1 - Respiratory Distress and Failure Flashcards
Gas exchange
Air taken in during inspiration –> O2 diffuses from alveoli –> into blood (some dissolves into plasma) –> most O2 is attached to hemoglobin
As blood passes through the lungs –> CO2 diffuses from the blood –> into alveoli –> exhaled
Lung parenchyma
Portion of lungs involved in gas exchange
02 consumption per minute for adults vs infants
Adults 3 to 4 ml/kg per minute
Infants 6 to 8 ml/kg per minute
Early Signs of Tissue Hypoxia
- Tachypnea
- Inc respiratory effort - nasal flaring, retractions
- Tachycardia
- Pallor, mottling, cyanosis
- Agitation, Anxiety, Irritability
Late Signs of Tissue Hypoxia
- Bradypnea
- Inc resp - head bobbing, seesaw resp, grunting
- Bradycardia
- Pallor, mottling, cyanosis
- Dec LOC
atmospheric pressure during inspiraration
intrathoracic is less than atmospheric pressure
Mainly diaphragm, intervcostal muscles, accessory muscles
atmospheric pressure during expiration
less than intrathoracic pressure. Relaxation of the inspiratory muscles and elastic recoil of lung and chest wall
What happens when the diaphragm is flattened..
Contraction is less forceful and ventilation is less efficient. (eg acute asthma)
3 things that control breathing
- Voluntary
- central and peripheral chemoreceptors
- Brainstem resp centers
Spontaneous breathing is controlled by..
a group of resp centers located in the brainstem
Voluntary breathing is controlled by…
Cerebral Cortex
Central chemoreceptors respond to changes in…
Hydrogen ion of CSF
largely determined by PaCO2
Peripheral chemoreceptors respond to changes in…
Decrease in PAO2
Upper airway obstruction location
Outside the thorax
Nose, Pharynx, Larynx
Signs of upper airway
Stridor (insp)
Hoarseness, Cry, Barking Cough
Drooling, Snoring, Gurgling Sound
Sings of lower airway
Wheezing (exp)
Lung Tissue Disease explanation
Disease involving the substance of the lung
Child’s lungs become stiff
Fluid accumulation in alveoli, interstitum
Signs of lung tissue disease
Grunting, Crackles
Trying to increase end-expiratory pressure
Signs of disorder control of breathing
Child is “Breathing funny”
Reasons for disorder control of breathing
CNS infections, seizures, brain tumor, OD, metabolic abnormalities`
2 lower airway obstruction causes
- Asthma
2. Broncholitis
Lung tissue disease causes
Pneumonia, pulmonary contusion, bacterial, viral, aspiration
What is respiratory arrest
The absence of respirations with detectable cardiac activity
Specific Upper Airway Obstruction by Etiology (3)
- Croup
- Anaphylaxis
- Foreign-body airway obstruction (FBAO)
- Croup Managment
Nebulized epinephrine
Corticosteroids
- Anaphylaxis Managment
IM Epinephrine
Albuterol
Antihistamine
Corticosteroids
- Aspiration Foreign Body
Allow position of comfort
Specialty Consulation
Lower Airway Obstruction by Etiology (2)
- Bronchiolitis
2. Asthma
- Bronchiolitis Managment
Nasal Suctioning
Bronchodilator Trail
- Asthma Management
Albuterol Corticosteroids Subcutaneous Epi Magesium Sulfate Terbutaline
Lung Tissue Disease by Etiology (2)
- Phenumonia/Pneumonitis (Infectious, Chemical, Aspiration)
2. Pulmonary Edema (Cardiogenic, Noncardiogenic)
- Pneumonia/Pneumonitis Management
Albuterol
Antibiotics
CPAP
- Pulmonary Edema Management
Ventilation support / PEEP
Vasocative support
Consider Diuertic
Disordered Control of Breathing Etiology (3)
- Inc ICP
- OD/Poisoning
- Neuromuscular Disease
- Inc ICP Management
Avoid hypoxemia
Avoid hypercarbia
Avoid Hyperthermia
- OD/ Poisioning Managment
Antidote
Contact Poison Control
- Neuromuscular Disease
Consider noninvasive / invasive ventilatory support
3 Risks of hyperventilation
- Air enters the stomach (Gastric Distention)
- Risk of pneumothorax
- Severe air trapping
Magensium Sulfate can be used w/ asthma as a
Bronchodilator
2 uses for Terbutaline
- Bronchodilator
2. Tocolytic - anti-contraction to delay preterm labor for up to 48 hours
What is cardiogenic pulmonary edema
high pressure in pulmonary capillaries causes fluid to leak into the lung interstitial and alveoli
Most common cause of cardiogenic pulmonary edema is
Left ventricular myocardial dysfunction
What type of ET is used to reduce glottic air leak
Cuffed ET tube
Inc ICP fluid rate
20ml/kg IV isotonic crystalloid
What drug to avoid w/ children w/ neuromuscular disease
Succinylcholine
Rate of suction force needed for airway secretions
-80 to -120mm Hg
OPA is used on an
unconscious no gag reflex pt
Nasal Cannula oxygen rate
0.25 to 4 L/min
Simple O2 mask rate
Minimum 6L
Non-rebreathing mask rate
10 to 15 L/min
High Flow Nasal Cannula
4 to 40 L/min
DOPE
Displacement of the tube
Obstruction of the tube
Pneumo
Equipment Failure
After DOPE is checked and things are still unchanged…
It may be due to agitation, pain, or excessive movement
Analgesia
Sedation
Neuromuscular block agents
