Pneumothorax, Respiratory Failure Flashcards
What is respiratory failure?
Inability to meet adequate blood oxygen levels
What is the O2 and CO2 in type 1 and type 2 respiratory failure
Type 1 low O2, normal/low CO2
Type 2 low O2, high CO2
What investigation differentiates type 1 and 2 respiratory failure?
ABG
What type of respiratory failure is due to a VQ miss match?
Type 1
Name 4 causes of Type II respiratory failure
COPD, drug overdose, sleep apnoea, neuromuscular disease e.g. myasthenia
What type of respiratory failure would are PE cause?
Type 1
What type of respiratory failure with pulmonary fibrosis cause ?
Type 1
What type of respiratory failure would pulmonary edema cause?
Type 1
Obesity hypoventilation syndrome is also known as what?
Pickwickian syndrome
Early morning headache, daytime somnolence, nocturnal hypoventilation, hypercapnia, episodes of snoring followed by upper airway obstruction and apnoea are all features of what disorder
Obesity hypoventilation syndrome
What rate of oxygen delivery should be used in Type II respiratory failure?
24% oxygen
“Non-cardiogenic pulmonary oedema leading to acute respiratory failure” is the description of what?
Acute respiratory distress syndrome AKA acute lung injury
Dobutamine and nitric oxide are used in the management of ARDS, what type of drug is dobutamine, what type of drug is nitric oxide?
Dobutamine is an inotrope and nitric oxide is a vasodilator
In ARDS, PaO2 <60 or PaCO2 >45 are both indications for what?
Indications for mechanical ventilation
What type of ventilation is first line in the management of acute respiratory distress syndrome?
Non-invasive ventilation
What is a pneumothorax?
Air in the pleural cavity
What is a respiratory complication of mechanical ventilation?
Iatrogenic pneumothorax
Central line placements and lung biopsies can also cause iatrogenic pneumothorax
What is the chest x-ray appearance of a pneumothorax?
Absent lung markings over an area
Are cannabis, Marfan’s syndrome and tall thin body types associated with primary or secondary pneumothorax
Primary
Symptoms are minimal/ absent compared to secondary
What is the presentation of a pneumothorax?
Sudden onset pain +- SOB
Appear distressed, sweating, >HR
Reduced breath sounds + hyperresonant percussion over area
Secondary pneumothorax due to underlying lung disease, true or false
True
What are the three options for the management of a pneumothorax?
Observation, needle aspiration, chest drain
Where is a chest drain inserted?
4th/5th intercostal space midaxillary
Does the trachea deviate away from or towards a tension pneumothorax?
Away from
What is pulsus paradoxicus?
Pulse slows on inspiration
Where is the needle inserted in emergency needle decompression for a tension pneumothorax?
2nd or 3rd intercostal space midclavicular line
In the Mx of pneumothorax, the 1st line Mx depends on what factors?
Size >2cm and or breathless
If a primary pneumothorax is >2cm and /or breathless what is the mx? what if <2cm or not breathless
Aspirate 16-18G cannula
If successful consider discharge and OPD review in 2-4wk
If still breathless do chest drain + admit
If not breathless/<2cm consider discharge and OPD review in 2-4wk
If a secondary pneumothorax is >2cm and /or breathless what is the mx? what if sized 1-2cm?
Admit all
>2cm/SOB = chest drain size 8-14Fr
1-2cm = aspirate 16-18G cannula. if size remains 1-2cm chest drain
<1cm = high flow O2 + observe
Can a tension pneumothorax cause a raised JVP?
Yes
