Respiratory failure

Question 1

What are tachypnoea, use of accessory muscles, nasal flaring, and intercostal/suprasternal recession all signs of?

Answer 1

Respiratory compensation during respiratory failure

Question 2

What are tachycardia, hypertension and sweating all signs of in respiratory failure?

Answer 2

increased sympathetic tone

Question 3

What are altered mental state, bradycardia and hypotension all signs of in respiratory failure?

Answer 3

End organ hypoxia

Question 4

In respiratory failure, what is cyanosis a sign of?

Answer 4

Haemoglobin desaturation

Question 5

What are flapping wrists and a bounding pulse a sign of?

Answer 5

CO2 retention

Question 6

What would material blood gases in Type I respiratory failure show?

Answer 6

Hypoxaemia and normocapnia

Question 7

What is the PaO2 in Type I respiratory failure?

Answer 7

<8 kPa

Question 8

In which conditions does Type I respiratory failure normally occur?

Answer 8

COPD
Pneumonia
Asthma
Pulmonary fibrosis

Question 9

Why does Type I respiratory failure occur?

Answer 9

• Damage to lung tissue
• prevents adequate oxygenation of blood
• remaining normal lung is sufficient to excrete CO2 produced via metabolism
• -> less functioning lung tissue is needed for CO2 excretion compared to oxygenation of blood

Question 10

What would material blood gases in Type II respiratory failure show?

Answer 10

hypoxaemia and hypercapnia

Question 11

What is the PaO2 and PaCO2 in Type II respiratory failure?

Answer 11

PaO2: <8 kPa
PaCO2: >6.5 kPa

*basically is it type I respiratory failure but with fatigue

Question 12

In which conditions does Type II respiratory failure normally occur?

Answer 12

COPD
Severe asthma
Drug overdose
Poisoning

Question 13

Why does Type II respiratory failure occur?

Answer 13

• when alveolar ventilation is insufficient to excrete CO2 produced
• inadequate ventilation is due to reduced ventilatory effort (inability to overcome increased resistance to ventilation)
• CO2 is able to accumulate as the whole lung is affected

Question 14

What are the complications of respiratory failure?

Answer 14

Damage to vital organs
CNS depression (due to increased CO2)
Respiratory acidosis (CO2 retention)

Question 15

What are the causes of hypoventilation?

Answer 15

Respiratory muscles
Airway obstruction
Reduced lung/chest wall compliance
Damage to brainstem/spinal cord

Question 16

How is respiratory failure treated?

Answer 16

• supplemental O2 (facemask)
• control of secretion (physiotherapy)
• treatment of infection (abx)
• control of airways obstruction (bronchodilators, corticosteroids)
• limiting pulmonary oedema
• reducing load on respiratory muscles

Question 17

When should an O2 mask with nasal cannula be used?

Answer 17

for patients with normal vital signs (post-op)

Question 18

When should a face mask with reservoir bags be used?

Answer 18

patient in emergency (higher O2 concentration)

–> asthma attack, pneumonia, sepsis

Question 19

When should a venturi mask be used?

Answer 19

controlled treatment in long-term respiratory failure (COPD)

Question 20

What should be done for a patient with respiratory failure who does not show signs of CO2 retention?

Answer 20

Start high flow of O2
Monitor for drowsiness
Check ABG after 30 minutes

Question 21

What should be done for a patient with respiratory failure who does show signs of CO2 retention?

Answer 21

Set up a controlled mask
Titrate for lowest possible O2
Measure ABG ASAP
Repeat ABG 30 minutes later

Question 22

When is ventilation used?

Answer 22

Used for hypercapnia, not hypoxia**