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ARF Flashcards

1
Q

Function of Respiratory System

A

Gas exchange of oxygen and carbon dioxide from the atmosphere and the blood.

GASES:
O2 and CO2
Oxygen and Carbon Dioxide

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2
Q

ACUTE RESPIRATORY FAILURE

A

ARF is an umbrella term.
Results from one or more diseases involving the lungs or other body systems.

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3
Q

ARF is a characterized by (2 things)

A

Respiratory systems inability to supply sufficient oxygen (O2) to the tissues

or to eliminate carbon dioxide (CO2) from the bloodstream

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4
Q

DIAGNOSTIC CRITERIA FOR ARF - think hypercapnic or hypoxic

(alf is now 45)

A

PaO2 < 60 while receiving > 60% oxygen (normal range PaO2 75 – 100)
OR →
PCO2 > 45 with pH < 7.35 (acidic)
(normal PCO2 range 35 – 45)

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5
Q

FOUR MECHANISMS that cause Hypoxemic and Hypercapnic ARF

(Alf SHVD ARF, he’s causing it!)

A

VQ (ventilation-perfusion) MISMATCH
SHUNT (Type of VQ mismatch)
DIFFUSION LIMITATION
HYPOVENTILATION

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6
Q

normal V/Q ratios

A

Normally the volume of blood pumped thru the lungs each minute is about 4 – 5 L.
The volume of air in and out of the lungs each minute is about 4 –5 L
1ml of air to 1 ml of blood / each lung unit.
This would result in a V/Q ratio of 1:1 - this is what we want

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7
Q

VQ Mismatch is where

A

you don’t have enough perfusion or gas exchange to a lung area.

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8
Q

Common causes of V/Q Mismatch - on test - just 1 disease - the big one

A

PNA

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9
Q

V/Q - WHAT IS OBSTRUCTED: (2 things)

A

VENTILATION (AIR) OR PERFUSION (BLOOD FLOW)

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10
Q

ARDS

A

V/Q Mismatch because Fluid leaks out from the capillary into the alveoli

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11
Q

SHUNTS - what happens?

A

Blood passes through the lungs or heart without being oxygenated.

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12
Q

Two types of Shunts (shunts are AI)

A

ANATOMICAL
INTRAPULMONARY

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13
Q

Anatomical Shunt

(anatomically passing me by on the right side)

A

Blood passes from the right side of the heart to the left without being oxygenated.

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14
Q

Intrapulmonary Shunts

(intra V/Q)

A

this is the same as a VQ mismatch -
Either alveoli is plugged or blood vessel is plugged

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15
Q

Shunt ex: bld vessel plugged (literally a blood plug)

A

(PE)

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16
Q

Shunt: Airway plugged

(plugged pna)

A

(PNA)

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17
Q

DIFFUSION LIMITATION

(diffusely thick)

A

Alveolar-capillary membrane is thickened, destroyed or fibrotic

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18
Q

ALVEOLAR HYPOVENTILATION - what is altered?

(Alf drives)

A

Respiratory drive is altered

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19
Q

There are two types of ARF - just 1 and 2

A

TYPE I
Type II

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20
Q

TYPE I 
(Hypoxemic respiratory Failure)

(type A is alvin and pulmonary)

A

Oxygen failure
Inadequate transfer of 02 between alveoli and pulmonary capillary bed

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21
Q

CAUSES OF
hypoxemic ARF AND SAME FOR V/Q MISMATCH - know these!

(I need an ARF and glen APPP)

A

ARDS
PNA
Pulmonary Edema
Pulmonary Emboli
KNOW THESE

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22
Q

Type II 
(Hypercapnic respiratory failure) - think getting co2 out

A

Ventilatory failure– problem with inhalation/exhalation process
Respiratory system can’t ventilate out enough CO2 to maintain a normal Co2 level

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23
Q

Causes of Hypercapnia ARF - Four Categories (hyper respiratory is central to my chest muscles)

A

Respiratory (airway/alveoli)
Central Nervous System
Chest Wall
Neuromuscular

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24
Q

HYPERCAPNIC RESPIRATORY FAILURE - RESPIRATORY CAUSES (3 things - just think lung disease) - what about CF?

A

Airflow obstruction and trapping - ex.
Asthma
COPD (Emphysema)
Cystic Fibrosis

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25
Q

Asthma - breathing?

A

Bronchospasms, bronchial edema
↑ secretions – obstruct airflow
Narrowed Bronchioles
Labored breathing

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26
Q

HYPERCAPNIC RESPIRATORY FAILURE - COPD - is it obstructive?

A

Obstructed airflow

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27
Q

HYPERCAPNIC RESPIRATORY FAILURE - Cystic Fibrosis (fibrosis is stiff)

A

Stiff lungs and secretions obstruct airflow

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28
Q

Hypercapnic ARF - CNS causes (hyper brain)

A

Brainstem infarct and (TBI) Traumatic Brain Injury
Vital center for respirations compromised

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29
Q

Hypercapnic ARF - CHEST WALL CAUSES (3 things)

A

this is Dysfunction that limits lung expansion.
ex.
Flail Chest
Kyphoscoliosis
Obesity

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30
Q

hypercapnic - Flail Chest - what type of breathing

A

Mult Fx’d Ribs

Paradoxical Breathing

31
Q

hypercapnic - Kyphoscoliosis

A

Kyphoscoliosis
Spinal deformities prevents expansion of lungs

32
Q

Hypercapnia Respiratory Failure
Chest wall also caused by (just fat)

A

Morbid Obesity

33
Q

Hypercapnic ARF

NEUROMUSCULAR CAUSES

(alf and AL’s muscles are hyper phrantic) - and damage to which nerve?

A

(Respiratory muscles are weakened or paralyzed)
ALS (Amyotrophic Lateral Sclerosis)
Phrenic Nerve Injury

34
Q

S & S of Hypercapnic ARF cont (think apnea and you)

A

A severe morning headache suggest hypercapnia occurred during the night with an accumulation of CO2 (ACID).
train them to do Pursed lip breathing (I:E 1:3)
Tripod positioning (high fowlers with arms holding self up)

35
Q

EARLY SIGNS OF RESPIRATORY FAILURE - behavior? and heart and bp?

A

Restlessness, confusion agitation from ↓ O2 to the brain.
Tachycardia and mild hypertension

36
Q

Late signs Resp Failure - and what % is PA02 when it occurs?

(cyan is 45 yrs old)

A

Cyanosis
occurs when PaO2 is less than 45 mm Hg

37
Q

DIAGNOSTIC TESTS

A

ABG’S
Pulse ox, O2 saturation
CXR PA and Lat
V/Q scan
Chest CT
Blood and Sputum cultures
Bronchoscopy
Lung Biopsy

38
Q

TREATMENT OF ACUTE RESP FAILURE - just depends on the cause

A

Because many different problems can cause ARF, treatment will vary

Treat the underlying cause and concurrent medical problems

39
Q

treatment - Maintain adequate oxygenation and ventilation - what types? (basically all of them)

A

ADMINISTER O2
Face mask
Mechanical Ventilation
CPAP (continuous positive airway pressure)
BiPAP (Bi-level positive airway pressure)

40
Q

Mechanical Ventilaton

A

FIO2
Rate
Tidal Volume
PEEP (Positive End Expiratory Pressure)
ETCO2 end tidal carbon dioxide
(indicates adequate ventilation)

41
Q

CPAP Continuous Positive Airway Pressure - is it expiration or inspiration? (it’s in the name)

A

Delivers positive pressure during inspiration and expiration

42
Q

BiPAP - high or low during expiration?

(bi pap, he’s expiring)

A

Bilevel Positive Airway Pressure
Positive Pressure drops during expiration

43
Q

CAVEAT (caution) OF O2 ADMINISTRATION - and what should the % of O2 administration be? (not 90%)

A

Oxygen administration >60% can cause O2 toxicity with fibrotic changes in the lungs.

Caution in COPD patients
Chronic hypercapnia causes CO2 narcosis.
Respirations stimulated by low O2 levels.
If O2 is suddenly increased pt may go into respiratory arrest.

44
Q

peep - inspiration or expiration? (it’s in the name)

A

positive end-expiratory pressure (pressure in lungs at end of expiration)

45
Q

FIO2

A

fraction of inspired oxygen concentration

46
Q

V/Q

A

ventilation/perfusion ratio (relationship of ventilation to perfusion in the lungs) - it should be 1:1

47
Q

2 types of respiratory failure

A

hypoxemic and hypercapnic

48
Q

hypoxemic respiratory failure - what is the number?

A

oxygen failure
PaO2 less than or equal to 60 mm Hg at 60% oxygen

49
Q

hypoxemic respiratory failure can last how long?

A

acute (minutes to hours) or chronic (several days or longer)

50
Q

hypercapnic respiratory failure - the numbers, think CO2

A

ventilatory failure. PaCO2 greater than 45 mm Hg and ph less than 7.35

51
Q

hypercapnic respiratory failure can last how long?

A

acute (minutes to hours) or chronic (several days or longer)

52
Q

Pulmonary Emboli

A

Good alveoli (air) - poor perfusion - so ventilation perfusion problem

53
Q

we can give O2 in an emergency, but

A

we need to get an order afterwards. O2 is a drug.

54
Q

normal ABGs

A

ph 7.35 – 7.45
PaO2 75 – 100
PaCO2 35 – 45
HCO3 22 - 26

55
Q

common cause of VQ mismatch - fluid? - 3 things

(Steven in the hall)

A

secretions in airways
Pulmonary edema
Fluid in alveoli

56
Q

common cause of VQ mismatch - (just emboli)

A

Pulmonary emboli
↓ perfusion in lung

57
Q

common cause of VQ mismatch - just 1

(alden is a mismatch)

A

ARDS (Capillaries leaking fluids into alveoli)

58
Q

diffusion limitation - caused by

(diffuse the fibrosis in alden)

A

Pulmonary fibrosis
ARDS (late stage)

59
Q

alveolar Hypoventilation caused by 4 diseases - this is broad

(3 diseases and 1 other)

A

Lung disease
Neuromuscular disease
CNS disease
Chest wall dysfunction

60
Q

ARF - type I

(first, you need oxygen)

A

TYPE I (Hypoxemic respiratory Failure)
Decrease in oxygen

61
Q

ARF - type 2

A

Type II (Hypercapnic respiratory failure)
Increase in carbon dioxide
CO2=ACID

62
Q

type I - Hypoxemic Failure defined as:

A

PaO2 ≤60 when the pt is receiving FIO2 of ≥60%

63
Q

hypercapnic ARF - other reasons
(drugs)

A

other reasons - Narcotics, OD, Anesthesia
Decreased respiratory rate

64
Q

type II - hypercapnic - PaCo2? and pH?

A

CO2 = Carbon Dioxide = ACID

Defined as PaCo2 ≥45 with pH ≤7.35
This type almost always also has hypoxemia too.

65
Q

hypercapnic ARF - neuromuscular causes (think spine and aspirin)

A

Cervical Cord Injury
Guillain-Barre Syndrome

66
Q

how to titrate paO2 - this is the mask

(Alf’s oxygen is 55)

A

Titrate PaO2 at 55 to 60 or O2 sat > 90%.

67
Q

anatomical shunt - ex.

(anatomical babies)

A

It could be a Patent Ductus Arteriosus (babies) or Ventral Septal Defect (sometimes not identified until teens)

68
Q

hypercapnic ARF - neuromuscular causes

(hyper with MS, MD, and polio)

A

Poliomyelitis (polio)
Muscular Dystrophy
Multiple Sclerosis

69
Q

Sa02

A

02 sat in arterial blood measured with ABG

70
Q

how to diagnose ARF?

A

ABG really helpful

71
Q

pursed lip breathing

A

one inhale for every 3 exhales

72
Q

pulmonary emboli - are the capillaries ok?

A

yes, but poor perfusion=ventilation perfusion issue

XIO (400 decks)

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