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Critical Care > Respiratory Systm. Deterioration > Flashcards

Respiratory Systm. Deterioration Flashcards

1
Q

Bronchodilators are what?

A

Inhaled beta agonist and antimuscorinic agents given via pressurised metered dose inhalers with space or jet nebulisation.

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2
Q

Example of bronchodilator:

A

Salbutamol, terbutaline (beta agonists)
Antimuscorinic Agents (ipratropium)

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3
Q

Dose of bronchodilator?

A

Titrated to response, range from hourly to 6hrly.

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4
Q

Types of Tx for Acute exacerbations of COPD?

A

Bronchodilators.
Corticosteroids.
Antibiotics.
Controlled O2 therapy.
Ventilators Assistance.

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5
Q

What do corticosteroids do?

A

Hassan resolution and ⬇️ likelihood of relapse.

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6
Q

What corticosteroids do they give?

A

Prednisolone.

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7
Q

How long do corticosteroids get administered for?

A

2 weeks

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8
Q

Why are Abs given to pt with acute exacerbations of COPD?

A

If sputum is purulent

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9
Q

When is O2 indicated with exac. Of COPD?

A

If pt is hypoxic - sp02 of < 88 - 92%.

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10
Q

Exac. Of COPD: O2 dosage?

A

0-5 - 2 L/min via NP
Or
@24-28% via Venturi Mask

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11
Q

Exac. Of COPD: what must you consider when giving O2 to COPD pts?

A

CO2 retainers - carefully titration of O2 due to increased risk of hypercapnia if O2 dose is too high.

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12
Q

Exac. Of COPD: when is ventilatory assistant indicated?

A

⬆️ hypercapnia.
Acidosis.

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13
Q

Acute Asthma: what is cat 1?

A

Life threatening.

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14
Q

Acute Asthma: cat 2?

A

Moderate.

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15
Q

Acute Asthma: cat 3?

A

Mild.

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16
Q

Acute Asthma: physical exhaustion in life threatening asthma?

A

Yes and decreased level of consciousness.

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17
Q

Acute Asthma: resp. Function of cat 1 asthma?

A

Poor respiratory effort.
Soft or absent breath sounds.

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18
Q

Acute Asthma: Cat 1 (severe): RR:

A

Bradypnoea.

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19
Q

Acute Asthma: Cat 1 (severe): talks in?

A

Single words. Unable to speak.

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20
Q

Acute Asthma: Cat 1 (severe): HR?

A

Cardiac arrhythmia or bradycardia.
Usually presents before cardiac arrest.

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21
Q

Acute Asthma: Cat 1 (severe): central cyanosis?

A

Present.

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22
Q

Acute Asthma: Cat 1 (severe): wheeze intensity?

A

Quiet. Silent.

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23
Q

Acute Asthma: Cat 1 (severe): pulse 02:

A

⬇️ 90%

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24
Q

Acute Asthma: Cat 2 (moderate): physical exhaustion:

A

May be present

25
Q

Acute Asthma: Cat 2 (moderate): resp. Function:

A

In obvious distress, chest wall movement. Use of accessory muscles.

26
Q

Acute Asthma: Cat 2 (moderate): RR:

A

⬆️24.

27
Q

Acute Asthma: Cat 2 (moderate): talks in..

A

Phrases. Unable to complete sentence in 1 breath.

28
Q

Acute Asthma: Cat 2 (moderate): HR?

A

^ or = 110 bpm.

29
Q

Acute Asthma: Cat 2 (moderate): central cyanosis

A

May be present

30
Q

Acute Asthma: Cat 2 (moderate): wheeze intensity?

A

Moderate to loud.

31
Q

Acute Asthma: Cat 2 (moderate): spO2:

A

90-94%

32
Q

Acute Asthma: Cat 3 (mild): physical exhaustion:

A

None

33
Q

Acute Asthma: Cat 3 (mild): resp, function:

A

Some intense WOB

34
Q

Acute Asthma: Cat 3 (mild): RR:

A

⬇️24

35
Q

Acute Asthma: Cat 3 (mild): talks in..

A

Normal

36
Q

Acute Asthma: Cat 3 (mild): HR?

A

⬇️ 110

37
Q

Acute Asthma: Cat 3 (mild): central cyanosis?

A

None.

38
Q

Acute Asthma: Cat 3 (mild): wheeze:

A

Variable.

39
Q

Acute Asthma: Cat 3 (mild): spO2.

A

^ 94%

40
Q

Risk of ARDS?

A

Pneumonia.
Major trauma.
Inhalation injury.
Pulmonary contusion.
Drowning.
Aspiration of gastric contents.
Non-cardiogenic shock.
Pulmonary vasculitis.
Drug over dose.
Non-pulm. Sepsis
Severe burns.
Acute lung injury
Pancreatitis
Reperfusion oedema post lung transplant.
ETOH abuse
^ 30 BMI
Hypoalbuminemia
Chemotherapy
DM acidosis (pH 7.35)
Tachyponea
O2 supplementation.

41
Q

Pathophysiology of ARDS:

A

Inflammatory response causes disruptions in aveolar function. (Decrease capillary permeability.
Causes oedema to form.
Decrease compliance
Increase pulm. Vascular resistance.
Resulting in overall poor gas exchange due to VQ mismatch.

42
Q

Phases of ARDS

A

Exudate phase.
Proliferation phase
fibronic phase

43
Q

Where are blood gases taken?

A

Direct venepuncture of artery

44
Q

Most common site for taking a blood gas

A

Radial artery

45
Q

Blood gases: what are they measuring?

A

pH
paO2
paCO2
H3O3- (bicarbonate)
Base excess

46
Q

Normal pH levels:

A

7.35 - 7.45

47
Q

Normal paO2 levels:

A

80-100

48
Q

Normal paCO2 levels:

A

35 - 45

49
Q

Normal bicarbonate levels:

A

22-26

50
Q

Normal Base Excess:

A

-2 to + 2

51
Q

What is base excess?

A

Indicate the amount of excess or insufficient bicarbonate, in the body and the amount of acid or alcalinity needed to maintain homeostasis.

52
Q

Acute Resp. failure categories?

A

Type 1 - hypoxemic
Type 2 - Hypercapnemic

53
Q

Hypoxaemic Resp. Failure caused by:

A

Diffusion abnormalities that impending passage of O2 to aveolus and pulmonary circulation.

54
Q

Hypercapnemic resp. Failure is from:

A

Insufficient spontaneous ventilation from either ⬇️ respiratory drive, ⬆️ workload or conducting airway disorders that limit movement of gas in and out of lungs.

55
Q

What is VQ mismatch?

A

When lung devices O2 without blood or blood without O2.

56
Q

When does VQ mismatching occur?

A

Pts with COPD, pneumonia, chronic bronchitis, pulmonary oedema, airway obstruction, pulmonary embolism.

57
Q

2 types of VQ mismatching

A

Dead space
Shunting

58
Q

VQ shunting means:

A

Poor oxygenation to alveoli but good blood flow.

59
Q

VQ dead space means:

A

Well oxygenated pt but poor blood flow.

Critical Care (7 decks)

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