Hitna stanja u pulmologiji
Hitna stanja u pulmologiji
Hitna stanja u pulmologiji
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S. Dodig <strong>Hitna</strong> <strong>stanja</strong> u <strong>pulmologiji</strong><br />
prva 24 sata arterijska krv dobiva iz umbilikalne arterije. Ako se ne može<br />
dobiti uzorak arterijske krvi, može se koristiti arterijalizirana kapilarna<br />
krv (iz hiperemizirane usne resice, prsta ili pete) (23). Arterijalizirana<br />
kapilarna krv nije pouzdana kada je oštećena periferna cirkulacija.<br />
U uzorku krvi ne smije biti mjehurića zraka, niti uzorak smije biti<br />
zagađen anestetikom (ako se ubodno mjesto prethodno anestezira). S<br />
uzorkom se mora oprezno rukovati, jer eritrociti mogu hemolizirati. Krv se<br />
mora odmah dopremiti u laboratorij i odmah analizirati, jer se u leukocitima<br />
i in vitro odvijaju metabolički procesi tako da se kod temperature od 37<br />
°C pO 2<br />
u uzorku smanjuje, pCO 2<br />
uvećava za 0,4 - 2,0 kPa/sat, a pH se<br />
smanjuje za oko 0,06 pH jedinica/sat (tj. 0,001/min), što se nikako ne smije<br />
zanemariti. Ako se analiza ne može odmah učiniti, krv treba pohraniti u<br />
hladnjak. S druge strane, pH ovisi o temperaturi: pH pune krvi raste s<br />
padom temperature za 0,0147 pH jedinica/°C. Očigledno je da pretragu<br />
plinova u krvi treba odmah učiniti (uzorak stariji od 3 sata nije koristan<br />
za analizu).<br />
Ako bolesnik ima vrućicu, vrijednosti plinova u krvi se moraju korigirati<br />
unosom podataka o temperaturi bolesnika. Također je potrebna korekcija<br />
vrijednosti hemoglobina kod bolesnika s anemijom.<br />
RESPIRATORY<br />
EMERGENCIES<br />
SUMMARY - Respiratory emergencies may occur in large entities, ranging from<br />
outpatients to the operating theatre and intensive care medicine. Laboratory staff<br />
need to work closely with pulmonologists in dealing with many aspects of a<br />
critically ili patient (acute respiratory failure, adult respiratory distress syndrome,<br />
pulmonarj embolism and infarction, intensive care of asthma). The evaluation of<br />
oxygenation and acid-base status in critically ili patients is crucial to their proper<br />
management. Arterial samples for analysis should preferably be obtained from the<br />
radial artery. A proper understanding of arterial blood gases, alueolar-arterial<br />
oxygen difference, and acid-base status are crucial to the proper management of<br />
critically ili respiratory patients.<br />
Key words: respiratory emergencies, acute respiratory failure, adult respiratorj<br />
distress syndrome, pulmonaiy embolism and infarction, lung diseases as a result<br />
of drugs and poisonings, droivning, blood gases, alveolar-arterial oxygen difference<br />
LITERATURA<br />
1. Hadžić N, Radonić M, Vrhovac B, Vucelić 3. Bullock BL, Rosendahl PP Pathophysiol-<br />
B. Priručnik interne medicine. Zagreb: ogy. Adaptations and Alterations in Func-<br />
JUMENA, 1985. tion. 2. izd.Glevniew, Illinois: Scott,<br />
2. Vrhovac B, Bakran 1, Granić M, Jakšić Foresman and Comp, 1988.<br />
B, Labar B, Vucelić B. Interna medicina. 4. Burlon GG, Hodgkin JE. Respiratory<br />
Zagreb: Naprijed, Medicinska biblioteka, care. A Guide to clinical practice. 2. izd.<br />
1991. Philadelphia: JB Lippincott Comp, 1984.<br />
BIOCHEMIA MEĐICA god 7, br. 1-2, 1997. 13
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