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Pulmonary > Respiratory Failure > Flashcards

Respiratory Failure Flashcards

1
Q

What is respiratory failure?

A

A potentially life-threatening deterioration in the gas exchange function of the respiratory system:

  • Impairment of oxygenation
  • Inadequacy of CO2 excretion
  • A mixture of both
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2
Q

What is the precise site of O2 and CO2 exchange ?

A

the respiratory unit (respiratory bronchioles + alveoli)

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3
Q

What can confirm respiratory failure from history and physical exam?

A

Arterial Blood Gases (ABG’s) are required to confirm the diagnosis

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4
Q

What are some symptoms of resp failure?

A 
Dyspnea
Fatigue
Headache
Anxiety
Confusion
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5
Q

What are signs of resp failure?

A 
Tachypnea
Bradypnea
Altered mental status
Cyanosis
Accessory Muscle Use
Indrawing
Paradoxical abdominal breathing
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6
Q

What are normal ABG values?

A

PaO2 > 60 mm Hg
PaCO2 = 40 mm Hg
[H+] = 40 nM/l (pH = 7.40)
[HCO3-] = 24 mmol/l

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7
Q

What are the type of respiratory failure?

A

Impaired Oxygenation (Type I)
Hypoventilation (Type II)
Mixed (Type III)

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8
Q

What can be indicated by an abnormal Abnormal A-aDO2, in the presence of high PAO2, low PaO2 and low PaCO2?

A

Oxygen impairment (due to diffusion limitation)

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9
Q

What is hypoxemia?

A

PaO2 < 60 mm Hg and/or SaO2 < 90%

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10
Q

What causes hypoxemia in normal lungs?

A

↓ FiO2
↓ barometric pressure
Hypoventilation

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11
Q

What causes hypoxemia in abnormal lungs?

A

Shunt
VQ mismatch
Diffusion impairment
Impaired cardiopulmonary function

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12
Q

What is hypercapnia?

A

PaCO2 > 40 mm Hg +/- acidosis

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13
Q

What causes hypercapnia?

A

↑ CO2 production
↑ Deadspace ventilation
↓ Minute ventilation

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14
Q

What causes increased CO2 production?

A

Fever, sepsis, seizures, exercise, excessive carbohydrate loads in diet

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15
Q

T or F: ↑ CO2 production leads to hypercapnia only when there is co-existing cardiopulmonary dysfunction

A

T

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16
Q

What conditions would increase dead space ventilation?

A

COPD, asthma, cystic fibrosis, pulmonary fibrosis, thoracic cage abnormalities,

17
Q

What is minute ventilation?

A

Minute ventilation refers the to volume of air entering and leaving the lungs per unit time (liters/minute)

18
Q

What causes a decrease in minute ventilation?

A 
CNS/respiratory center depression
Spinal cord lesions
Peripheral nerve dysfunction
Disorders of the neuromuscular junction
Respiratory muscle weakness
Structural abnormalities of the chest/thoracic spine (scoliosis)
Upper airway, lung or pleural disease
19
Q

What are causes of ventilation failure?

A

Drug-induced CNS depression (resp center)
Metabolic alkalosis
Traumatic quadriplegia (peripheral nerve)
Guillain-Barré Syndrome (peripheral nerve/muscle weakness)
Myasthenia gravis (neuromuscular junction)
Phrenic nerve paralysis
Hereditary myopathy (DMD)

20
Q

T or F: Immediate management of resp failure is not required

A

F: required

21
Q

How to manage respiratory failure?

A

Rapid evaluation
ABC’s/resuscitation
Support: oxygen, ventilatory support
Specific treatment for the underlying cause

22
Q

What does ABCs involve?

A

A - Airway
Assess if patient able to speak (good if can), look for edema, blood, vomitus, foreign body

B - Breathing --> abnormal then CPR
Look for work of breathing, respiratory rate
Listen to breath sounds
Feel the air at mouse and nose
Check for pulse oximetry (O2 Sat)

C - Circulation
Assess mental status, color
Feel peripheral pulses
Check HR, rhythm, BP

23
Q

What are the two types of supportive therapy for resp failure?

A

Oxygen &

Ventilation

24
Q

What are ways to give O2 (21%)?

A

Nasal prongs/cannulae
Venturi mask
CPAP
Simple or reservoir mask

Same as ventilation and O2:
Bag + mask devices
BiPAP
Endotracheal tube/tracheostomy + positive pressure mechanical ventilation

25
Q

How to give ventilation?

A

Mouth-to-mouth or mouth-to-mask rescue breathing
Negative pressure ventilation (“iron lung”)

Bag and mask devices
BiPAP
Endotracheal tube/tracheostomy + positive pressure mechanical ventilation

26
Q

HOw much O2 to give?

A

Give enough O2 to keep SpO2 at least 90% (PaO2 55 mm Hg)

Treat hypercapnia/hypoventilation if/when develops

Pulmonary (25 decks)

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