心因性休克的診斷與治療 (2021)
⭕️ 心因性休克 (CS, Cardiogenic Shock) 的診斷要件:
臨床表徵:血流灌注不足在臨床上出現的表徵,例如四肢冷汗、少尿、意識混亂、頭暈、脈壓變窄。
生化數據:血流灌注不足反映在組織缺氧和細胞代謝改變,例如Creatinine 升高、代謝性酸中毒和血清乳酸升高。
CS 是一種臨床診斷,因此血液動力學參數,例如降低的心臟指數 (CI) 和升高的肺微血管楔壓 (PCWP),並不是必要強制性的診斷要件。
以前CS的定義包括,低血壓定義為收縮壓(SBP)<90毫米汞柱30分鐘以上,或者使用Catecholamine維持SBP需要> 90 mmHg。但2020 ESC就不再將血壓列入診斷條件之ㄧ。休克發生時,組織灌注和氧合會顯著降低,但經由代償機制可以通過血管收縮來保持血壓。因此,血流灌注不足並不表示存在着低血壓。
如果出現低血壓,卻沒有血流灌注不足的現象,可能預示著較好的預後。
在 SHOCK Registry研究中,即使在血壓正常的患者中,血流灌注不足的臨床表徵與院內死亡有顯著風險關連。這說明了,不論低血壓如何,早期辨識血流灌注不足表徵可辨識高危險患者。
歐洲重症醫學學會將休克定義為:組織灌注不足,且無法提供足夠的氧氣以維持細胞的基礎代謝,導致危及生命的全身性急性循環衰竭。(其中低血壓的存在不是定義CS的先決條件。)
基於這些考慮,ESC將CS定義為:
由原發性心血管疾病引起的症候群,其中CO不足,導致組織血流灌注不足而危及生命,並與組織氧代謝受損和產生高乳酸血症。根據其嚴重程度,可能導致多器官功能異常和死亡。
⭕️ 心因性休克的分期
根據臨床嚴重程度和對治療的反應,CS型態可分為前CS前期、CS 和難治型CS。
CS前期
早期辨識CS可以快速啟動適當的措施與治療。即使在正常的SBP情況下,周邊血流灌注不足,出現的臨床症狀被稱為CS前期,並且出現在明顯的CS之前。休克前期可能發生在嚴重的急性心衰竭,可能與組織灌注不足的臨床症狀有關,但不會影響細胞基礎代謝和正常的乳酸。這種狀態應與血壓正常的CS區分開來,後者代表CS的實體,具有血流灌注不足和細胞改變(包括細胞缺氧和乳酸升高)的所有特徵,但沒有低血壓。血壓正常的CS患者全身血管阻力較大,但左心室(LV)射出分率、CO和PCWP與典型的CS患者相似,因此突顯血流灌注不足的風險。
難治型CS
被定義為:儘管給予足夠劑量的兩種血管升壓收縮劑,治療潛在病因,但仍存在組織灌注不足的CS。
⭕️ SCAI分類
SCAI分類描述了CS的五個進展階段,從A(有CS風險)到 E極度),這種分類可以在臨床環境中迅速方便應用。SCAI分類利用低灌注的臨床評估、乳酸值和侵入性血流動力學評估。最近,SCAI分類已在一大群未經選擇的重症心臟加護病房 (CCU)患者中得到驗證,無論CS病因如何,都提供了穩健的死亡風險分類。
A: At risk, 風險期。有CS風險;SBP=N, CI>2.5; 乳酸: 正常,沒有血流灌注不足。
B: Beginning, 開始期。相對低血壓,或心跳加速而沒有血流灌注不足,CI <2.2, PA sat ≧65%,乳酸< 2.2 mmol/L。
C: Classic, 典型期。血流灌注不足,除了輸液急救,還需要血管增壓劑,MCS或ECMO來恢復血流灌注。
D: Deteriorating 惡化期。緊急加護治療後,無法穩定。超過30分鐘後,病人的低血壓,血流灌注不足仍無改善。需要更多的輸液,或額外的MCS。乳酸 > 5 mmol/L。
E: Extremis, 極度期。難治之心跳停止,進行中的CPR,需要緊急使用介入治療,包括ECMO。
⭕️ 流行病學和預後
CS的患病率因CS的定義、臨床狀況和數據收集時代而異。CS佔急性心衰竭的2-5%,ICU的14-16%。院內死亡率在30%和 60%之間變化,近一半的院內死亡發生在就診的前24小時內。1年死亡率約為50%-60%;70-80 %CS發病後出現在第30〜60天死亡。
心因性休克的病生理、藥物治療、MCS……
⭕️ 完整全文閱讀:
⭕️ 心因性休克的診斷與治療
https://reurl.cc/6D2b6M
資料下載:
表 1. 非急性冠心症病因之心因性休克特徵與治療
https://reurl.cc/35Dbq9
表 2. 短期機械循環輔助的特徵
https://reurl.cc/gz7rW4
表3 強心及血管升壓劑之特性
https://reurl.cc/r1x0g1
Ref:
■Cardiogenic shock. ESC. European Journal of Heart Failure (2020) 22, P. 1315-1341
■SCAI分類:Catheter Cardiovasc Interv 2019;94:29–37
同時也有6部Youtube影片,追蹤數超過361萬的網紅Dan Lok,也在其Youtube影片中提到,What Does Freedom Mean To You? Once You Know The Answer But You’re Not Sure How To Achieve It, Click Here To Discover Which Of Dan’s Recommended High-...
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risk of shock 在 Raf Yaakob Facebook 的最讚貼文
Southampton 1 v @manchesterunited 1
So many criticising Ole on the line up. I disagree for those who wants to see Sancho and Varane starting the game.
Sancho is not ready. Fitness wise. He cant last 90 mins. Might risk to injury. And if he played when he’s not at his fittest and didn’t perform, media and haters will give him a hard time.
Varane is another case. It’s his first week of training with the squad. All eyes on him. So give another 1-2 (max) games before he take his place next to Maguire. I reckon Varane and Sancho are going to start the next game 🤞🏽
Ole gave chance for Martial to shine. He didn’t take his chance and he didn’t contribute enough. Next game he will be on the bench.
Mctominay have a slight injury concern. For precaution, Ole played Matic. And Matic was below average. He’s not mobile enough and he didn’t set the tempo right from the back. Not solid like Scottie last week.
Fred didn’t carry his last week form to this week. Maybe he’ll still play or maybe van de Beek will start. We’ll see. Don’t be shock if Ole starts Lingard next week. I think Jesse in raring to go. Ole is giving a fair chance to all the players. They should have taken the chance well.
Last but not least, it’s still very early in the season. The squad will improve as days goes by. Just hope that they will be no major injuries to our key players. It’s going to be a long and tough season ahead. Win, Lose or Draw, I’m still UNITED till the end.
- Mr President -
P/S: Not sure if United will sign a mobile and effective CDM this month. Such an important role. I don’t think they will sign anyone if the “right” player is not available. Who do you want United to sign? Comment below 👇🏽
risk of shock 在 北歐心科學 NordicHearts Facebook 的精選貼文
陳雲:美國自由派政治及文化雜誌《大西洋雜誌》報導陳雲,說我是特朗普在香港的最忠實支持者,撰寫《特朗普厚黑學》(2017)支持特朗普,主張舉美國旗向美國示好及締結友誼,並且分析特朗普的務實政治及保護世界免收共產主義危害。文章的首三段、中段及結尾壓卷一段都是引述陳雲對特朗普的見解。
//To speak to Wan Chin, the host of a YouTube politics show, is to hear echoes of American conservative radio: An “invasion” of immigrants is crossing the border, filling public housing and sapping up limited government resources, he told me; the coronavirus is a “Frankenstein” superbug weaponized in a Chinese lab; and President Donald Trump’s “Rambo way” of leadership has finally called out China for its hostilities. When Trump was diagnosed with COVID-19, Chin took to Facebook to wish him “a speedy recovery from the mild flu,” parroting the president’s own downplaying of the virus’s severity.
Chin isn’t an American shock jock, though. In fact, he doesn’t even live in the United States. He is, instead, an early and prominent advocate of Hong Kong’s prodemocracy movement: His 2011 book, On the Hong Kong City-State, was a formative text for the localist movement, which seeks to promote and protect Hong Kong’s identity and way of life, separate from that of mainland China. Chin, a former professor, peppered his opinions with historical references to ancient Chinese dynasties and arcane tidbits from folk tales. The walls of his office are lined with Chinese and Buddhist shrines, ornately carved out of dark wood. As he spoke, a woman entered and lit a small bunch of incense, the fragrant smoke twisting upward toward a red “Make Hong Kong Great Again” T-shirt hanging near the door.
Chin is also an unapologetic cheerleader for Trump, whom he calls a “hero,” and he is far from alone. This city lies at the forefront of the global fight for democracy, a place where protesters have for more than a year stood against Beijing’s attack on Hong Kong’s autonomy, free press, and liberal institutions. Yet support for the president—whose own assault on democratic norms, gushing over the Tiananmen Square massacre, on-again, off-again praise of Chinese President Xi Jinping, initial lukewarm support of Hong Kong’s protest movement, and self-admitted slow-rolling of sanctions over Xinjiang’s mass-detention camps in favor of a trade deal—remains stronger in some quarters than for his Democratic rival, Joe Biden.
Following Trump’s election in 2016, Chin published The Trump Strategy, a book that analyzed the president’s dealings with China. Last year, when enormous protests erupted in Hong Kong, Chin urged his supporters to carry Trump flags and wear Trump gear to protests as punitive legislation targeting Hong Kong was making its way through Washington, playing to the president’s oversize ego and hoping to “catch his eye.” Chin told me he was drawn to Trump’s rhetoric on the economic risk China poses to the world, and used Hong Kong as an example of what he saw as state capture accomplished through Chinese state-owned enterprises—snatching up newspapers and swathes of real estate since the city returned to Chinese rule in 1997—as the type of threat Trump was sounding the alarm against...
Chin, the political commentator, said Trump had created irreversible momentum against China, but he nevertheless acknowledged the president’s contradictions. He is “a good leader, but not a democratic leader,” he told me. During his time in office, Trump had been “violating a lot of good practice of democracy,” he added, but, in exchange for taking on China, this was a “necessary evil.”//
risk of shock 在 Dan Lok Youtube 的精選貼文
What Does Freedom Mean To You? Once You Know The Answer But You’re Not Sure How To Achieve It, Click Here To Discover Which Of Dan’s Recommended High-Income Skills You Were Born To Do To Achieve Freedom: https://freedom.danlok.link
When you think about “freedom”, what immediately comes to mind? Is it the ability to do anything you want, whenever you want it? Is it being able to live your life without having to do anything at all? Dan’s definition of freedom has changed over the years, and his answer to this question will shock you. So if you want to know what “freedom” means to Dan, watch this video.
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Dan Lok has been viewed more than 1.7+ billion times across social media for his expertise on how to achieve financial confidence. And is the author of over a dozen international bestselling books.
Dan has also been featured on FOX Business News, MSNBC, CBC, FORBES, Inc, Entrepreneur, and Business Insider.
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#DanLok #Freedom
Please understand that by watching Dan’s videos or enrolling in his programs does not mean you’ll get results close to what he’s been able to do (or do anything for that matter).
He’s been in business for over 20 years and his results are not typical.
Most people who watch his videos or enroll in his programs get the “how to” but never take action with the information. Dan is only sharing what has worked for him and his students.
Your results are dependent on many factors… including but not limited to your ability to work hard, commit yourself, and do whatever it takes.
Entering any business is going to involve a level of risk as well as massive commitment and action. If you're not willing to accept that, please DO NOT WATCH DAN’S VIDEOS OR SIGN UP FOR ONE OF HIS PROGRAMS.
This video is about What Does Freedom Mean To You?
https://youtu.be/ElnCOz7twz4
https://youtu.be/ElnCOz7twz4
risk of shock 在 Dan Lok Youtube 的精選貼文
How Do You Know When Someone Is Loyal? You Can’t. What You Can Do Instead Is Help Your Employees Get What They Want, So You Can Scale Fast. How? One Way Is To Use Dan’s Top Business Secrets Found Here: http://loyal.danlok.link
For entrepreneurs, business owners, and corporations, one of the most painful experiences is when one of your employees stab you in the back, betray you, or go work for the competitors. So a frequent question is, “How do you know when someone is loyal?” In this video, Dan Lok shares his experience with employees and loyalty through his +23 years in business. The answer will SHOCK you.
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3.) Dan Lok’s Best Secrets - https://www.youtube.com/watch?v=FZNmFJUuTRs&list=PLEmTTOfet46N3NIYsBQ9wku8UBNhtT9QQ
Dan Lok is a Chinese-Canadian business magnate and global educator known for being the founder and chairman of Closers.com - the world’s #1 virtual-closers network, Copywriters.com, and SalesCalls.com. Beyond his businesses, Mr. Lok has led several global movements to redefine modern education where he has taught individuals from 150+ countries to develop high income skills and financial confidence.
Beyond his success in business, he was also a two time TEDx opening speaker. An international best-selling author of 12+ books. A member of Young Presidents Organization (YPO) - a private group of global chief executives whose companies employ 22 million people and generate 9-trillion USD in annual revenues. He also hosts The Dan Lok Show - a series on elite business tycoons and world-leading entrepreneurs.
Today, Mr. Lok continues to be featured in thousands of media channels and publications every year and is widely seen as one of the top business leaders by millions around the world.
If you want the no b.s. way to master your financial destiny, then learn from Dan. Subscribe to his channel now.
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#DanLok #Loyalty #Loyal
Please understand that by watching Dan’s videos or enrolling in his programs does not mean you’ll get results close to what he’s been able to do (or do anything for that matter).
He’s been in business for over 20 years and his results are not typical.
Most people who watch his videos or enroll in his programs get the “how to” but never take action with the information. Dan is only sharing what has worked for him and his students.
Your results are dependent on many factors… including but not limited to your ability to work hard, commit yourself, and do whatever it takes.
Entering any business is going to involve a level of risk as well as massive commitment and action. If you're not willing to accept that, please DO NOT WATCH DAN’S VIDEOS OR SIGN UP FOR ONE OF HIS PROGRAMS.
This video is about How Do You Know When Someone Is Loyal?
https://youtu.be/8zZ1YMXOLvk
https://youtu.be/8zZ1YMXOLvk
risk of shock 在 Dan Lok Youtube 的最佳解答
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So many people ask Dan, “Does location matter for success in life?” Well, there’s only one answer to that, and in this video, Dan discusses if location matters for success. So watch this video now to discover if location matters for success in life. The answer might shock you!
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3.) Dan Lok’s Best Secrets - https://www.youtube.com/watch?v=FZNmFJUuTRs&list=PLEmTTOfet46N3NIYsBQ9wku8UBNhtT9QQ
Not long ago, Dan Lok was just a poor immigrant boy. He had nothing but a strong desire to get out of debt and make enough to provide for his single mom. With this strong desire, Dan quit his job as a grocery bagger. He dropped out of college. And he became an entrepreneur.
After 13 failed businesses, Dan finally became a self-made millionaire at age 27 and multi-millionaire by age 30.
Fast forward to today, Dan is now an official Forbes Book author with over 13 internationally best-selling books. He’s the founder and chairman of several multimillion dollar businesses. And outside of his business success, he is one of the most-watched, most quoted and most followed educators of our time. In total, his videos have been watched over 100-million times across his social media platforms. His emails are read by over 2,000,000 people every month.
If you want the no b.s. way to master your financial destiny, then learn from Dan. Subscribe to his channel now.
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#DanLok #SuccessInLife #Success
Please understand that by watching Dan’s videos or enrolling in his programs does not mean you’ll get results close to what he’s been able to do (or do anything for that matter).
He’s been in business for over 20 years and his results are not typical.
Most people who watch his videos or enroll in his programs get the “how to” but never take action with the information. Dan is only sharing what has worked for him and his students.
Your results are dependent on many factors… including but not limited to your ability to work hard, commit yourself, and do whatever it takes.
Entering any business is going to involve a level of risk as well as massive commitment and action. If you're not willing to accept that, please DO NOT WATCH DAN’S VIDEOS OR SIGN UP FOR ONE OF HIS PROGRAMS.
This video is about Does Location Matter For Success In Life?
https://youtu.be/B0ymI5bVbA8
https://youtu.be/B0ymI5bVbA8
risk of shock 在 Spot the Problem!...Risk of Electric Shock! - YouTube 的推薦與評價
... risk of electric shock. * How to use an outlet checker to see if you have a live (hot) and neutral switched...or any other incorrect wiring ... ... <看更多>