Respiratory Depression (Acidosis)

Question 1

Patient post op received morphine 4 times Now presenting with RR 5\min .

Q1: How co2 is transported in blood ?

Answer 1

In form of bicarbone in 70% - Carbamino Hb in 20% - dissolved CO2 10%

Question 2

Q4: what is Chloride shift?

Answer 2

Bicarbonate shifts out of the plasma and chloride shift into RBCs to make cellular balance

Question 2

Q2: Bicarbonate equation?

Answer 2

H2O+CO2=H+ +HCO3 (SEE BOOK)

Question 3

Q3: Where does this happen?

Answer 3

Inside RBCs

Question 4

Q6: What is the cause of your diagnosis ?

Answer 4

Morphine Toxicity

Question 5

Q5. Interpret the following ABG; (pH=7.27 / PaO2= 7.5 kPa / PaCO2=8.8 / HCO3=26mm)

Answer 5

Uncompansted Res. Acidosis

Question 6

Q7. Why still no metabolic compensation ?

Answer 6

Because kidney takes time for compensation 3-5 dys

Question 7

Q8: What is the name of receptors responsible for respiratory ?

Answer 7

Central and Peripheral Chemoreceptors

Question 8

Q9: Where is the central respiratory centers?

Answer 8

Medulla / Pons (detect pH level in blood and send signals to brain to adjust ventilation rate by ↓ or ↑CO2 levels )

Question 9

Q Which ion crosses BBB – >

Answer 9

H+

Question 10

Q. Where is peripheral chemoreceptors?

Answer 10

Aortic and Carotid bodies ( stimulated by O2 levels in blood)

Question 11

Q10: What type of respiratory failure is that ?

Answer 11

Type II

Question 12

Q11: How will you manage this patient & where ? Why ?

Answer 12

CCRiSP protocol
In ITU – > pt need to take naloxone (Dose= 0.4-2mg/ 2-3min “max=10mg”) as antidote and it has short acting half-life (pt may have cardiac arrest) so pt needs monitoring in ITU besides may need ventilatory support
S/E of Naloxone; N, V Pulmonary edema and cardiac arrest

Question 13

Alternative to Morphine – >

Answer 13

fentanyl