respiratory failure

Question 1

what are the types of respiratory failure ?

Answer 1

type 1 - hypoxemic RF
type 2 - hypercapnic RF

Question 2

what are the normal values of ABGs ?

Answer 2

PaO2 : 75-100
PaCO2 : 35-45
Hco3 : 22-26
pH :7.35 - 7.45

Question 3

what are the ABG findings in type 1 vs type 2 RF ?

Answer 3

1- Pao2 is decreased in type 1 whilst PaCo2 is normal
2- Pao2 is decreased in type 2 whilst PaCo2 is increased

Question 4

what are the main mechanisms that causes type 1 respiratory failure ?

Answer 4

intrapulmonary shunt
diffusion limitation
v/q mismatch
decreased Fio2

Question 5

what are examples of diseases that cause intrapulmonary shunts ?

Answer 5

pneumonia - alveoli filled with pus
atelectasis - collapsed alveoli
ARDS - alveoli filled with exudate

Question 6

what is the difference between type 1 and type 2 acute respiratory failure ?

Answer 6

1- o2 - both low

2- Co2 - normal or low in type 1, high CO2 in type 2

3- pH - normal or alkalotic in type 1 , normal or acidotic in type 2

4- bicarb - normal in both

Question 7

what is the difference between type 1 and type 2 in chronic resp failure ?

Answer 7

1- O2- both low

2- CO2 - normal or low in type 1 , high in type2

3- pH- normal or alkalotic in type 1, normal or acidotic in type 2

4- bicarb - normal in type 1, high in type 2

Question 8

what is the normal V/Q ratio ?

Answer 8

0.8

Question 9

if the V/Q ratio is above the norrmal what is that an indicator of ?

Answer 9

decreased perfusion

Question 10

if the V/Q ratio is below the normal what is that an indicator of ?

Answer 10

decreased ventilation

Question 11

what is a physiological dead space ?

Answer 11

at the apex of the lung there is alot of ventilation with barely any perfusion ( wasted ventilation )

Question 12

what is the V/Q in pulmonary embolism ?

Answer 12

very very high due to the creation of a dead space

Question 13

what investigation are required in cases of respiratory failure ?

Answer 13

ABG
Chest X-ray
US
Ventilation-perfusion scan

Question 14

what are the causes of decreased perfusion in the lungs ?

Answer 14

emphysema
pulmonary embolism

Question 15

what are the indications for oxygen therapy ?

Answer 15

MAHA <3
1- peri and post cardiac or respiratory arrest
2- acute and chronic hypoxemia
3- low cardiac output and metabolic acidosis

Question 16

what are the types of oxygen delivery devices ?

Answer 16

low flow devices - below normal insp flow rate
high flow devices - above normal insp flow rate

Question 17

what are the types of low flow devices ?

Answer 17

nasal cannula 1-6 L
simple face mask 6-8 L
reservoir mask 8 - 12 L

Question 18

what are the types of high flow devices ?

Answer 18

venture masks
high flow nasal cannula

Question 19

what are the non invasive methods of ventilation ?

Answer 19

CPAP - in OSA only
BIPAP - better to start with it in type 2 RF if there is no indication for IMV especially in COPD

Question 20

what are the causes of type 1 RF ?

Answer 20

shunt
decreased atmospheric pressure
ventilation perfusion mismatch
pneumonia
ARDS
pulmonary embolism

Question 21

what is intrapulmonary shunting ?

Answer 21

lung areas with high ventilation low perfusion

Question 22

ay V/Q mismatch y3mel what type of RF ?

Answer 22

type 1

Question 23

any decrease in alveolar ventilation ye3mel what type of RF ?

Answer 23

type 2

Question 24

what is thee target Spo2 in hypercapnic patients ?

Answer 24

88-92 to prevent killing the hypoxic drive

Question 25

what are the indications for invasive MV ?

Answer 25

unable to tolerate the non invasive MV
disturbed conscious level
massive aspiration
inability to remove secretions
refractory haemodynamic instability
respiratory or cardiac arrest
hypoxemia
ventricular arrhythmia