Resp Failure

Question 1

Define respiratory failure

Answer 1

Inadequate oxygenation to meet metabolic demands

Inadequate clearance of CO2

Question 2

Signs to anticipate respiratory failure

Answer 2

Increased RR
Signs of distress/WOB - nasal flaring, retractions, seesaw breathing, grunting
Inadequate RR, effort or chest excursion (diminished breath sounds, gasping)
Decreased LOC
Cyanosis with abnormal breathing despite Supp O2

Question 3

2 types of respiratory failure

Answer 3

Hypoxemic - from V/Q mismatch

Inadequate alveolar ventilation - UA obstruction, neuromuscular disease, thoracic trauma, muscle fatigue

Question 4

Why kids are at greater risk of resp failure

Answer 4

Require more O2 per kg
Infants - obligate nasal breathers - issue with nasal obstruction
Smaller caliber airways - higher resistance especially with inflammation - Poiseulle’s law - resistance is inversely proportional to the radius^4 - small decrease in radius = huge increase in resistance
More compliant chest wall
Weaker diaphragm
Delayed presentations due to inability to verbalize Sx at young ages

Question 5

What are the diagnostic criteria for ARDS?

Answer 5

Acute Respiratory Distress Syndrome

Acute onset
Severe hypoxemia (PO2 < 200 mm Hg regardless of fraction of inspired O2 and end-expiratory pressure)
Diffuse bilateral infiltrates on CXR
Normal Left atrial pressure

Question 6

Indications for intubation

Answer 6

Progressive respiratory exhaustion - unlikely to reverse quickly
Hypoxemia despite greater than 60% oxygen administration
Apnea, hypoventilation that requires mechanical ventilation
Need for airway protection (upper airway obstruction, loss of protective airway reflexes)
Shock
Airway access for pulmonary toileting

Question 7

List the steps to perform endotracheal intubation

Answer 7

Preoxygenate with 100% oxygen by bag-valve-mask device
Prepare equipment (suction, ETT, laryngoscope, monitors, ETCO2, CO2 detector)
Confirm functioning IV line
Administer medication (atropine < 12 mo, sedative and paralytic - ie ketamine, succinycholine)
Intubate the trachea - observing the tube pass through the vocal cords
Verify proper placement - auscultate the chest, check for CO2 by capnography, CXR)
Secure ETT
Evacuate the stomach with NG/OG

Question 8

Risk factors for difficult intubations

Answer 8

Congenital

• Micrognathia
• Macroglossia
• Cleft or high arched palate
• Protruding upper incisors
• Small mouth
• Limited mobility of TMJ

Acquired

• Hoarseness/stridor/drooling
• Facial burns/singed facial hair
• Facial fractures/oral trauma
• FB

Question 9

Mnemonic for deterioration after intubation

Answer 9

DOPE

Displacement (of the ETT)
Obstruction (secretions, tissue, FB)
Pneumothorax
Equipment