Respiratory Emergencies Flashcards
Most common causes of ARDS?
- direct lung injury: pneumonia, inhalation injury, aspiration
- indirect lung injury: sepsis, pancreatitis. trauma, blood transfusion
- shock
Tx of ARDS?
- 1: lung protective strategy: mechanical ventilation
- 2: fluid conservative strategy
- treat underlying cause
2 types of positive pressure ventilation?
- non invasive (CPAP and Bipap)
- invasive
Indications for intubation?
- failure to protect airway
- failure of Oxygenation
- failure of ventilation
NIPPV considerations?
- before beginning: eval pt and potential for relieving underlying condition
- acute COPD exacerbations and cardiogenic pulm edema - good indications for NPPV
- best utilized in alert, cooperative pts whose resp condition is expected to improve in 48-72 hours
Disadvantages of NIPPV?
- claustrophobia
- increased workload for RRT
- unprotected airway
- inability to suction deep airway
- gastric distention
- delay in intubation
CIs of NIPPV?
- hemodynamic instability
- facial trauma
- decreased LOC/inability to cooperate
- required sedation
- unable to clear secretions
- aspiration risk
- active upper GI bleed
- ## recent oral, esophageal or gastric surgery
BiPap
IPAP/EPAP
5 things you need to remember with mechanical ventilation?
- mode
- rate: works as back up(most impt setting in obstruction pts)
- Vt = protection (small amt, think baby lungs)
- FiO2
- PEEP = EPAP = CPAP
Indications for mechanical ventilation?
- lung injury: ALI/ARDS, O2 failure
- obstructive: Severe asthmatic/COPD exac
What should you have at hand if there are complications with vent?
a Bag vlave mask
3 questions you need to think about when pt presents with dyspnea?
- does pt need to be intubated immediately?
- is this rapidly reversible?
- can he/she run?
When should you intubate?
- if you answer yes to any one of these:
- failure to protect the airway?
- failure to Oxygenate? (worried about pefusion to brain)
- failure to ventilate?
What does failure to oxygenate mean?
- means that respiratory failure will occur
What are the 2 types of respiratory failure?
- type 1: hypoxemic: PO2 less than 60
- type 2: hypercapnic: pCO2 greater than 50
Causes of Hypoxia?
- low PiO2 (high altitude)
- hypoventilation: LOC
- diffusion: fibrosis, pneumonia
- shunt: CV cause, or alveoli filled with fluid or collapsed (won’t respond to supp O2)
- V/Q mismatch
Causes of type 2 (hypercapnia)
- incrased CO2 production: sepsis, fever, burns
- alveolar hypoventilation: reduced minute ventilation (absolute hypoventilation) or increased dead space (relative hypoventilation): COPD, PE
What are signs of hypoxemia?
- cyanosis
- restlessness
- confusion
- anxiety
- delirium
- tachypnea
- bradycardia or tachycardia
- HTN
- cardiac dysrhythmias
- tremor
Signs of hypercapnia?
- dyspnea
- HA
- HTN
- peripheral and conjuctival hyperemia
- tachycardia
- tachypnea
- impaired consciousness
- papilledema
eval of respiratory failure?
- O2 sats
- ABGs
- Chemistry
- CXR
- EKG
When should you worry about severe respiratory dysfunction?
- when PO2 less than 60 mmHg
- PCO2 greater than 50 mm Hg
What is a vital sign of the pulmonary pt?
- Pulse Ox
What should you watch for in acute asthma exacerbation?
- beware of accessory muscle use, fragmented speech, orthopnea, diaphoresis, agitation, low BP (consider anaphylaxis), severe sxs that fail to improve with initial tx
- impending respiratory failure: inable to maintain resp effort and rate, cyanosis, depressed mental status, severe hypoxemia
- is tidal volume getting smaller?