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肺和胃肠道症状：在生命的尽头的普通物理症状课件.ppt

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CommonPhysicalSymptomsattheEndofLife:PulmonaryandGISymptomsMikeMarschke,-,78YO,-3l/minnasalcannulaoxygen,,hasapersistentcough,withgrayphlegmHeisonsteroidsandnebulizersWhatisDyspnea?Subjectivesensethatyouneedtobreath,thatyou‘hungerair.’MechanismRespiratoryCenterofMedullaChemoreceptorssensinglowO2,hiCO2Mechanoreceptors(Jreceptors)inlung,respiratorymuscles,anddiaphragmVascularcongestion-CHFCerebralCortexMeasurements?pO2,pCO2,O2satsPeakflowsPulmonaryfunctiontestsmeasuringlungvolumesandflowPrognosis<6mos.:ClassIVrespiratoryfailure(=dyspneaatrest)FrequentER/hospitalstays,recurringpulmonaryinfections,intubationspO2<56mmHg,O2sat<89%,pCOs>“breathless”“heavyandsuffocating”.-distantbreathsounds,coarsecracklesatbasesbilaterally,RR=32atrest,takesbreathesinmid-.2+edemabilaterallowerextremitiesTheBargainerHasnowishtobe“brutalized”.,labs?pleteassessment–

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