ABCDE breathing Flashcards
target oxygen saturation level in acute asthma
94-98
assessment ABCDE breathing
Vitals:
- RR
- SpO2
look:
- cyanosis
- increased work of breathing
- cough
- inability to speak in full sentences
feel:
- tracheal position
- chest expansion
- percussion
listen:
- breath sounds and added sounds
interventions and investigations ABCDE breathing
if o2 sats low
- oxygen 15L NRM
- ABG
- CXR
what are the different types of oxygen delivery and their corresponding FiO2 range limits (WARD BASED)
Nasal cannula: 24 – 44% oxygen
Simple face mask: 40 – 60% oxygen
Venturi masks: 24 – 60% oxygen
Face mask with reservoir (non-rebreather mask): 60 – 95% oxygen
why are venturi masks useful?
Venturi masks can be used to deliver exact concentrations of oxygen. The most common use for these is in patients with COPD who are at risk of retaining carbon dioxide if the FiO2 is too high
this means it is a ‘fixed performance device’ - the fraction of inspired oxygen (FiO2) remains constant regardless of inspiratory flow rates
what is PEEP
Positive end-expiratory pressure (PEEP)
End-expiratory pressure refers to the pressure that remains in the airways at the end of exhalation.
Additional pressure in the airways at the end of exhalation stops the airways from collapsing.
what oxygen delivery methods have PEEP
High-flow nasal cannula
CPAP
Non-invasive ventilation (BiPAP)
Mechanical ventilation
what intervention may be needed for type 1 resp failure if normal O2 delivery methods not adequate
CPAP
what intervention may be needed for type 2 resp failure if normal O2 delivery methods not adequate
biPAP
how are NIV and BiPAP different?
NIV is a form of breathing support delivering air, usually with added oxygen, via a facemask by positive pressure, used in respiratory failure.
The term NIV is often used interchangeably with the trade name BiPAP (Bi-level Positive Airway Pressure), which is the most commonly used machine in the UK.
is CPAP a type of NIV?
CPAP does not technically involve “ventilation”, as it provides constant pressure and the job of ventilation is still dependent on the respiratory muscles. Therefore, CPAP is not technically classed as non-invasive ventilation (NIV).
what is ECMO
Blood is removed from the body, passed through a machine where oxygen is added and carbon dioxide is removed, then pumped back into the body. The process is similar to haemodialysis but for respiratory support rather than renal support.
ECMO is only used short-term, where there is a potentially reversible cause of respiratory failure.
Extracorporeal membrane oxygenation (ECMO) is the most extreme form of respiratory support and is very rarely used. It is used where respiratory failure is not adequately managed by intubation and ventilation.
what is Cheyne-Stokes respiration
cyclical apnoeas, with varying depth of inspiration and rate of breathing. May be caused by stroke, raised intracranial pressure, pulmonary oedema, opioid toxicity, hyponatraemia or carbon monoxide poisoning.
what is Kussmaul’s respiration
deep, sighing respiration associated with metabolic acidosis (e.g. diabetic ketoacidosis).
tracheal deviation causes? which way would it go?
The trachea deviates away from tension pneumothorax and large pleural effusions.
The trachea deviates towards lobar collapse and pneumonectomy.
cause of symmetrical reduction in chest expansion
pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.
hyperinflation eg copd
causes of asymmetrical reduction in chest expansion
pneumothorax, pneumonia and pleural effusion can all cause ipsilateral reduced chest expansion.
cause stony dullness
typically caused by an underlying pleural effusion.
cause dullness to percussion
suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).
Stony dullness: typically caused by an underlying pleural effusion.
what is bronchial breathing
harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between. This type of breath sound is associated with consolidation.
what is wheeze? causes?
a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s)
Wheezing can be either expiratory, inspiratory, or both. Expiratory wheezing is more common and may mean that a person has a mild blockage causing the wheezing.
asthma, COPD and bronchiectasis. pulmonary oedema
what are coarse crackles?
discontinuous, brief, popping lung sounds typically associated with fluid/secretions
pneumonia, bronchiectasis and pulmonary oedema.
what are fine crackles? causes?
sounding similar to the noise generated when separating velcro. Fine end-inspiratory crackles are associated with pulmonary fibrosis.
what is type 1 resp failure? pathophysiology?
low PaO2, normal PaCO2 (1 thing wrong)
pH likely normal
ventilation/perfusion (V/Q) mismatch
As a result of the VQ mismatch, PaO2 falls and PaCO2 rises. The rise in PaCO2 rapidly triggers an increase in a patient’s overall alveolar ventilation, which corrects the PaCO2 but not the PaO2 due to the different shape of the CO2 and O2 dissociation curves. The end result is hypoxaemia (PaO2 < 8 kPa /60mmHg) with normocapnia (PaCO2 < 6.0 kPa / 45mmHg).¹
Reduced ventialtion and normal perfusion:
- pulmonary oedema
- bronchoconstriction
- pneumonia
Reduced perfusion with normal ventilation:
- pulmonary embolism