mmHg • IC 2 L/min/m2 • IRVS 2000 dyna.seg.cm-5/m2 • SvO2 55% • O QUE FAÇO? Cristiano Hecksher

  5. Mulher, 80 anos. PNEUMONIA evolui c/ choque. • PAM 65 mmHg • PAPO 18 mmHg • IC 3 L/min/m2 • IRVS 1200 dyna.seg.cm-5/m2 • SvO2 85% Cristiano Hecksher

  6. O que foi tratado? Cristiano Hecksher

  7. DO2 Cristiano Hecksher

  8. Mulher, 80 anos. PNEUMONIA evolui c/ choque. • PAM 50 mmHg • PAPO 18 mmHg • IC 4 L/min/m2 • IRVS 800 dyna.seg.cm-5/m2 • SvO2 90% • E AGORA????? Cristiano Hecksher

  9. Perfusão Tecidual • Alterações na microcirculação: • Formação de microtrombos; • Alteração reológica das hemácias; • Adesão de plaquetas ao endotélio • Adesão de leucócitos ao endotélio; • Disfunção do endotélio (p.ex: endotelina); • Edema intersticial. Keller S, et al. Shock 2006. Croner RS, et al. Crit Care 2006. Cristiano Hecksher

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