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respiratory failure Flashcards

1
Q

how is respiratory failure determined

A

pao2<8kpa 60mmhg
low level of o2 in blood hypoxaemia

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2
Q

what is brain stem death

A

where a person no longer has any activity in their brain stem and has permanently lost the potential for consciousness and the capacity to breathe

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3
Q

what is cardiac failure

A

the heart is unable to pump sufficiently to maintain blood flow to meet the bodys needs. heart failure with noraml ejection fraction

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4
Q

end stage renal failure

A

when the kidneys stop working well enough for you to live without dialysis or a transplant permanent and cannot be fixed

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4
Q

hepatic failure

A

inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology/ billirubin/inr/ albumin/encephalopathy

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5
Q

whta is pulmonary failure

A

lungs fail to ventilate

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6
Q

respiratory overview

A

ventilation, gas exchange in the alveoli o2 in and co2 out
heart pumps blood around the pulmonary and systemic circulations
gas exchange in the tissues
tissue respiration o2 consumption and co2 production

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7
Q

two types of respiratory failure how do you classify them

A

type 1 respiratory failure is when there is low o2 but co2 removal is normal
type 2 respiratory failure is when there is both inadequate o2 intake and co2 removal

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8
Q

type 1 respiratory failure

A

normal paco2 <6kpa need to get more o2 to patient

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9
Q

type 2 respiratory failure

A

high paco2> 6kpa impairment to ventilation
hypoxia refers to a deficiency of oxygen reaching tissues or conditions where fio2 is low. fraction of inspiration of oxygen

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10
Q

what are some causes of breathlessness in young people

A

anaemia
pregnancy
cystic fibrosis
pneumonia
anxiety
tachyarrythmia
vigorous exercise
viral uti
asthma
myocarditis
metabolic acidosis
left heart failure
drugs
intersitial lung disease
pah
pleural effusion
pneumonia
pulmonary embolus
pneumothorax
smoking
vasculitis

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11
Q

assessing blood oxygen concentration

A

resting oxygen concentration is about 98%
majority of population will be above 94%
hyperventilating will increase oxygen concentration to 100%

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12
Q

how do oxygen saturation probes work

A

infra red light looks at the colour of blood. venous blood is slightly blueish but when oxygenated it turns red.
if all the haemoglobin is deoxygenated haemoglobin the blood will be blue 0% saturation
if all haemoglobin is oxygenated oxyhaemoglobin the blood will be red 100% saturation

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13
Q

how do you assess patient with suspected respiratory failure

A

acidotic or alkalotic
respiratory component- co2 high respiratory acidosis or respiratory compensation for metabolic alkalosis
co2 low respiratory alkalosis or respiratory compensation for metabolic acidosis
metabolic component- bicarbonate low- metabolic acidosis (or renal compensation for respiratory alkalosis)
bicarbonate high- metabolic alkalosis or renal compensation for respiratory acidosis

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14
Q

explain the alveolar- arterial gradient

A

A-a gradient= pao2 -pao2 = pA- ao2
pao2=pio2 - (paco2/0.8)
should be <2kpa in normal healthy people
<4kpa is acceptable in hospital patients

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15
Q

acute and chronic respiratory failure
explain what acute type 1 respiratory failure is

A

acute type 1 respiratory failure- low oxygen normal or low co2. normal ph or alkalotic, normal hco3- high A- a gradient

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16
Q

what is acute type 2 respiratory failure

A

low o2 high co2 normal ph or acidiotic, normal hco3- normal of high A-a gradient

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17
Q

what is chronic type 1 respiratory failure

A

low oxygen, normal or low co2 normal ph or alkalotic normal hco3-

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18
Q

what is chronic type 2 respiratory failure

A

low o2 high co2 normal ph or acidiotic high hco3-

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19
Q

explain how type 1 respiratory failure works

A

respiratory failure is defined as a low partial pressure of oxygen in systemic arterial blood pao2<8kpa
type 1 respiratory failure is defined as hypoxaemia without hypercapnia(inadequate co2 removal resulting in high co2)
a problem that affects either ventilation or perfusion or both can cause type 1 respiratory failure
acute management is with oxygen and treatment of underlying cause

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20
Q

what is acute management of type 1 respiratory failure

A

acute management is with oxygen and treatment of underlying cause

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21
Q

what does fi02 stand for

A

fraction of inspired oxygen

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22
Q

what are some causes of type 1 respiratory failure

A

-pneumonia
-pneumothorax
-interstitial lung disease
-obesity
-copd
-asthma
-pulmonary oedema
-acute respiratory distress syndrome

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23
Q

what is the equation of life

A

DO2- cao2 x co

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24
what can go wrong with respiratory system
poor ventilation but good perfusion- shunt good ventilation but poor perfusion- deadspace poor diffusion across membrane hypoventilation
25
what is the partial pressure of oxygen in the air
21kpa
26
what is the partial pressure of oxygen in 40% fraction inspired oxygen (fio2)
40kpa
27
what is the partial pressure of oxygen in the arteries
13kpa
28
what is the partial pressure of oxygen in tissues
2/3 kpa (2 or 3)
29
how do you check oxygen saturation in patients
always check the fraction of inspired oxygen
30
what are some oxygen delivery systems
nasal cannula face mask face tent high flow nasal cannula non rebreather venturi mask
31
what are the stages of pneumonia (infection in airspaces of the lungs)
fever productive cough, breathless consolidation bronchial breathing shunt leads to type 1 respiratory failure and then type 2 antibiotics, oxygen
32
what are the stages of asthma (narrowing of the small airways secondary to inflammation thick walls and mucus)
straw problem wheeze (cf stridor) mucus plugging shunt- poor ventilation normal perfusion hypoxia exhaustion hypoventilation silent chest dilate anti inflammator monitor co2
33
how is pneumonia treated
antibiotics physio therapy oxygen
34
how is asthma treated
dilate- bronchodilaters such as inhalers anti inflammator monitor co2
35
what is pulmonary oedema
swelling of the tissues between the blood vessels and the air spaces due to back pressure from the left ventricle more difficult to get oxygen across diffusion problem but also potentially low flow
36
what is pulmonary embolism
increased deadspace blocked cvs system (cardiovascular) reduced cardiac output |reduced delivery of oxygen more extracted >25% extracted by tissues cant oxygenate it enough next time around
37
what is opioid overdose
reduced ventilatory drive hypoventilation rising co2 initially eventually drop in oxygen shunt
38
what is neuromuscular disease
smaller breaths exhaustion rising co2 type 2 respiratory failure the oxygen falls eventually
39
what are common causes of type 2 respiratory failure
copd myasthenia gravis muscle disorders chest wall deformity acute respiratory distress syndrome head and cervical cord injury pulmonary oedema drug overdose opiates
40
what is pulmonary embolism caused by
pulmonary embolism is a blood clot causing obstruction in the pulmonary vascular tree.its propogated via the right heart from venous circulation where it was formed, typically the deep veins of the leg (deep vein thrombosis)
41
what are the 2 causes of v1 mismatch
high v/q ratio low v/q ratio
42
what does high v/q lead to
increased ventilation increased alveolar deadspace decreased perfusion response to bronchial constriction to decrease the amount of ventilation to the underperfused area of the lung causes pe emphysema fibrosis and vasculitis
43
what does a low v/q ratio lead to
reduced ventilation increased perfusion increased physiological shunt response to hypoxic vasoconstriction in the underventilated area of the lung promoting blood flow to other well ventilated parts causes- physiological shunt, pulmonary oedema, asthma, chronic bronchitis, heptao pulmonary syndrome and pneumonia
44
what are the two main variables constituting the main determinants of the blood oxygen concentration
v ventilation- airflow, gasflow that reaches the alveoli q perfusion- blood that reaches the alveoli
45
what is the ideal ventilation and perfusion ratio
0.8
46
what is an experiment to measure ventilation/perfusion ratio
a tracer is inhaled. this shows the ability of gas to reach all aspects of the lungs a different tracer is put into the blood shows the ability to perfuse the lungs the two images are compared to show that the ventilation and perfusion and to show whether there is a mismatch or not example (there is ventilation but no perfusion (deadspace) or there is perfusion but no ventilation (shunt)
47
what are normal breathing parameters breathing rate
12-16 breaths per minute
48
what is normal tidal volume
500ml
49
what is the anatomical deadspace volume
150ml
50
what is the alveolar deadspace volume
350ml
51
how is breathing controlled
by dual innervation (autonomic nervous system and respiratory centre in medulla) under automated control driven by respiratory control centre in medulla brain stem alterations by the autonomic nervous system voluntary somatic control- hyperventilation
52
how is breathing controlled under specific circumstances
chemo receptors in the carotid and aortic arch sense co2, o2 and ph- stimulates the sns somatic nervous system breathe faster and harder
53
what is breathing reserve
the difference between the maximal volume of air that a person can ventilate during maximal exercise and the maximal capacity of their lungs to ventilate air indicates how much reserve capacity the respiratory system has when under stress such as during exercise
54
what happens when breathing reserve fails
we fail to clear co2 vasodilation and sleepiness as a protective mechanism
55
what happens if we fail to get oxygen in
organ failure brain heart kidneys lactate muscles to lungs
56
what are the signs of respiratory failure
not enough o2 in the blood pao2<8kpa plus/minus raised co2 (type 1 and 2 respiratory failure) not fulfilling primary task
57
list different oxygen delivery systems
nasal cannula face mask face tent venturi mask non rebreather high flow nasal cannula
58
equation of life
do2= cao2 (arterial oxygen pressure) x co
59
what are the saturations of oxygen in mixed venous blood
50-75%
60
what is the oxygen saturation in arterial blood
97%
61
what does spo2 mean
peripheral capillary oxygen saturation percentage of haemoglobin molecules in the blood which are saturated with oxygen
62
what is 100% spo2 equivalent to
pao2 anything higher than 15 kpa
63
what is 98% spo2 equivalent to
pao2 13kpa
64
what is 90% spo2 equivalent to
pao2 8kpa
65
what is 75% spo2 equivalent to
pao2 5.3kpa
66
what is 50% spo2 equivalent to
pao2 3.6kpa
67
if your po2 drops from 80 to 15 will there be a spo2 delivery drop from 100%
no
68
if your pao2 drops from 5.3 to 3.6kpa what is the spo2 delivery drop
drops by 25% from 75% to 50%
69
does oxygen have a high or low solubility
low solubility so oxygen needs a huge area of alveoli open to get across
70
is the solubility of co2 high or low
high so carbon dioxide transfers much more quickly and clearance depends on minute ventilation
71
what is pneumonia
infection in airspaces of the lungs fever productive cough, breathless consolidation bronchial breathing shunt type 1 and then type 2 treated with antibiotics, physiotherapy and oxygen
72
asthma
chronic inflammation disorder secondary to type 1 hypersensitivity resulting in reversible bronchoconstriction
73
features of asthma
straw problem wheeze (cystic fibrosis stridor) mucus plugging shunt- no ventilation but normal perfusion hypoxia- insufficient oxygen delivery to tissues exhaustion hypoventilation silent chest dilate antiinflammator monitor co2
74
describe pulmonary oedema
swelling of the tissues between blood vessels and the air spaces due to back pressure from left ventricle more difficult to get oxygen across diffusion problem but also potentially low flow
75
what is pneumothorax
a collapsed lung
76
describe pulmonary embolism
increased deadspace blocked cardiovascular system reduced cardiac output reduced delivery of oxygen more extracted more than 25% extracted by tissues cannot oxygenate it enough
77
describe opioid overdose
reduced ventilatory drive hypoventilation rising co2 initially eventually drop in oxygen shunt
78
describe neuromuscular disease
smaller breaths exhaustion rising co2 type 2 the oxygen falls eventually
79
is there a greater resistance in the upper airway or the lower airway
upper airway generally has a higher resistance as airflow in upper airway tends to be more turbulent which increases resistance
80
what noise do you get with upper airway obstruction
stridor
81
what noise do you get with a lower airway obstruction
ronchi (low pitched sound) or wheezing

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