Acute Respiratory Failure

Question 1

Common causes of acute hypercapnic respiratory failure

Answer 1

Anything that makes a patient unable to move air in an out of lungs

Stroke, ALS, spine injury, chest wall disorders, drug overdose

Question 2

What is the critical level for PaO2/FIO2 ratio?

Answer 2

<200

Question 3

Is hypoxemic or hypercapnic respiratory failure more common in sleep apnea?

Answer 3

Hypercapnic - not able to move air in/out of lungs

Question 4

Normal ranges for:
Blood pH:
PaO2:
PaCO2:
HCO3:

Answer 4

Blood pH: 7.35 to 7.45
PaO2: 80 to 100
PaCO2: 35 to 45
HCO3: 22 to 26

Question 5

Most common symptom of hypercapnia

Answer 5

Drowsiness

Question 6

Describe the rule of 4s in respiratory failure treatment

Answer 6

(Liters supplemental O2 x4) + 21 = FIO2

Helps classify their respiratory failure based on how much supplemental oxygen was required to get them to a stable (93%?) level

Question 7

Most common cause of acute hypoxemic respiratory failure

Answer 7

V/Q mismatching most common

Usually due to fluid-filling/collapse of alveoli

Also pneumonia, pneumothorax, PE

Question 8

Name as many complications from mechanical ventilation as you can (8)

Answer 8

Aspiration pneumonia

Alveolar overdistension

Atelectasis (if no deep breaths)

VTE (prevent with lovenox and compression stockings)

GI bleeding from stress (prevent with H2 antagonists)

Pressure ulcers

Neuromuscular weakness from critical illness (CIP)

ARDS can occur within 7 days
(body produces pulm edema and inflammation) (treat with NMJ and proning)

Question 9

If a patient in acute respiratory failure has a PaO2 of 85 and CO2 of 55 are they hypoxemic or hypercapnic?

Answer 9

Hypercapnic

Question 10

Acute respiratory failure is a syndrome of …. or ….

Answer 10

Oxygenation failure or CO2 elimination failure

Question 11

Drunk-like confusion, agitation, slurred speech, asterixis, and papilledema is more commonly seen with hypoxemic or hypercapnic respiratory failure?

Answer 11

Hypercapnic

Question 12

Most common first symptom of hypoxemia

Answer 12

Dyspnea

Question 13

Which is more common, acute hypoxemic respiratory failure or acute hypercapnic respiratory failure?

Answer 13

Acute hypoxemic respiratory failure

Question 14

True or false. A patient with mild hypoxemia will be tachycardic and a patient with severe hypoxemia will be bradycardic

Answer 14

True

Question 15

Role of PEEP in respiratory failure

Answer 15

Used to keep alveoli open and prevent atelectasis

Question 16

True or false. Hypothyroidism is a reversible cause of respiratory failure.

Answer 16

True

Question 17

If supplemental oxygen doesn’t help a patient in acute respiratory failure, what would be the next step?

Answer 17

Mechanical ventilation

Question 18

Best test to reliably assess a patient for hypoxemia or hypercapnia?

Answer 18

ABG

Question 19

True or false. BiPAP is a noninvasive mechanical ventilation that helps with oxygenation and ventilation

Answer 19

True

Question 20

Why include a CBC in respiratory failure workup?

Answer 20

Look for anemia

Question 21

If a patient in acute respiratory failure has a PaO2 of 55 and CO2 of 40 are they hypoxemic or hypercapnic?

Answer 21

Hypoxemic

Question 22

What is the preferred mechanical ventilation method in COPD patients who are in acute respiratory failure?

Answer 22

BiPAP

Use instead of intubation because they can become dependent

Question 23

When to consider intubation in acute respiratory failure

Answer 23

General anesthesia

Airway protection

Unconscious patient