ARF Flashcards
Respiratory Failure:
A clinical condition in which the _____ system fails to maintain _______.
pulmonary system
adequate gas exchange
Respiratory Failure:
Failure to meet _____, ______, or _____ demand of the patient.
Oxygenation,
Ventilation,
Metabolic
Deficiency in the performance of the pulmonary system usually occurs ____ to another disorder that has ____ the normal function of the pulmonary system.
secondary,
altered
What are the causes of respiratory failure?
- ____
- _____
- _____
- Depressed ventilatory drive
- Failing ventilatory pump
- Gas Exchange organ
Any combination
Respiratory failure can be __
a. Acute
b. Chronic
c. acute-on-chronic
d. All of the above
d. all of the above
Whane PaO2 is lower than 8.0 kPa and PaCO2 is normal this is…
Type 1 Respiratory failure (oxygenation failiure)
When PaO2 is lower than 8.0 kPa and PaCO2 is higher than 6.5 kPa this is….
Type 2 Respiratory failure (ventilation failure)
Type 1 Respiratory failure is classified as…
PaO2 is ____ than 8.0 kPa
PaCO2 is ______ than 6.5kPa
lower
normal
Type 2 Respiratory failure is classified as…
PaO2 is ____ than 8.0 kPa
PaCO2 is ______ than 6.5kPa
lower
higher
Normal value of PaO2?
12-15 kPa
Normal value of PaCO2?
4.5-5.5 kPa
Normal value of pH
7.35 - 7.45
higher =alkalotic
lower = acidotic
Type 1 respiratory failure is caused by diseases that damage ______
the lung tissues
Type 1 respiratory failure is caused by impaired gas diffusion across _______ membrane
alveolar capillary
Pulmonary diseases that can lead to type 1 respiratory failure are…?
Asthma
Pneumonia
Effusion
COPD
Vascular diseases that can lead to type 1 respiratory failure are…?
Pulmonary embolism
Cardiogenic pulmonary
Oedema
CCF (congestive cardiac failure)
What is V/Q ratio?
Ventilation/perfusion
What is considered a normal V/Q ratio?
0.8
Pathphysiologcal processes involved in Acute Resp Failure are:
A_____ H____
V_____ and P_____ mismatch
D______ impairment
Alveolar Hypoventilation
Ventilation and Perfusion mismatch
Diffusion impairment
PROGRESSION OF HYPOXAEMIA 1. 2. 3. 4.
- low O2 at cellular level
- tissue hypoxia (impaired perfusion)
- Lactic acidosis
- multiple organ dysfunction
MECHANISMS UNDERLYING AIRFLOW LIMITATIONS IN COPD
Small Airways disease:
1.
2.
3.
Parenchymal Destruction
1.
2.
Small Airways disease:
- Airway inflammation
- Mucus retention
- Increased Airway Resistance
Parenchymal Destruction
- Loss of alveolar attachment
- Decrease in elastic recoil
Risk factors for COPD Mitigatable: C\_\_\_\_\_ O\_\_\_\_\_ E\_\_\_\_\_ I\_\_\_\_\_\_
Cigarette smoke
Occupational dust and chemicals
Enviromental smoke/tobacco
Indoor and outdoor air pollution
Risk factors for COPD Un-Mitigatable: G\_\_\_\_\_ I\_\_\_\_\_ S\_\_\_\_ E\_\_\_\_ A\_\_\_\_\_\_
Genes
Infections
Socio-economic status
Aging population
Diagnosis of COPD Symptoms: S\_\_\_\_\_\_ C\_\_\_\_\_\_ C\_\_\_\_\_ S\_\_\_\_
PLUS Risk Factors: T\_\_\_\_\_ O\_\_\_\_\_ I\_\_\_\_\_
Tested by S______
Diagnosis of COPD Symptoms: Short of breath Chronic Cough Sputum production
PLUS Risk Factors: Tabacco Occupation Indoor/outdoor pollution
Tested by Spirometry
Exasperation of COPD:
Increased d______.
Increased cough; increased sputum purulence and increased sputum v______.
U_____ a____ symptoms (eg, colds and sore throats).
Increased wheeze and chest tightness.
Malaise.
Reduced exercise tolerance.
Increased f______.
Marked respiratory distress with dyspnoea and tachypnoea, acute c_______, increased c_____, peripheral o______.
Respiratory failure - may develop and may require non-invasive ventilation (NIV)
Exasperation of COPD:
Increased dyspnoea.
Increased cough; increased sputum purulence and increased sputum volume.
Upper airway symptoms (eg, colds and sore throats).
Increased wheeze and chest tightness.
Malaise.
Reduced exercise tolerance.
Increased fatigue.
Marked respiratory distress with dyspnoea and tachypnoea, acute confusion, increased cyanosis, peripheral oedema.
Respiratory failure - may develop and may require non-invasive ventilation (NIV)
NICE Guideline treatment of COPD A\_\_\_\_\_\_\_ O\_\_\_\_\_\_\_ P\_\_\_\_\_\_\_ N\_\_\_\_\_\_\_ B\_\_\_\_\_\_ IV T\_\_\_\_\_\_\_\_\_\_\_ NIV (Non-I\_\_\_\_\_ V\_\_\_\_\_\_)
NICE Guideline treatment of COPD Antibiotics Oxygen therapy Physiotherapy Nebulised Bronchodilators IV theophyline NIV (Non-Invasive Ventilation)
DIFFERENTIAL COPD vs. Asthma Age: Symptom progression: History:
COPD:
Onset in later life
Symptoms slowly progressive
Long smoking history
ASTHMA Onset early in life Symptoms vary day to day Symptoms worse at night/morning Allergy, rhinitis, and/or eczema Family history of Asthma
Asthma definition:
Chronic ______ disorder of the _______.
Airflow ________ and increased resistance
___________, airway oedema and mucus production Air trapping, prolong exhalation, V/Q mismatch, shunt
Asthma definition:
Chronic inflammatory disorder of the airway.
Airflow obstruction and increased resistance
Bronchoconstriction, airway oedema and mucus production Air trapping, prolong exhalation, V/Q mismatch, shunt
Signs and Symptoms:
W\_\_\_\_\_ C\_\_\_\_\_ t\_\_\_\_\_ Unable to talk in full sentences H\_\_\_\_\_ – \_\_\_\_\_\_ SpO2 C\_\_\_\_\_ Hyperventilating Dyspnoea – SoB Peak airway flow is < \_\_%
Signs and Symptoms:
Wheezy Chest tightness Unable to talk in full sentences Hypoxic – decreased SpO2 Cough Hyperventilating Dyspnoea – SoB Peak airway flow is < 75%
Moderate Asthma:
Increasing ____
PEF ________
No features of ______
Moderate Asthma:
Increasing symptoms
PEF >50-75% best or predicted
No features of acute severe asthma
Severe Asthma: One of - PEF \_\_\_\_ best or predicted RR greater than\_\_\_\_\_ and HR greater than \_\_\_\_ Inability to complete \_\_\_\_\_\_\_
Severe Asthma:
One of -
PEF 33-50% best or predicted
RR greater than 25/min and HR greater than 110/min
Inability to complete sentences in one breath
Life-threatening Asthma Severe asthma plus one of - PEF less than \_\_\_\_ SPO2 less than \_\_\_\_\_ PaO2 less than \_\_\_\_\_kPa S\_\_\_\_\_ c\_\_\_\_\_ C\_\_\_\_\_\_ poor \_\_\_\_\_\_\_ effort A\_\_\_\_\_\_\_ Exhaustion/ altered conscious level
Life-threatening Asthma Severe asthma plus one of - PEF less than 33% SPO2 less than 92% PaO2 less than 8kPa Silent chest Cyanosis poor respiratory effort Arrhythmia Exhaustion/ altered conscious level
Near-fatal Asthma
Raised _______ and/or requiring _____ _____ with raised inflation pressures
Near-fatal Asthma
Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures
‘Pneumonia is an I_____ of the lung tissue. When a person has pneumonia the a____ s____ in their lungs become filled with m_______, f_____ and i______ cells
‘Pneumonia is an infection of the lung tissue. When a person has pneumonia the air sacs in their lungs become filled with microorganisms, fluid and inflammatory cells
Signs and symptoms of Pneumonia:
T\_\_\_\_\_ C\_\_\_\_\_ S\_\_\_\_\_ W\_\_\_\_\_ normal range 4.0-11.0 Spo2 < maybe – History/risk factors ?Sepsis
Signs and symptoms of Pneumonia:
Temperature Cough Sputum WCC normal range 4.0-11.0 Spo2
ABCDE Assessment
Acute Respiratory Failure
Airway
Airway:
Look for signs of airway obstruction,
Treat as medical emergency if obstructed
Give high flow oxygen (15l non-rebreather)
Tgt O2 = 94-98% , 88 -92% at risk of hypercapnea (COPD)
(Resus, 2019)
ABCDE Assessment
Acute Respiratory Failure
Breathing
During the immediate assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions (e.g. acute severe asthma, pulmonary oedema, tension pneumo thorax, and massive haemothorax).
Breathing:
Look listen feel for signs of respiratory distress.
Count respiratory rate (12-20 is normal)
Assess depth, rhythm and symmetry
Look for chest deformity - raised Jugular venous pulse (JVP)
Record inspired oxygen concentration and monitor SpO2
Listen to the patient’s breath sounds a short distance from face
Percuss chest (hyper resonance or dullness)
Auscultate the chest
Check tracheal position
Feel the chest wall to detect surgical emphysema or crepitus
Respiratory distress is:
s______, central cy_____, use of the a_____ muscles of respiration, and a_______ breathing.
Respiratory distress is:
sweating, central cyanosis, use of the accessory muscles of respiration, and abdominal breathing.
Breath sounds
Rattling airway noises indicate the presence of airway s_____, usually caused by the inability of the patient to cough sufficiently or to take a deep breath.
S_____ or w____ suggests partial, but significant, airway obstruction.
Breathing sounds
Rattling airway noises indicate the presence of airway secretions, usually caused by the inability of the patient to cough sufficiently or to take a deep breath. Stridor or wheeze suggests partial, but significant, airway obstruction.
Breathing:
Breathing Assessment:
L_____ L____ F____ for signs of respiratory distress.
Count respiratory rate (__-__ is normal)
Assess d____, r___ and s_____
Look for chest d_____ - raised J____ _____ ____ (JVP)
Record inspired oxygen concentration and monitor SpO2
Listen to the patient’s breath sounds a short distance from face
Percuss chest (hyper r_______ or dullness)
Auscultate the chest
Check t_____ position
Feel the chest wall to detect surgical e_____ or crepitus
Breathing:
Breathing Assessment:
Look listen feel for signs of respiratory distress.
Count respiratory rate (12-20 is normal)
Assess depth, rhythm and symmetry
Look for chest deformity - raised Jugular venous pulse (JVP)
Record inspired oxygen concentration and monitor SpO2
Listen to the patient’s breath sounds a short distance from face
Percuss chest (hyper resonance or dullness)
Auscultate the chest
Check tracheal position
Feel the chest wall to detect surgical emphysema or crepitus
Consider NIV (non-invasive ventilation)
The specific treatment of respiratory disorders depends upon the cause. Nevertheless, all critically ill patients should be given o______. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. they are at risk of h______ respiratory failure - often referred to as type 2 respiratory failure). Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their _______ _____ tensions are allowed to decrease. In this group, aim for a lower than normal PaO2 and oxygen saturation. Give oxygen via a V_____ 28% mask (_ L min-1) or a 24% Venturi mask (4 L min-1) initially and reassess. Aim for target SpO2 range of 88–92% in most COPD patients, but evaluate the target for each patient based on the patient’s a____ b____ g___ measurements during previous exacerbations (if available). Some patients with chronic lung disease carry an oxygen alert card (that documents their target saturation) and their own appropriate Venturi mask.
The specific treatment of respiratory disorders depends upon the cause. Nevertheless, all critically ill patients should be given oxygen. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their blood oxygen tensions are allowed to decrease. In this group, aim for a lower than normal PaO2 and oxygen saturation. Give oxygen via a Venturi 28% mask (4 L min-1) or a 24% Venturi mask (4 L min-1) initially and reassess. Aim for target SpO2 range of 88–92% in most COPD patients, but evaluate the target for each patient based on the patient’s arterial blood gas measurements during previous exacerbations (if available). Some patients with chronic lung disease carry an oxygen alert card (that documents their target saturation) and their own appropriate Venturi mask.
