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INTERNAL MED 3+ conditions > Respiratory failure > Flashcards

Respiratory failure Flashcards

1
Q

Define respiratory failure

A

Acute or chronic impairment of gas exchange between the lungs and blood - causes hypoxia with/without hypercapnia

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2
Q

Type 1 respiratory failure

A

Hypoxic respiratory failure

  • no hypercapniea
  • Arterial PaO2 <60mmHg
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3
Q

Type 2 respiratory failure

A

Hypercapnic respiratory failure

  • Arterial PaO2 <60mmHg
  • Arterial PaCO2 >50mmHg
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4
Q

Normal PaO2

A

75-100mmHg

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5
Q

Normal PaCO2

A

38-42mmHg

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6
Q

Mortality from respiratory failure

A

20-40%

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7
Q

Gender differences in respiratory failure

A

M=F

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8
Q

What pulmonary infection is most often associated with respiratory failiure

A

Pneumonia

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9
Q

3 main causes of respiratory failure

A
  • Respiratory causes
  • Non-respiratory causes
  • Traumatic causes
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10
Q

Respiratory causes of respiratory failure

A
  • Acute exacerbation of asthma
  • Pulmonary embolism
  • Pulmonary oedema
  • Acute respiratory distress syndrome (ARDS)
  • Pneumonia
  • Acute epiglotitis
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11
Q

Non-respiratory causes of respiratory failure

A
  • Hypovolaemia
  • Shock
  • Severe anaemia
  • Drug overdose
  • Neuromuscular disorder
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12
Q

Traumatic causes of respiratory failure

A
  • Blood loss
  • Direct thoracic injury
  • Pulmonary contusion
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13
Q

3 broad reasons for hypercapnic respiratory failure

A
  1. Increased dead space - anatomical
  2. Reduced minute ventilation
  3. Increased CO2 production
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14
Q

Causes for increased dead space in respiratory failure

A
  • PE
  • Vascular disease
  • Hyperinflation
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15
Q

2 causes of reduced minute ventilation

A
  • Decreased central respiratory drive

- Decreased respiratory neuromuscular/thoracic cage function

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16
Q

Reasons for decreased central respiratory drive

A
  • Sedatives
  • Encephalitis
  • Stroke
  • Sleep apnoea
  • Alkalosis
  • Hypothyroidism
  • Hypothermia
  • Starvation
17
Q

Reasons for decreased respiratory neuromuscular/thoracic cage function

A
  • MND
  • Muscular disorders
  • Toxins
18
Q

Difference between hypoxia and hypoxaemia

A
  • Hypoxaemia - PaO2 low

- Hypoxia - low O2 at tissue level

19
Q

Pathophysiology of respiratory failure

A
  • CO2/O2 exchange fails

- Metabolic demands for O2 and body system acid base stabilisation are not maintained

20
Q

Type 1 and 2 respiratory failure have what in common?

A
  • Hypoxemia

- Causes cellular anoxia and tissue asphyxia

21
Q

Consequence of chronic hypoxia

A

Stimulates increases int he number of circulating RBC (erythrocytosis)

22
Q

What does hypercapnia cause

A
  • Carbonic acid accumulation

- Respiratory acidosis

23
Q

Causes of hypercapnia

A
  • Poor ventilatory muscle function
  • Obstructed airways and alveoli
  • Secretions in small airways
  • Chest wall abnormalities
24
Q

Classification of acute respiratory failure

A
  • Acute lack of O2 transfer to the blood by the respiratory systems OR acute failure of the respiratory system to remove CO2
25
Q

Classification of chronic respiratory failure

A
  • Long-term lack of O2 delivery to the blood by the respiratory system
  • Worsening respiratory acidosis
  • Chronically low PaO2 or high PaCO2
  • High carbonic acid with renal compensation (increased reabsorption of bicarbonate)
  • Increased RBC count
26
Q

Classification of type 1 hypoxic respiratory failure

A

PaO2 <60mmHg or 10% decrease in baseline

chronic lung disease may have PaO2 50mmHg already

27
Q

Classification of type 2 hypercapnic respiratory failure

A

PaO2 <60mmHg and PaCO2 >50mmHg

28
Q

Clinical presentation of type 1 respiratory failure

A
  • Dyspnoea
  • Agitation
  • Anxiety
  • Headache
  • Confusion
  • Somnolence
  • Seizure
  • Tachypnoea - fatigues - decreased RR
29
Q

Clinical presentation of type 2 respiratory failure

A
  • ** Generally tolerate symptoms better
  • ** Respiratory failure develops more slowly
  • Headache
  • Confusion
  • Disorientated
  • Coma
  • Seizure
  • Hypoventilate - respiratory acidosis
  • Agitation
  • Slurred speech
  • Tremour
30
Q

Symptoms of SEVERE hypercapnia

A
  • Asterixis
  • Myoclonus (jerky movements)
  • Seizures
  • Papilloedema (optic nerve swelling)
  • Dilated superficial veins
31
Q

At what PaCO2 is there a decreased level of consciousness

A

PaCO2 >75mmHg

if chronic - may only develop symptoms >90mmHg

32
Q

Risk factors for respiratory failure

A
  • Smoking
  • Young or old
  • Pulmonary infection
  • Chronic lung disease
  • Upper and lower airway obstruction
  • Alveolar abnormalities
  • Perfusion abnormalities
  • Cardiac failure
  • Peripheral nerve abnormalities
  • Muscle system abnormalities
  • Opiates + sedatives
  • Toxic fumes/gases
  • Traumatic spinal injury
33
Q

Investigations for respiratory failure

A
  • Pulse oximetry
  • Blood gas analysis
  • FBC
  • ECG
  • CXR
  • Capnometry (measures CO2 in expired gases)
  • Pulmonary function test
  • Toxicology testing
  • Chest CT
  • CTPA
  • V/Q lung scanning
  • Cardiothoracic US
34
Q

DDX for respiratory failure

A
  • Hyperventilation secondary to metabolic acidosis
  • Hyperventilation secondary to anxiety
  • Sleep apnoea
  • Obesity
35
Q

Acute management of respiratory failure

A
  • Airway clearance
  • Supplemental O2
  • Treat underlying cause

If unconscious - endotracheal intubation and mechanical ventilation

36
Q

Complications of respiratory failure

A
  • Pneumothorax
  • Endotracheal tube misplacement/dislodgement
  • Nosocomial infection
  • Throat pain with intubation
37
Q

Describe chronic type 2 respiratory failure

A

High PaCO2 but normal pH due to renal compensation

INTERNAL MED 3+ conditions (18 decks)

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