Case report

1
Case report

• 96-01-18 QA

2

• Name ?xx
• Chart number 17416839
• Sex male
• Age 24 y/o
• Past History none
• Operation removal of implants for left
  olecranon and calcaneous fracture

3
Sent patient to PACU without extubation due to
hypothermia
4
1649 pH 7.285 PCO2 59.3 PO2 146.4 HCO3
28.4 TCO2 30.3
Sedation with dormicum and propofol, GCSE1M6Ve
Resp. rate 15 bpm Vital signs stable GCS
E4M6V5
Extubation but failed
Jackson-Ree bagging, aminophyllin, nasal airway,
check ABG
5
Sent patient to ward
6
Discussion
7
Guideline for extubation

• Adequate saturation
• Adequate breathing pattern
• Level of consciousness
• Full recovery of muscle strength

8
Weaning

• Vt gt 5 ml/kg
• RR lt 30 beats /min.
• Vital capacity gt 10 ml/kg
• Negative respiratory pressure
• lt 25 cm H2O
• Minute ventilationlt 10 L/min.
• PO2 gt 60 mmHg

9
Upper airway obstruction

• Dentofacial characteristics
• inability to retain a dental appliance
• resulting from an orthodontic orthodontic program
  
• Increased nasal resistance
• Lower position of tongue lost of the lateral
  expansile forces of the tongue on the palate
• Rotated mandible
• Unopposed medial forces of the buccinator and
  masseter muscles
• Nasal airway obstruction in children and
  secondary dental deformities
• Francis B. Quinn, Jr., M.D. 1996

10
Complications of hypothermia

• Cardiac arrhythmias
• Hypotension
• Pulmonary edema
• Pancreatitis, peritonitis,GI bleeding
• Acute tubular necrosis
• Intravascular thrombosis
• Metabolic acidosis
• Rhabdomyolysis, gangrene, compartment syndrome
• Hypothermia. www.emedicine.com Lastest uptake on
  2005-09-22

11

• Thanks!