ARF, ARDS Flashcards
What are some causes of hypoxemic respiratory failure?
–Acute Respiratory Distress Syndrome (ARDS)
–Pneumonia
–Toxic inhalation (smoke)
–Hepatopulmonary Syndrome
–Pulmonary Embolism
–Inflammatory state and related alveolar injury
–Anatomic shunt (VSD)
–Cardiogenic pulmonary edema
–Shock (decrease blood flow through pulmonary vasculature)
–High cardiac output states: diffusion limitation
What are some causes of hypoxemic respiratory failure?
–Asthma –COPD –Cystic Fibrosis - Brainstem injury or infarction –Sedative and opioid overdose –Spinal cord injury –Severe head injury –Thoracic trauma (flail chest) –Kyphoscoliosis –Pain –Severe obesity –Myasthenia Gravis –Critical illness polyneuropathy –Acute myopathy –Guillain-Barre Syndrome –Multiple sclerosis –Muscular dystrophy
What are four mechanisms of hypoxemic respiratory failure?
- Ventilation-Perfusion Mismatch
- Shunt (VSD, ASD, Intrapulmonary)
- Diffusion limitation (Thickening, damage to alveolar-capillary membrane)
- Alveolar hypoventilation (Decrease in ventilation resulting to increase in PaCO2 and decrease in PaO2, CNS, chest wall dysfunction, Acute Asthma, Neuromuscular Diseases)
What are four mechanisms of hypercapnic respiratory failure?
–Airway and Alveoli Abnormalities (COPD, Cystic Fibrosis, Asthma)
–CNS Abnormalities (Opioid, BZD Overdose brain not responsive to rising CO2 level in the blood, CVA, Head injuries)
–Chest Wall Abnormalities (Flail chest, kyphoscoliosis
–Neuromuscular Conditions (Guillain-Barre Syndrome, Muscular Dystrophies, Myasthenia Gravis)
Hypoxemic specifics:
- Dyspnea
- Tachypnea
- Prolonged expiration (I:E= 1:3, 1:4)
- Nasal flaring
- Intercostal muscle retraction
- Use of accessory muscle in respiratory
- Decrease Sp02 (<80%)
- Paradoxic chest or abdominal wall movement with respiratory cycle late
- Cyanosis (late)
Hypoxemic nonspecifics:
- Agitation
- Disorientation
- Restlessness, combative behavior
- Delirium
- Confusion
- Decrease LOC
- Tachycardia, Hypertension, Cool skin, diaphoretic
- Dysrhythmia, Hypotension (late)
Hypercapnic specifics
•Dyspnea•Use of tripod positioning•Pursed-lip breathing•Decrease RR or rapid rate with shallow respiration•Decrease TV•Decrease minute ventilation
Hypercapnic nonspecifics
- Morning headache, disorientation, confusion, agitation, progressive somnolence•Elevated ICP, Coma (late)
- Tachycardia, Hypertension, Dysrhythmia, Bounding pulse
- Muscle weakness•Decrease DTR•Tremors, seizures (late)
Assessment upon respiratory failure
▪Pursed-lip breathing ▪“Two-word” “three-word” dyspnea ▪Supraclavicular retractions ▪Suprasternal retractions ▪Intercostal retractions ▪Tripod-positioning ▪Crackles ▪Wheezing ▪Absence of breath sounds
VQ scan and CT Angiogram of Chest Scan will measure the diagnosis of??
Pulmonary embolism
What are some types of noninvasive positive pressure ventilations
BIPAP- two levels
CPAP- continuous
What are some types of invasive positive pressure ventilations
Endotracheal Tube (ETT) and mechanical ventilator
When is it NOT appropriate for patients to use a BIPAP o
patients with excessive secretions, decreased level of consciousness, high O2 requirements, facial trauma, hemodynamic instability
Proper positioning for patients with ventilation
head of bed elevated to assist lung ventilation;
**tripod positioning for optimal comfort and efficiency during breathing
Management for patients who are on ventilation
▪Hydration and Humidification
▪Chest Physiotherapy
▪Airway suctioning
▪Ambulation
