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Critical Care > Acute Respiratory Failure > Flashcards

Acute Respiratory Failure Flashcards

1
Q

A V/Q mismatch of <1 means what?

A

there is a decrease in ventilation (decrease PaO2)

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2
Q

A V/Q mismatch of >1 means what?

A

there is dead space ventilation (decrease PaO2/increased PaCO2)

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3
Q

What type of condition would cause a decrease in ventilation (V)?

A

any disease that fills up the alveoli with fluid (e.g. pneumonia)

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4
Q

What condition is commonly associated with a decrease in perfusion (Q)?

A

PE

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5
Q

What are the 3 types of respiratory failure?

A
  • hypoxemic respiratory failure
  • hypercarbic respiratory failure
  • mixed respiratory failure
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6
Q

Traditionally what test has been used to provide “cutoffs” to guide the clinician when determining respiratory failure?

A

ABGs

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7
Q

Using an ABG how is hypoxemia and hypercapnia defined?

A
  • hypoxemia = RA PaO2 <50-60 mmHg
  • hypercapnia = PaCO2 > 45 mmHg
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8
Q

What are the 3 tests used for diagnosing respiratory failure?

A
  • physical exam
  • ABG
  • CXR
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9
Q

What is a late sign of respiratory failure?

A

cyanosis

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10
Q

What 3 components of the ABG will tell us about acid-base balance?

A
  • pH
  • pCO2
  • HCO3
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11
Q

What component of the ABG will tell us about ventilation?

A

pCO2

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12
Q

What component of the ABG will tell us about oxygenation?

A
  • pO2
  • O2 saturation
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13
Q

How is hypoxic respiratory failure defined using an ABG?

A
  • pO2 and O2 sat will be low
  • room air PaO2 < 60 mmHg
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14
Q

How is hypercapnic respiratory failure defined using an ABG?

A
  • decrease in pH and increase in pCO2
  • PaCO2 > 45 mmHg with pH < 7.35
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15
Q

What 2 clinical features suggest acute respiratory failure?

A
  • increased work-rate of breathing
  • altered mental status
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16
Q

What are the 3 elements of an ABG?

A
  • acid-base
  • ventilation
  • oxygenation
17
Q

What does the oxygen hemoglobin dissociation curve say about the relationship pO2 and O2 saturation?

A

When the saturation is high you hold onto O2 better, when the saturation drops the ability to hold on O2 is rapidly decreased

18
Q

A SaO2 of 90 is equal to a PaO2 of ___.

A

60

19
Q

What are the 2 major measures of oxygenation?

A
  • Alveolar-arterial gradient
  • PaO2:FiO2 ratio
20
Q

How is the A-a gradient determined? What does it provide?

A
  • need to calculate Alveolar O2 then subtract from measured arterial O2 via ABG
  • it provides a sense of “how hard” it is to transfer O2 from the alveoli to the blood
21
Q

What change in A-a gradient usually indicates a V/Q mismatch or a shunt?

A

high gradient (normal = <10 torr but increases with age)

22
Q

A ____ paO2:FiO2 ration is bad.

A

low

23
Q

If a patient presents in respiratory distress but has a _____________ what diagnosis should you consider?

  1. normal CXR
  2. CXR with alveolar pattern
  3. CXR interstitial pattern
  4. CXR with lobar consolidation
  5. CXR with hyperinflated lungs
A
  1. PE
  2. CHF, ARDS
  3. mild CHF, pulmonary fibrosis, atypical pneumonia
  4. pneumonia
  5. COPD
24
Q

What CXR pattern is this?

A

normal CXR

25
Q

What CXR pattern is this?

A

alveolar filling pattern

26
Q

What CXR pattern is this?

A

interstitial pattern

27
Q

What CXR pattern is this?

A

lobar consolidation

28
Q

What CXR pattern is this?

A

hyperinflated (smoker)

29
Q

What are the 5 mechanisms of hypoxia?

A
  • decreased ventilation (e.g. OD)
  • decreased FiO2 (e.g. on top of Mt. Everest)
  • decreased diffusion (diseased alveolar-capillary interface)
  • decreased V/Q
  • shunt (ventilation is 0)
30
Q

If you turn up the O2 and the patient’s O2 sat does not improve you should immediately consider what mechanism of hypoxia?

A

shunt

31
Q

In normal physiology, both ventilation and perfusion is greater at the ________ of the lungs.

A

bases

32
Q

What are the 2 types of anatomic shunts?

A
  • intracardiac shunts
  • pulmonary arteriovenous malformations (AVMs)
33
Q

What are the 4 disease causes of respiratory failure d/t V/Q mismatch?

A
  • COPD
  • asthma
  • pneumonia
  • CHF
34
Q

What are the 3 disease causes of respiratory failure d/t a shunt?

A
  • ARDS
  • pulmonary edema
  • pneumonia
35
Q

What are the 4 disease causes of respiratory failure d/t hypoventilation?

A
  • CNS depression
  • obesity hypoventilation syndrome
  • kyphoscoliosis
  • neuromuscular weakness
36
Q

Dysfunction in any one of these 5 things can cause hypercapnia?

A
  • CNS
  • peripheral NS (wiring)
  • Bellows (thoracic cage)
  • Upper airway
  • Lungs
37
Q

Management of hypercapnia involves these 3 things.

A
  • supplemental O2
  • treat underlying cause
  • support ventilation
38
Q

What is the main purpose of PEEP?

A

to prevent end expiratory alveolar collapse

Critical Care (8 decks)

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