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mbbs year 1 module 3 circulation and breathing > respiratory failure > Flashcards

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-

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

20
Q

what is acute management of type 1 respiratory failure

A

acute management is with oxygen and treatment of underlying cause

21
Q

what does fi02 stand for

A

fraction of inspired oxygen

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

23
Q

what is the equation of life

A

DO2- cao2 x co

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

25
Q

what is the partial pressure of oxygen in the air

A

21kpa

26
Q

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

A

40kpa

27
Q

what is the partial pressure of oxygen in the arteries

A

13kpa

28
Q

what is the partial pressure of oxygen in tissues

A

2/3 kpa (2 or 3)

29
Q

how do you check oxygen saturation in patients

A

always check the fraction of inspired oxygen

30
Q

what are some oxygen delivery systems

A

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

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

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)

mbbs year 1 module 3 circulation and breathing (6 decks)

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