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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
Q

what can go wrong with respiratory system

A

poor ventilation but good perfusion- shunt
good ventilation but poor perfusion- deadspace
poor diffusion across membrane
hypoventilation

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25
Q

what is the partial pressure of oxygen in the air

A

21kpa

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26
Q

what is the partial pressure of oxygen in 40% fraction inspired oxygen (fio2)

A

40kpa

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27
Q

what is the partial pressure of oxygen in the arteries

A

13kpa

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28
Q

what is the partial pressure of oxygen in tissues

A

2/3 kpa (2 or 3)

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29
Q

how do you check oxygen saturation in patients

A

always check the fraction of inspired oxygen

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30
Q

what are some oxygen delivery systems

A

nasal cannula
face mask
face tent
high flow nasal cannula
non rebreather
venturi mask

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31
Q

what are the stages of pneumonia (infection in airspaces of the lungs)

A

fever productive cough, breathless
consolidation bronchial breathing
shunt leads to type 1 respiratory failure and then type 2
antibiotics,
oxygen

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32
Q

what are the stages of asthma (narrowing of the small airways secondary to inflammation thick walls and mucus)

A

straw problem
wheeze (cf stridor)
mucus plugging
shunt- poor ventilation normal perfusion
hypoxia
exhaustion
hypoventilation
silent chest
dilate anti inflammator monitor co2

33
Q

how is pneumonia treated

A

antibiotics
physio therapy
oxygen

34
Q

how is asthma treated

A

dilate- bronchodilaters such as inhalers
anti inflammator
monitor co2

35
Q

what is pulmonary oedema

A

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
Q

what is pulmonary embolism

A

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
Q

what is opioid overdose

A

reduced ventilatory drive
hypoventilation
rising co2 initially
eventually drop in oxygen
shunt

38
Q

what is neuromuscular disease

A

smaller breaths
exhaustion
rising co2 type 2 respiratory failure
the oxygen falls eventually

39
Q

what are common causes of type 2 respiratory failure

A

copd
myasthenia gravis
muscle disorders
chest wall deformity
acute respiratory distress syndrome
head and cervical cord injury
pulmonary oedema
drug overdose opiates

40
Q

what is pulmonary embolism caused by

A

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
Q

what are the 2 causes of v1 mismatch

A

high v/q ratio
low v/q ratio

42
Q

what does high v/q lead to

A

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
Q

what does a low v/q ratio lead to

A

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
Q

what are the two main variables constituting the main determinants of the blood oxygen concentration

A

v ventilation- airflow, gasflow that reaches the alveoli
q perfusion- blood that reaches the alveoli

45
Q

what is the ideal ventilation and perfusion ratio

A

0.8

46
Q

what is an experiment to measure ventilation/perfusion ratio

A

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
Q

what are normal breathing parameters
breathing rate

A

12-16 breaths per minute

48
Q

what is normal tidal volume

A

500ml

49
Q

what is the anatomical deadspace volume

A

150ml

50
Q

what is the alveolar deadspace volume

A

350ml

51
Q

how is breathing controlled

A

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
Q

how is breathing controlled under specific circumstances

A

chemo receptors in the carotid and aortic arch
sense co2, o2 and ph- stimulates the sns somatic nervous system
breathe faster and harder

53
Q

what is breathing reserve

A

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
Q

what happens when breathing reserve fails

A

we fail to clear co2
vasodilation and sleepiness as a protective mechanism

55
Q

what happens if we fail to get oxygen in

A

organ failure
brain heart kidneys lactate
muscles to lungs

56
Q

what are the signs of respiratory failure

A

not enough o2 in the blood
pao2<8kpa
plus/minus raised co2 (type 1 and 2 respiratory failure)
not fulfilling primary task

57
Q

list different oxygen delivery systems

A

nasal cannula
face mask
face tent
venturi mask
non rebreather
high flow nasal cannula

58
Q

equation of life

A

do2= cao2 (arterial oxygen pressure) x co

59
Q

what are the saturations of oxygen in mixed venous blood

A

50-75%

60
Q

what is the oxygen saturation in arterial blood

A

97%

61
Q

what does spo2 mean

A

peripheral capillary oxygen saturation
percentage of haemoglobin molecules in the blood which are saturated with oxygen

62
Q

what is 100% spo2 equivalent to

A

pao2 anything higher than 15 kpa

63
Q

what is 98% spo2 equivalent to

A

pao2 13kpa

64
Q

what is 90% spo2 equivalent to

A

pao2 8kpa

65
Q

what is 75% spo2 equivalent to

A

pao2 5.3kpa

66
Q

what is 50% spo2 equivalent to

A

pao2 3.6kpa

67
Q

if your po2 drops from 80 to 15 will there be a spo2 delivery drop from 100%

A

no

68
Q

if your pao2 drops from 5.3 to 3.6kpa what is the spo2 delivery drop

A

drops by 25% from 75% to 50%

69
Q

does oxygen have a high or low solubility

A

low solubility so oxygen needs a huge area of alveoli open to get across

70
Q

is the solubility of co2 high or low

A

high so carbon dioxide transfers much more quickly and clearance depends on minute ventilation

71
Q

what is pneumonia

A

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
Q

asthma

A

chronic inflammation disorder secondary to type 1 hypersensitivity resulting in reversible bronchoconstriction

73
Q

features of asthma

A

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
Q

describe pulmonary oedema

A

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
Q

what is pneumothorax

A

a collapsed lung

76
Q

describe pulmonary embolism

A

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
Q

describe opioid overdose

A

reduced ventilatory drive
hypoventilation
rising co2 initially
eventually drop in oxygen
shunt

78
Q

describe neuromuscular disease

A

smaller breaths
exhaustion
rising co2 type 2
the oxygen falls eventually

79
Q

is there a greater resistance in the upper airway or the lower airway

A

upper airway generally has a higher resistance as airflow in upper airway tends to be more turbulent which increases resistance

80
Q

what noise do you get with upper airway obstruction

A

stridor

81
Q

what noise do you get with a lower airway obstruction

A

ronchi (low pitched sound) or wheezing

cb (24 decks)

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