Respiratory emergencies Flashcards
The decision to intubate is determined upon what 3 things?
- ) Failure to Protect the airway?
- ) Failure to Oxygenation?
- ) Failure to Ventilation?
*if yes to any of these, intubate!
In a critical care situation, what are 3 questions you should be thinking when assessing dyspnea?
- Does this patient need to be intubated immediately?
- is this rapidly reversible?
- Can he/she run?
Failure to oxygenate/ventilate = ?
respiratory failure
What are the two types of respiratory failure and their subtypes?
Type1: Hypoxemic -p02 less than 60 Subtypes: -Low Pi02 -hypoventilation -Diffusion -Shunt -V/Q mismatch
How do you tell the difference between shunt and V/Q mismatch?
if you give the patient O2 and nothing happens you know its a shunting problem. If you give O2 and the underlying problem is a V/Q mismatch you will see their O2 increase.
**most cases are a V/Q mismatch.
Type 2: Hypercapneic
- PCO2 greater than 50 (if not a chronic retainer)
- increased CO2 production (sepsis, fever, burns)
- alveolar hypoventilation
- -Reduced minute ventilation
- -increased dead space.
Signs of hypoxemia
- cyanosis
- restlessness
- confusion
- anxiety
- delerium
- tachypnea
- brady or tachypnea
- HTN
- cardiac dysrhythmias
- tremor
Signs of hypercapnia
- dyspnea
- HA
- HTN
- peripheral and conjuntival hyperemia
- tachycardia
- tachypnea
- impaired conciousness
- papilledema
- lethargy
- AMS
Evaluation of emergent dyspnea
O2 sats ABGs Chemistry CXR EKG
Which two diseases have good outcomes with the use of BIPAP?
COPD, CHF
“Can the patient run for his/her life?” Why do we assess this?
- were assessing their reserve *how much work are they doing?
- how long have they been doing it?
- what effect is it having?
- *How long can they continue doing it?
Acute Asthma
- sx of impending respiratory failure
- whats happening to their tidal volume?
- Residual volume?
- co2?
- inability to maintain respiratory effort and rate
- cyanosis
- depressed mental status
- severe hypoxemia
Tidal volume: decreases
Residual volume: decreases
CO2: increases
Acute Asthma: assessment
- measure peak flow
- supplemental O2
- ABGs are generally not useful initially
- Establish IV
- CXR generally not useful initially
- Frequent reassessment to determine if intubation and mechanical ventilation is needed**
What does peak flow measurement tell us?
What is peak flow less than 40% of predicted categorized as?
- the severity of airway obstruction
- less than 40% predicted is SEVERE
Danger signs that signify impending ventilatory failure?
- deteriorating mental status
- silent chest
- pulsus paradoxus
- CO2 retention/elevated PCO2
- Acidosis
- Cyanosis
- Hypoxemia
What is pulsus paradoxus? what diseases might you find this?
-increased lung volumes lead to very high negative pressures in the chest causing more venous return to get “sucked in.” This increased venous return can be dramatic enough to distend the right ventricle to the point of compressing the left ventricle, thus affecting left ventricular outflow. Once can feel decreased peripheral pulses during inspiration.
May occur with asthma, cardiac tampanode, pericarditis.
Acute Ashtma Medical Therapy
- albeuterol
- ipatropium bromide
- methylprednisolone
- magnesium sulfate (relaxes smooth muscle)
- Epinephrine (for suspected anaphylactic rxn or unable to use inhaled bronchodilator)
- Terbutaline (only when severe and unresponsive to standard therapy)
COPD Exacerbation Tx
- Ipratropium (bronchodilator)
- Albeuterol (bronchodilator)
- Corticosteroids
- Abx
- Oxygenation Fi02 to achieve pO2 greater than 55-60 or SaO2 90-93%.
- watch for CO2 retention!
High Altitude Illness
-what are the types?
- acute mountain sickness (AMS)
- high altitude pulmonary edema (HAPE)
- High altitude cerebral edema (HACE)
what is hypobaric hypoxia?
Hypobaric hypoxia is a condition where the body is deprived of a sufficient supply of oxygen from the air to supply for body tissues whether in quantity or molecular concentration. Hypoxic hypoxia affects the body’s ability to transfer oxygen from the lungs to the bloodstream.
What happens physiologically to the body when it is exposed to hypobaric hypoxic conditions?
fluid retention
vasoconstriction
pulmonary artery HTN
increased endothelial permeability
edema
Acute Mountain sickness presentation:
- onset
- sx
- tx
onset: several hours at new altitude, maximum severity 24-48hrs
Sx:
- HA plus 1 or more of the following:
- -GI ubset
- -generalized weakness/fatigue
- -dizziness or lightheaded
- -difficulty sleeping
Tx:
- oxygen
- gradual descent and acetazolamide (carbonic anhydrase inhibitor),
- others for sx relief:
- -non-narcotic analgesic
- -antiemetics
High Altitude Pulmonary Edema (HAPE)
- onset
- sx
- tx
onset: 2-4 days after arrival of 8000feet, exacerbated by heavy physical activity
sx:
- dyspnea at rest**
- cough
- fatigue
- HA
- anorexia
- cyanosis
- rales
- tachypnea
- tachycardia
Tx:
- Hyperbaric therapy
- descent of at least 2000ft
- oxygen and CPAP
- rest/warmth
- Acetazolamide, dexamethasone, sildenafil, nifedipine, salmeterol (LABA)
Smoke Inhalation;
-3 main consequences
- impaired oxygenation
- thermal injury to upper airway
- injury to the lower airway and lung parenchyma
What are three things that may be inhaled cause impaired oxygenation?
- Hypoemic gas mixture
- carbon monoxide
- cyanide
